Risk of pelvic organ prolapse treatment based on extended family history
Risk of pelvic organ prolapse treatment based on extended family history
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DOI：
10.1016/j.ajog.2019.12.271
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发表时间：
2020-07-01
影响因子：
9.8
通讯作者：
Cannon-Albright, Lisa A.
中科院分区：
文献类型：
--
作者：
Allen-Brady, Kristina;Norton, Peggy A.;Cannon-Albright, Lisa A.
背景：一级亲属中有盆腔器官脱垂家族史是盆腔器官脱垂的危险因素；然而，考虑到延伸到远亲的家族史，可以更准确地确定风险，并可能改善盆腔器官脱垂的风险预测估计。目的：本研究的目的是根据不同的盆腔器官脱垂家族史来评估盆腔器官脱垂治疗的风险，包括受影响亲属的数量和类型、接受盆腔器官脱垂治疗的亲属年龄、家族史是母系还是父系。研究设计：这是一项基于人群的回顾性研究，涉及犹他州人口数据库，该数据库是一个人口资源，包括与医疗记录相关的广泛家谱信息。研究人群包括453,522名女性：4628名诊断为治疗（手术或子宫）盆腔器官脱垂的女性及其15,530名一级亲属；33,782名二级亲属，66,469名三级亲属。我们根据特定的家族史星座估计盆腔器官脱垂治疗的相对风险。结果：随着家族史治疗的一级亲属盆腔器官脱垂患者数量的增加，相对危险度估计也随之增加（一级亲属，>= 1[相对危险度，2.36；95%可信区间，2.15-2.58]，一级亲属，>= 2[相对危险度，3.79；95%可信区间，2.65-5.24]，一级亲属，>= 3[相对危险度，6.26；95%可信区间，1.29-18.30]）。家族史上有3个患病的三度亲属（如表兄弟），没有患病的一、二度亲属与有1个患病的一度亲属的风险相似。一级家庭成员的相对风险估计值随着治疗年龄的增加而降低。具有阳性母亲家族史的个体患盆腔器官脱垂的风险始终高于具有相同父亲家族史的个体，但父亲遗传仍然起作用。在研究的女性人群中，约有4%的人因盆腔器官脱垂而接受治疗的风险为50 - 2倍，根据其家族史，被认为是高危人群。结论：我们基于广泛的盆腔器官脱垂家族史，使用基于大量人群的样本，提供治疗盆腔器官脱垂的估计。盆腔器官脱垂治疗的风险随着患病女性近亲和远房女性亲属数量的增加、亲属中盆腔器官脱垂治疗的年龄越早以及母体遗传而增加。这些风险估计可能对盆腔器官脱垂高危人群的遗传研究和风险降低策略的调查有用。
BACKGROUND: Family history of pelvic organ prolapse among first-degree relatives is an established risk factor for pelvic organ prolapse; however, consideration of the constellation of family history that extends to distant relationships allows for more accurate determination of risk and may improve pelvic organ prolapse risk prediction estimates.OBJECTIVE: The purpose of this study was to assess risk for pelvic organ prolapse treatment based on varying family histories of pelvic organ prolapse and included number and types of affected relatives, ages of relatives at pelvic organ prolapse treatment, and whether the family history is of maternal or paternal origin.STUDY DESIGN: This was a retrospective, population-based study that involved the Utah Population Database, which is a population resource that includes extensive genealogy information linked to medical records. The study population included 453,522 total women: 4628 women with a diagnosis of treated (surgical or pessary) pelvic organ prolapse and their 15,530 first-degree relatives; 33,782 second-degree relatives, and 66,469 third-degree relatives. We estimated relative risk of treated pelvic organ prolapse based on specific family history constellations.RESULTS: Relative risk estimates increased with a family history of increasing numbers of treated first-degree relatives with pelvic organ prolapse (first-degree relatives, >= 1 [relative risk, 2.36; 95% confidence interval, 2.15-2.58], first-degree relatives, >= 2 [relative risk, 3.79; 95% confidence interval, 2.65-5.24], and first-degree relatives, >= 3 [relative risk, 6.26; 95% confidence interval, 1.29-18.30]). Having a family history of >= 3 affected third-degree relatives (eg, first cousins) and no affected first- or second-degree relatives was similar in risk to having 1 affected first-degree relative. Relative risk estimates decreased with increasing age of treatment for first-degree family members. Risks in individuals with a positive maternal family history for pelvic organ prolapse were consistently higher than risks in individuals with equivalent paternal family history, but paternal inheritance still played a role. Approximately 4% of the total studied female population was found to have a >2-fold risk of being treated for pelvic organ prolapse and is considered high-risk based on their family history.CONCLUSION: We provide estimates for treated pelvic organ prolapse based on an extensive family history of pelvic organ prolapse using a large population-based sample. Risk for treated pelvic organ prolapse increased with increasing numbers of affected close and distant female relatives, earlier age of pelvic organ prolapse treatment in relatives, and maternal inheritance. These risk estimates may be useful for genetic studies and investigation of risk reduction strategies in those at highest risk for pelvic organ prolapse.