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【medical-news】【资讯翻译】HRT激素替代治疗可使女性患者有心脏受益

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http://www.medicinenet.com/script/main/art.asp?articlekey=163795
Hormone Therapy May Benefit Some Women's Hearts
Oct. 9, 2012 -- Hormone replacement therapy (HRT) may do more than ease hot flashes and mood swings. A new study suggests that women who start taking hormones during menopause might get some protection against heart disease without seeing increases in other serious risks.

The study, which was published in BMJ, tested a theory called the timing hypothesis.

In older women many years past menopause, hormone replacement therapy using both estrogen and progesterone has been shown to raise risks for heart attacks, strokes, blood clots, dementia, and breast cancer.

What's been less clear is whether hormones might be safer and more beneficial if they are replaced as they naturally start to drop off, around the time of menopause.

Though the results of the new study look promising, experts who were not involved in the research caution that it is not a game-changer.

"This trial is not a trial that's going to change how we prescribe hormone replacement therapy. This isn't going to change practice. There are issues about this trial," says Suzanne Steinbaum, MD, director of Women and Heart Disease at Lenox Hill Hospital in New York City.

But she says the new results are intriguing and should open the door to more research.

"Women who are symptomatic with hot flashes, difficulty sleeping, mood swings, difficulty concentrating, who are recently menopausal, these women actually might benefit from HRT. Not just for symptom relief, but for preventing heart attacks and deaths," Steinbaum says.

Hormone Replacement for Younger Women

The study randomly split 1,006 healthy women in Denmark into two groups: The first group got HRT; the second group got no treatment. All the women in the study were near menopause and no more than two years away from their last menstrual period.

The study was designed to run for 20 years. But researchers stopped it early -- after 10 years -- when results from the large Women's Health Initiative (WHI) study a decade ago found that women taking combined hormone therapy had more heart attacks, strokes, dangerous blood clots in the legs and lungs, and breast cancer than women taking placebo pills.

Fearing for the safety of the women in their study, the Danish researchers advised them to stop taking their hormones. But they continued to chart the women's health for nearly six more years.

In contrast to what happened in the WHI, the Danish women who took HRT were less likely to die over the course of the study or be hospitalized because of a heart attack or heart failure.

There were no meaningful differences in strokes, dangerous blood clots, or cancers between the two groups.

"I think this is a breakthrough in the sense that this is what most doctors in the field have believed is the truth," says researcher Louise Schierbeck, MD, an endocrinologist at Hvidovre Hospital in Denmark.

"When the results from the WHI came, in 2002, everything was turned upside down," says Schierbeck, referring to the swift impact of that study, which caused millions of women to stop taking their hormones.

But Schierbeck and others think the results of the WHI have unfairly applied to younger women.

"The main problem with the WHI was that the women were so much older. They were, on average 63 years old when they were included in that study," she says.

"It doesn't make sense to treat menopausal symptoms when you are more than 10 years away from menopause. By that time, your entire biology has changed. It's completely unnatural."

Last week, U.S. researchers announced preliminary results from the smaller Kronos Early Estrogen Prevention Study, showing that younger women could get relief from some of the worst symptoms of menopause with little short-term risk. That study has only followed women for about four years, so it couldn't shed light on what might happen to cancer risks or dementia as the women got older.

Findings Come With Caveats

While the new study seems to bolster the timing hypothesis, experts caution that it has some important limitations.

The original intent of the trial was to see if HRT could help with bone health. Questions about cancers, strokes, heart disease risks, and deaths were asked after all the data for the study had already been gathered. That can sometimes skew research results.
Women and their doctors knew whether or not they were taking hormones. That can bias the results.
With just over 1,000 women, the study was relatively small. In contrast, the WHI trials of HRT included more than 27,000 women.
The study was partly funded by drug companies that make HRT and thus have a financial interest in the outcome of the study.
In addition, researchers mixed two different groups of women, those with and without a uterus. That's important because women who've had their uterus surgically removed are prescribed a different kind of HRT than women who still have a uterus. They take estrogen alone.

Many studies, including the WHI, have shown that taking estrogen alone is safer for younger women and may even offer some protection against heart disease and breast cancer, compared to when it is balanced with progesterone. Women who still have their uterus have to take both because using estrogen by itself raises the risk for endometrial cancer.

Mixing both groups of women in the study may have muddied the results, says Rowan T. Chlebowski, MD, PhD, chief of medical oncology at the David Geffen School of Medicine at UCLA.

For women who still had their uterus, the study tested an estrogen-progesterone combination that isn't commonly used in the U.S., Chlebowski says, so it's unclear whether the results would apply to women in this country.

"All these things mean that the study doesn't really provide useful information," Chlebowski says.

Other experts agree.

"Overall, the number of clinical events was far too small to provide reassurance about the risks of stroke, heart attack, blood clots, or cancer with hormone therapy, and the findings should not be used to support the use of long-term hormone therapy for chronic disease prevention," says JoAnn E. Manson, MD, DrPH, chief of the division of preventive medicine at Brigham and Women's Hospital in Boston.

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2012-10-12 10:22 浏览 : 2173 回复 : 10

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shumufeng 编辑于 2012-10-13 19:47

• 一年又半-深圳入职后

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认领本文翻译，48小时内未完成，请其他战友认领！”

2012-10-12 11:05

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• （原创）低血糖、低血钠、多尿，高尿糖、酮体阳性？

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粗译：

Oct. 9, 2012 -- Hormone replacement therapy(HRT) may do more than ease hot flashes and mood swings. A new study suggeststhat women who start taking hormones during menopause might get some protectionagainst heart disease without seeing increases in other serious risks.
2012年10月9日讯----荷尔蒙替代治疗可能确实不仅仅是减轻潮热和情绪波动。一项新的研究提示在停止期间实施荷尔蒙治疗的妇女可能会得到对于不会增加严重风险的心脏病的保护。

The study, which was published in BMJ, tested atheory called the timing hypothesis.
发表在BMJ上的这项研究测试了一个叫做时间假设的理论。

In older women many years past menopause,hormone replacement therapy using both estrogen and progesterone has been shownto raise risks for heart attacks, strokes, blood clots, dementia, and breastcancer.

对于停经多年的老年妇女来说，使用雌激素和孕激素的荷尔蒙替代疗法增加心脏病、中风、血栓、痴呆和肺癌风险。

What's been less clear is whether hormonesmight be safer and more beneficial if they are replaced as they naturally startto drop off, around the time of menopause.
在停经期间，如果荷尔蒙在确实开始减少的时候就被代替，对于荷尔蒙是否安全些和更有效还不是很清楚。

Though the results of the new study lookpromising, experts who were not involved in the research caution that it is nota game-changer.
虽然新的研究看起来是有希望的，但是没有参与这项研究的专家警示到这些研究结果并不是规则改变者。

"This trial is not a trial that's going tochange how we prescribe hormone replacement therapy. This isn't going to changepractice. There are issues about this trial," says Suzanne Steinbaum, MD,director of Women and Heart Disease at Lenox Hill Hospital in New York City.
新纽约城的莱讷克斯山医院的的妇女和心脏病主任Suzanne Steinbaum（医学博士）说，这个试验不是将会改变我们如何荷尔蒙替代治疗开出医嘱的试验。这将不会改变临床实践。这个试验有些问题。

But she says the new results are intriguing andshould open the door to more research.
但是她说新的结果是有趣的并且将会引发更多新的研究。

"Women who are symptomatic with hotflashes, difficulty sleeping, mood swings, difficulty concentrating, who arerecently menopausal, these women actually might benefit from HRT. Not just forsymptom relief, but for preventing heart attacks and deaths," Steinbaumsays.
Steinbaum说，有潮热、睡眠困难、情绪波动、注意力集中困难等症状的妇女和最近绝经的妇女事实上可能从荷尔蒙替代治疗中获益。并不仅仅是减轻症状，并且也会预防心脏病和死亡。

Hormone Replacement for Younger Women
年轻女性的荷尔蒙替代治疗

The study randomly split 1,006 healthy women inDenmark into two groups: The first group got HRT; the second group got notreatment. All the women in the study were near menopause and no more than twoyears away from their last menstrual period.
这项研究将丹麦的1006名妇女随机分成了2组：第一组进行荷尔蒙替代治疗；第二组不进行荷尔蒙替代治疗。这项研究中的所有的妇女都是快要停经了并且距离最后月经周期不到两年的妇女。

The study was designed to run for 20 years. Butresearchers stopped it early -- after 10 years -- when results from the largeWomen's Health Initiative (WHI) study a decade ago found that women takingcombined hormone therapy had more heart attacks, strokes, dangerous blood clotsin the legs and lungs, and breast cancer than women taking placebo pills.
这项研究设计实施20年。但是研究在早期就停止了试验—10年后—当10年后来自大型妇女健康倡议的研究的结果发现于服用安慰剂的妇女相比，实施了共同荷尔蒙治疗的妇女中有更多人患有心脏病、中风、在腿和肺上的危险血栓、肺癌。

Fearing for the safety of the women in theirstudy, the Danish researchers advised them to stop taking their hormones. Butthey continued to chart the women's health for nearly six more years.
出于对在他们的研究中的妇女的健康的考虑，丹麦的研究人员建议这些妇女停止荷尔蒙替代治疗。但是，他们继续追踪妇女的健康将近六年。

In contrast to what happened in the WHI, theDanish women who took HRT were less likely to die over the course of the studyor be hospitalized because of a heart attack or heart failure.
与在WHI中的妇女相比，丹麦的进行了雌激素替代治疗的妇女在研究过程中不太可能死亡或是因为心脏病或是心力衰竭而住院。

There were no meaningful differences instrokes, dangerous blood clots, or cancers between the two groups.
两组妇女在中风、危险血栓或是癌症方面不同没有什么意义。
"I think this is a breakthrough in thesense that this is what most doctors in the field have believed is thetruth," says researcher Louise Schierbeck, MD, an endocrinologist atHvidovre Hospital in Denmark.
丹麦的Hvidovre医院的内分泌专家LouiseSchierbeck（医学博士）说，我想在某种程度上这是在这个领域中的大多数医生相信是事实的
一个突破。

"When the results from the WHI came, in2002, everything was turned upside down," says Schierbeck, referring tothe swift impact of that study, which caused millions of women to stop takingtheir hormones.
Schierbeck提到，当2012年得知WHI的结果之后，每件事都被颠覆了，这涉及对这项研究的阻止对数百万的妇女停止服用荷尔蒙的快速的影响。

But Schierbeck and others think the results ofthe WHI have unfairly applied to younger women.
但是Schierbeck和其他研究人员认为WHI的结果对年轻点的妇女不是很清楚。

"The main problem with the WHI was thatthe women were so much older. They were, on average 63 years old when they wereincluded in that study," she says.
她说，在WHI中的主要问题就是妇女的岁数都大了点。当她们参与了这项研究的时候，她们平均年龄63岁。

"It doesn't make sense to treat menopausalsymptoms when you are more than 10 years away from menopause. By that time,your entire biology has changed. It's completely unnatural."
当你在停经10多年之后治疗停经症状就没有什么意义了。在那个时候，你的整个机体都改变了。完全不是自然的状态。

Last week, U.S. researchers announcedpreliminary results from the smaller Kronos Early Estrogen Prevention Study,showing that younger women could get relief from some of the worst symptoms ofmenopause with little short-term risk. That study has only followed women forabout four years, so it couldn't shed light on what might happen to cancerrisks or dementia as the women got older.
上周，美国研究人员宣布了来自Kronos早期雌激素预防研究的初级结果表明年轻一点的妇女将会从比较小的短期风险停经的严重症状中得到缓解。这项研究仅仅是随访妇女大约4年，所以，这项研究并不能清楚得显示当妇女在年龄大一点的时候对于癌症风险和痴呆将会发生什么情况。

Findings Come With Caveats
发现引发的警示

While the new study seems to bolster the timinghypothesis, experts caution that it has some important limitations.
虽然新的研究似乎对时间假设是个鼓励，但是专家们警示到它有一些重要的限制。

The original intent of the trial was to see ifHRT could help with bone health. Questions about cancers, strokes, heartdisease risks, and deaths were asked after all the data for the study hadalready been gathered. That can sometimes skew research results.

这项实验的最初的目的是看看HRT是否对骨骼健康是否有利。在获得了研究的数据之后，出现了有关癌症、中风、心脏病风险和死亡的问题。有时候这些问题会对实验结果产生歪曲。

Women and their doctors knew whether or notthey were taking hormones. That can bias the results.

这些妇女和她们的医生知道是否她们可以服用荷尔蒙。那将会影响实验结果。

With just over 1,000 women, the study wasrelatively small. In contrast, the WHI trials of HRT included more than 27,000women.
The study was partly funded by drug companiesthat make HRT and thus have a financial interest in the outcome of the study.
In addition, researchers mixed two differentgroups of women, those with and without a uterus. That's important becausewomen who've had their uterus surgically removed are prescribed a differentkind of HRT than women who still have a uterus. They take estrogen alone.
对于仅仅超过1000多名妇女来说，这项研究是相对较小的。相比之下，HRT的WHI试验包括了27000对名妇女。这项研究得到了使用HRT治疗的药物公司的一部分资助并且这些结果就有了一些经济利益。除此之外，研究人员将有子宫和没有子宫的两组妇女混合在一起。这是非常重要的，因为那些仍然有子宫的妇女相比，那些通过手术将子宫摘掉的妇女要实施一种不同的HRT。她们仅仅是服用雌激素。

Many studies, including the WHI, have shownthat taking estrogen alone is safer for younger women and may even offer someprotection against heart disease and breast cancer, compared to when it isbalanced with progesterone. Women who still have their uterus have to take bothbecause using estrogen by itself raises the risk for endometrial cancer.
包括WHI的很多研究显示对年轻点的妇女仅仅是使用雌激素是更安全的并且可能甚至提供对心脏病和肺癌的保护。仍有还有子宫的妇女必须都服用雌激素和孕激素，因为单独使用雌激素将会增加子宫内膜癌的风险。

Mixing both groups of women in the study mayhave muddied the results, says Rowan T. Chlebowski, MD, PhD, chief of medicaloncology at the David Geffen School of Medicine at UCLA.

加利福尼亚大学洛杉矶分校的大卫格芬医学院的医学肿瘤学负责人Rowan T. Chlebowski（医学和哲学博士）说，将这项试验中两组妇女混合在一起将会混淆实验结果。

For women who still had their uterus, thestudy tested an estrogen-progesterone combination that isn't commonly used inthe U.S., Chlebowski says, so it's unclear whether the results would apply towomen in this country.
对于仍然有子宫的妇女来说，这项研究测试一个在美国不是被普通应用的雌激素-孕激素联合的试验。Chlebowski提到，所以结果是否施用这些国家的妇女来说是不清楚的。

"All these things mean that the studydoesn't really provide useful information," Chlebowski says.
赫莱博夫斯基说，所有这些事情意为着这项研究并没有真正提供有用的信息。

Other experts agree.
其他专家表示同意。

"Overall, the number of clinical eventswas far too small to provide reassurance about the risks of stroke, heartattack, blood clots, or cancer with hormone therapy, and the findings shouldnot be used to support the use of long-term hormone therapy for chronic diseaseprevention," says JoAnn E. Manson, MD, DrPH, chief of the division ofpreventive medicine at Brigham and Women's Hospital in Boston.

布里格姆预防医学部兼波士顿女子医院的负责人JoAnnE. Manson（医学博士、公关医学博士）说到，总体来看，临床结果数据远远不能对实施荷尔蒙治疗的中风、心脏病、血栓和肺癌的风险提供保证，并且这些发现也不能对临床疾病预防的长期荷尔蒙治疗的使用提供支持。

2012-10-13 17:02

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• 【心电旋律 27】青年男性心肌梗死背后的真凶！

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粗译：1855字。

2012年10月9日讯----荷尔蒙替代治疗可能确实不仅仅是减轻潮热和情绪波动。一项新的研究提示在停止期间实施荷尔蒙治疗的妇女可能会得到对于不会增加严重风险的心脏病的保护。发表在BMJ上的这项研究测试了一个叫做时间假设的理论。

对于停经多年的老年妇女来说，使用雌激素和孕激素的荷尔蒙替代疗法增加心脏病、中风、血栓、痴呆和肺癌风险。在停经期间，如果荷尔蒙在确实开始减少的时候就被代替，对于荷尔蒙是否安全些和更有效还不是很清楚。虽然新的研究看起来是有希望的，但是没有参与这项研究的专家警示到这些研究结果并不是规则改变者。

新纽约城的莱讷克斯山医院的的妇女和心脏病主任Suzanne Steinbaum（医学博士）说，这个试验不是将会改变我们如何荷尔蒙替代治疗开出医嘱的试验。这将不会改变临床实践。这个试验有些问题。但是她说新的结果是有趣的并且将会引发更多新的研究。

Steinbaum说，有潮热、睡眠困难、情绪波动、注意力集中困难等症状的妇女和最近绝经的妇女事实上可能从荷尔蒙替代治疗中获益。并不仅仅是减轻症状，并且也会预防心脏病和死亡。

年轻女性的荷尔蒙替代治疗

这项研究将丹麦的1006名妇女随机分成了2组：第一组进行荷尔蒙替代治疗；第二组不进行荷尔蒙替代治疗。这项研究中的所有的妇女都是快要停经了并且距离最后月经周期不到两年的妇女。

这项研究设计实施20年。但是研究在早期就停止了试验—10年后—当10年后来自大型妇女健康倡议的研究的结果发现于服用安慰剂的妇女相比，实施了共同荷尔蒙治疗的妇女中有更多人患有心脏病、中风、在腿和肺上的危险血栓、肺癌。

出于对在他们的研究中的妇女的健康的考虑，丹麦的研究人员建议这些妇女停止荷尔蒙替代治疗。但是，他们继续追踪妇女的健康将近六年。与在WHI中的妇女相比，丹麦的进行了雌激素替代治疗的妇女在研究过程中不太可能死亡或是因为心脏病或是心力衰竭而住院。
两组妇女在中风、危险血栓或是癌症方面不同没有什么意义。

丹麦的Hvidovre医院的内分泌专家LouiseSchierbeck（医学博士）说，我想在某种程度上这是在这个领域中的大多数医生相信是事实的
一个突破。Schierbeck提到，当2012年得知WHI的结果之后，每件事都被颠覆了，这涉及对这项研究的阻止对数百万的妇女停止服用荷尔蒙的快速的影响。但是Schierbeck和其他研究人员认为WHI的结果对年轻点的妇女不是很清楚。她说，在WHI中的主要问题就是妇女的岁数都大了点。当她们参与了这项研究的时候，她们平均年龄63岁。当你在停经10多年之后治疗停经症状就没有什么意义了。在那个时候，你的整个机体都改变了。完全不是自然的状态。

上周，美国研究人员宣布了来自Kronos早期雌激素预防研究的初级结果表明年轻一点的妇女将会从比较小的短期风险停经的严重症状中得到缓解。这项研究仅仅是随访妇女大约4年，所以，这项研究并不能清楚得显示当妇女在年龄大一点的时候对于癌症风险和痴呆将会发生什么情况。

发现引发的警示

虽然新的研究似乎对时间假设是个鼓励，但是专家们警示到它有一些重要的限制。

这项实验的最初的目的是看看HRT是否对骨骼健康是否有利。在获得了研究的数据之后，出现了有关癌症、中风、心脏病风险和死亡的问题。有时候这些问题会对实验结果产生歪曲。

这些妇女和她们的医生知道是否她们可以服用荷尔蒙。那将会影响实验结果。

对于仅仅超过1000多名妇女来说，这项研究是相对较小的。相比之下，HRT的WHI试验包括了27000对名妇女。这项研究得到了使用HRT治疗的药物公司的一部分资助并且这些结果就有了一些经济利益。除此之外，研究人员将有子宫和没有子宫的两组妇女混合在一起。这是非常重要的，因为那些仍然有子宫的妇女相比，那些通过手术将子宫摘掉的妇女要实施一种不同的HRT。她们仅仅是服用雌激素。

包括WHI的很多研究显示对年轻点的妇女仅仅是使用雌激素是更安全的并且可能甚至提供对心脏病和肺癌的保护。仍有还有子宫的妇女必须都服用雌激素和孕激素，因为单独使用雌激素将会增加子宫内膜癌的风险。

加利福尼亚大学洛杉矶分校的大卫格芬医学院的医学肿瘤学负责人Rowan T. Chlebowski（医学和哲学博士）说，将这项试验中两组妇女混合在一起将会混淆实验结果。

对于仍然有子宫的妇女来说，这项研究测试一个在美国不是被普通应用的雌激素-孕激素联合的试验。赫莱博夫斯基提到，所以结果是否施用这些国家的妇女来说是不清楚的。他说，所有这些事情意为着这项研究并没有真正提供有用的信息。其他专家表示同意。

布里格姆预防医学部兼波士顿女子医院的负责人JoAnnE. Manson（医学博士、公关医学博士）说到，总体来看，临床结果数据远远不能对实施荷尔蒙治疗的中风、心脏病、血栓和肺癌的风险提供保证，并且这些发现也不能对临床疾病预防的长期荷尔蒙治疗的使用提供支持。

2012-10-13 17:02

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