这篇系统的综述总结了女性生殖因素(初潮年龄,奇偶校验,口服避孕药[OC]使用,更年期的年龄,和绝经后激素[PMH]使用)和眼内压(IOP)或开角型青光眼(OAG)。
了解女性生殖因素与青光眼之间的关联可能有助于阐明疾病的发病机制,并有助于临床预测和个性化治疗策略。重要的是,一些因素是可以改变的,这可能会导致新的疗法。
两位审稿人独立提取MEDLINE中的文章,Embase,Cochrane系统评价数据库,和Cochrane中央对照试验注册数据库以确定相关研究。资格标准包括年龄>18岁的人类受试者的研究;IOP或OAG的测量结果;队列,病例控制,横截面,或随机对照试验设计;报告的关联度量,例如危险比,相对风险,赔率比,或平均差异,具有相关的置信区间;以及至少以下变量之一的测量暴露:初潮年龄,奇偶校验,OC使用,更年期的年龄,或PMH使用。
我们共纳入了27项研究。研究设计的实质性差异,暴露和治疗水平,治疗持续时间,和变量报告排除了对已确定研究的有意义的定量综合。总的来说,在使用PMH和较低IOP之间发现了相对一致的关联.仅使用雌激素的PMH可能与较低的OAG风险有关,可以通过种族来修改。与联合使用雌激素和孕激素PMH没有发现显着关联。没有发现月经初潮时的胎次或年龄与青光眼之间的强烈关联。但是更年期年龄较小与青光眼风险增加有关,并确定与OC使用持续时间较长的不良关联,尽管没有发现与OC使用的总体关联。
使用PMH与降低IOP或OAG风险之间的关联是潜在的临床相关和可改变的风险因素,应进一步研究。尽管这需要在纳入研究的偏倚风险较高的背景下进行解释.未来的研究应特别检查与IOP的关联,以及遗传因素与OAG风险之间的关系如何受到女性生殖因素的影响。
This systematic
review summarizes evidence for associations between female reproductive factors (age at menarche, parity, oral contraceptive [OC] use, age at menopause, and postmenopausal hormone [PMH] use) and intraocular pressure (IOP) or open-angle glaucoma (OAG).
Understanding the associations between female reproductive factors and glaucoma may shed light on the disease pathogenesis and aid clinical prediction and personalized treatment strategies. Importantly, some factors are modifiable, which may lead to new therapies.
Two reviewers independently extracted articles in MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials databases to identify relevant studies. Eligibility criteria included studies with human subjects aged > 18 years; a measured outcome of either IOP or OAG; a cohort, case-control, cross-sectional, or randomized controlled trial design; a reported measure of association, such as the hazard ratio, relative risk, odds ratio, or mean difference, with an associated confidence interval; and a measured exposure of at least 1 of the following variables: age at menarche, parity, OC use, age at menopause, or PMH use.
We included a total of 27 studies. Substantial differences in study designs, exposure and treatment levels, treatment durations, and variable reporting precluded a meaningful quantitative synthesis of the identified studies. Overall, relatively consistent associations between PMH use and a lower IOP were identified. Estrogen-only PMH use may be associated with lower OAG risk, which may be modified by race. No significant associations were found with combined estrogen-and-progesterone PMH use. No strong associations between parity or age at menarche and glaucoma were found, but a younger age at menopause was associated with an increased glaucoma risk, and adverse associations were identified with a longer duration of OC use, though no overall association with OC use was found.
The association between PMH use and lower IOP or OAG risk is a potentially clinically relevant and modifiable risk factor and should be investigated further, although this needs to be interpreted in the context of a high risk of bias across included studies. Future research should examine associations with IOP specifically and how the relationship between genetic factors and OAG risks may be influenced by female reproductive factors.