不同途径激素补充治疗对绝经妇女血脂影响的系统评价

Effects of hormone replacement therapy to lipid in postmenopausal women: A systemic review

目的:系统评价不同途径激素补充治疗(hormone replacement therapy,HRT)对绝经妇女血脂影响,指导临床有效安全应用。方法:检索已发表的关于比较试验组(经皮HRT)和对照组1(口服HRT)、试验组(经皮HRT)与对照组2(空白/安慰剂)对血脂及同型半胱氨酸(homocysteine,HCY)的影响的随机对照试验(randomized controlled trials,RCT);根据Cochrane协作网推荐的系统评价方法对总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、甘油三酯(triglycerides,TG)、HCY进行系统评价。结果:纳入文献22篇,研究对象共1 507人,试验组为609人,对照组1为589人,对照组2为309人。系统评价结果:试验组与对照组2相比,试验组TC值(MD=0.29,95%CI=0.03~0.55,P=0.030),HCY值(MD=0.71,95%CI=0.10~1.32,P=0.020)均比对照组明显降低;单用雌激素亚组中,两组LDL-C值均降低,且差异有统计学意义(MD=0.31,95%CI=0.13~0.48,P=0.001);两组TG值和HDL-C值的变化均无统计学差异(MD=-0.02,95%CI=-0.11~0.06,P=0.590),(MD=-0.02,95%CI=-0.13~0.09,P=0.750)。试验组与对照组1相比,TC值、LDL-C值、TG值、和HCY值的变化均无统计学差异,结果分别为:(MD=0.03,95%CI=-0.14~0.20,P=0.730),(MD=-0.04,95%CI=-0.13~0.04,P=0.270),(MD=0.05,95%CI=-0.16~0.26,P=0.650),(MD=0.32,95%CI=-0.47~1.11,P=0.420)。HDL-C值的变化无统计学差异(MD=0.01,95%CI=-0.10~0.12,P=0.860),但单用雌激素亚组中,2组HDL-C值均明显降低,且差异有统计学意义(MD=0.19,95%CI=0.10~0.28,P=0.000)。结论:经皮HRT与口服HRT相比,对血脂及HCY的影响几乎无差别,但与未接受HRT的女性相比,经皮HRT对血脂及HCY的影响是有益的,可能对心血管疾病有一级预防作用。

Objective ：To evaluate the effects of hormonal replacement therapy （HRT） on lipid in postmenopausal women by meta- analysis. Methods：Databases of PubMed,Ovid and Embase were searched from January 1985 to December 2012. Randomized con- trolled trials （RCTs） assessing the efficacy of different HRT for cardiovascular diseases （CVD） in postmenopausal women were col- lected. Pooled odds ratio（OR） with the 95% confidence interval（C/） was calculated using random-effect or fixed-effect model when appropriate.Total cholesterol （TC）, high density lipoprotein cholesterol （ HDL-C ）, low density lipoprotein cholesterol （ LDL-C ）, triglyc- erides（TG）,homocysteine（HCY） were used based on Cochrane＇s recommend. Results：Twenty-two RCTs involving a total of 1 507 premenopausal or postmenopausal women were included in the meta-analysis.Three group were divided：transdermal HRT group, con- trol 1 group（oral HRT）, control 2 group （blank control group）.Levels of TC and HCY were decreased significantly in transdermal HRT group than in control 2 group（MD=0.29,95%CI=O.03 to 0.55,P=0.030）, （MD=0.71,95%CI=0.10 to 1.32,P=0.020）. Levels of HDL- C （MD=-0.02,95%CI=-0.13 to 0.09,P=0.750） and TG（MD=-0.02,95%CI=-0.11 to 0.06,P=0.590） were not significantly changed in transdermal HRT group and control 1 group. Levels of LDL-C were decreased significantly in transdermal HRT estrogen-only subgroup（MD=0.31,95%C1=0.13 to 0.48,P=0.001 ）. There was no significant change in level of TC,LDL-C,TG and HCY between transdermal HRT group and control 1 grouo（MD=O.03,95%CI=-0.14 to 0.20, P=0.730）, （MD=-O.04,95%CI=-0.13 to 0.04, P=0.270）, （MD=0.05,95%CI=-0.16 to 0.26,P=0.650）, （MD= 0.32,95%CI=-0.47 to 1.11 ,P=0.420）. Levels of HDL-C（MD= 0.01,95%CI=-0.10 to 0.12,P=0.860） were not significantly changed,but in estrogen-only subgroup,levels of HDL-C were decreased obviously,and there were significantly statistic dif-ferences between transdermal HRT group and control 1 group （MD=0.19,95%C1=0.10-0.28, P=0.000）. Conclusion ：There is no dif- ference between transdermal HRT and oral HRT concerning lipid and HCY. Compared with females do not receive HRT,females had transdermal HRT had better lipid and HCY;therefore transdermal HRT may be conducive to preventing CVD.