国际妇产科学杂志

国际妇产科学杂志 ›› 2016, Vol. 43 ›› Issue (5): 489-492.

• 综述 • 上一篇    下一篇

绝经期激素替代治疗的相关肿瘤风险研究进展

陈醒，周应芳，白文佩   

  1. 100034 北京大学第一医院妇产科（陈醒，周应芳）；首都医科大学附属北京世纪坛医院妇产科（白文佩）
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2016-10-15 发布日期:2016-10-15
  • 通讯作者: 白文佩

Research Progress of the Risk of Tumors of Menopausal Hormone Replacement Therapy

CHEN Xing，ZHOU Ying-fang，BAI Wen-pei   

  1. Department of Obstetrics and Gynecology，Peking University First Hospital，Beijing 100034，China（CHEN Xing，ZHOU Ying-fang）；Department of Obstetrics and Gynecology，Beijing Shijitan Hospital，Capital Medical University，Beijing 100038，China（BAI Wen-pei）
  • Received:1900-01-01 Revised:1900-01-01 Published:2016-10-15 Online:2016-10-15
  • Contact: BAI Wen-pei

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摘要： 绝经期激素替代治疗（MHT）已被证实能有效缓解绝经期综合征，但其在临床上的应用也经历了曲折的过程。随着人们对激素疗法认识的不断深化，激素治疗的风险也不断被人们所熟知，尤其是激素相关的肿瘤，如子宫内膜癌、卵巢癌、乳腺癌等。目前已有很多临床研究阐述了激素治疗的相关肿瘤风险。有子宫的患者使用雌激素治疗（estrogen therapy，ET）增加患子宫内膜癌的风险，需加用孕激素（estrogen-progesterone therapy，EPT）保护子宫内膜；EPT连续用药比序贯用药能更好地保护子宫内膜；对于已患子宫内膜癌的患者，早期患者使用雌激素并不增加肿瘤复发风险，并能改善生存质量。ET和EPT能增加卵巢癌的风险，且与病理类型有关；卵巢癌术后使用MHT并不增加复发的风险和死亡率，不影响预后。ET可能会降低乳腺癌风险，而EPT可能会增加乳腺癌的风险；乳腺癌患者不适用激素疗法。但是上述许多结果均需要临床研究的进一步检验，有些问题还缺少相关研究，甚至有些结论互相矛盾。综述近几年的临床研究结果，深化对激素治疗的认识，为临床指导激素治疗提供最新依据。

关键词: 激素替代疗法, 围绝经期, 绝经后期, 肿瘤

Abstract: Menopausal hormone replacement therapy (MHT) has been proven to alleviate menopausal syndrome. But the application of MHT experienced a meandering and winding process. With the changing attitude towards MHT, the risk of MHT has been widely recognized, especially hormone-associated tumors, such as endometrial cancer, ovarian cancer and breast cancer. Now the risk of tumors on MHT has been reported by a large number of clinical studies. ET in women with an intact uterus is associated with increased endometrial cancer risk. To diminish this increased risk, concomitant progestogen is recommended for women with an intact uterus when using ET. Women who have used progestins continuously are at lower risk of endometrial cancer compared with sequentially. Estrogen may not increase the recurrence of endometrial cancer and can improve the quality of life to women who have had early endometrial cancer. ET and EPT can increase incidence of ovarian cancer, which is associated with pathological type, however, to women who have had surgery of ovarian cancer, MHT application may not increase the recurrence and mortality of ovarian cancer, so as the prognosis. ET may reduce the risk of breast cancer while EPT may not. For women who have breast cancer, MHT is not recommended. But lots of conclusions above need to be further certified. Some issues cannot be solved now, while some conclusions are even contradictory. This paper will review conclusions of latest clinical studies to enhance the understanding of MHT and provide newest evidence about MHT.

Key words: Hormone replacement therapy, Perimenopause, Postmenopause, Neoplasms