本帖最後由 lsc0019 於 2009-8-8 01:22 編輯
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
July 23, 2009 — 根據線上發表於7月9日風濕病檔案期刊的前溯研究報告，停經與痛風風險增加有關，停經後荷爾蒙治療可以適度降低痛風風險。
荷蘭鹿特丹Erasmus MC大學醫學中心的A. Elisabeth Hak博士等人寫道，最近幾年的痛風發生率增加，其中主要發生在年長女性，而女性的痛風風險因素依舊未明。懷疑是性荷爾蒙和女性的痛風風險有關。與痛風有密切關係的血清尿酸值，隨著女性年紀持續增加，而男性的尿酸值並未隨著年紀而有顯著不同。
此一分析的目標在檢視停經、停經後使用荷爾蒙、自我報告的風險、醫師診斷、痛風發生率之間的關係，研究對象是護士健康研究中92,535名原本沒有痛風的婦女。多變項比率風險回歸分析用以校正其他與痛風有關的風險因素，包括年紀、身體質量指數、使用利尿劑、高血壓、喝酒、飲食。
在16年的追蹤期間，有1,703例痛風案例紀錄(1,240,231人-年)。痛風發生率，從45歲以下婦女每1,000人-年0.6例增加到75歲以上者的2.5例(趨勢P值 < .001)。停經前婦女的痛風發生率風險比停經後婦女高(多變項校正相對風險[RR]為1.26；95%信心區間[CI]為1.03 -1.55)。
相較於自然停經的50至54歲婦女，45歲以下自然停經婦女的痛風RR值為1.62 (95% CI，1.12 - 2.33)。使用停經後荷爾蒙治療之後，婦女的痛風風險降低(RR，0.82；95% CI，0.70 - 0.96)。
研究作者寫道，這些前溯發現指出停經增加了痛風風險，停經後荷爾蒙治療可適度降低痛風風險。因手術停經的婦女以及較年輕時即自然停經的婦女，痛風風險更會增加，這些與飲食及其他痛風風險因素如年紀、身體質量指數、使用利尿劑、高血壓無關。
研究限制為採信自我報告指出醫師診斷痛風。
國家健康研究中心支持本研究。Hak博士為Erasmus MC研究員(荷蘭鹿特丹Erasmus MC大學醫學中心)，且接受荷蘭"Vereniging Trustfonds Erasmus Universiteit Rotterdam"基金會的支持。
Ann Rheum Dis. 線上發表於2009年7月9日。
Postmenopausal Hormone Therapy May Modestly Reduce Gout Risk
By Laurie Barclay, MD
Medscape Medical News
July 23, 2009 — Menopause is linked to an increased risk for gout and postmenopausal hormone therapy to modestly reduced gout risk, according to the results of a prospective study reported online in the July 9 issue of the Annals of the Rheumatic Diseases.
"Despite the increase of gout incidence in recent years, and the substantial prevalence particularly in the older female population, the risk factors for gout in women remain ill defined," write A. Elisabeth Hak, MD, PhD, from Erasmus MC University Medical Center in Rotterdam, the Netherlands, and colleagues. "Sex hormones have been postulated to be associated with gout risk among women. Serum urate levels, which are closely associated with gout, increase substantially with age in women, whereas among men urate concentrations are not significantly different between middle and older age."
The goal of this analysis was to examine the association between menopause, postmenopausal hormone use, and risk of self-reported, physician-diagnosed, incident gout among 92,535 women without gout at baseline who were enrolled in the Nurses' Health Study. Multivariate proportional hazards regression analysis allowed adjustment for other risk factors associated with gout, including age, body mass index, diuretic use, hypertension, alcohol consumption, and diet.
There were 1703 incident gout cases documented during 16 years of follow-up (1,240,231 person-years). Gout incidence increased from 0.6 per 1000 person-years in women younger than 45 years to 2.5 in women 75 years or older (P for trend < .001). The risk for incident gout was higher in premenopausal women vs postmenopausal women (multivariate adjusted relative risk [RR], 1.26; 95% confidence interval [CI], 1.03 - 1.55).
Compared with women with ages 50 to 54 years at natural menopause, those younger than 45 years at natural menopause had a RR for gout of 1.62 (95% CI, 1.12 - 2.33). The risk for gout was decreased in women who used postmenopausal hormone therapy (RR, 0.82; 95% CI, 0.70 - 0.96).
"These prospective findings indicate that menopause increases the risk of gout, whereas postmenopausal hormone therapy modestly reduces gout risk," the study authors write. "This increase in the risk of gout tended to be more evident among women with surgical menopause and among women with younger age at natural menopause....These associations were independent of dietary and other risk factors for gout such as age, body mass index, diuretic use and hypertension."
Limitations of this study include reliance on self-report of physician-diagnosed gout.
The National Institutes of Health supported this study. Dr. Hak is the recipient of an Erasmus MC Fellowship (Erasmus MC University Medical Center, Rotterdam, the Netherlands) and has been supported by the Foundation "Vereniging Trustfonds Erasmus Universiteit Rotterdam," the Netherlands.
Ann Rheum Dis. Published online July 9, 2009. |
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