本文由小咖机器人翻译整理

期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-078078

摘要内容如下：

客观

评估颅内脑膜瘤与所选孕激素使用相关的风险。

设计

全国病例对照研究。

设置

法国国家卫生数据系统（即国家卫生数据系统）。

参与者

在总共108366名女性中，有18061名居住在法国的女性在2009年1月1日至2018年12月31日期间（宫内系统的限制包含期）因脑膜瘤接受了颅内手术，她们被视为病例组。每个病例与出生年份和居住地区的5个对照（90305个对照）相匹配。

主要结果指标

选择使用的孕激素有：黄体酮、羟孕酮、地屈孕酮、甲孕酮、醋酸甲羟孕酮、普罗孕酮、地诺孕素和宫内注射的左炔诺孕酮。对于每种孕激素，在指标日期前一年内至少使用一次（13.5 mg左炔诺孕酮宫内系统在三年内，52 mg在五年内）。条件Logistic回归用于计算每种孕激素与脑膜瘤相关性的比值比。

结果

平均年龄57.6岁（标准差12.8）。分析显示，使用甲孕酮的脑膜瘤风险过高（42例暴露者/18061例（0.2%）比79例暴露者/90305例（0.1%），比值比3.49（95%置信区间2.38至5.10）），醋酸甲羟孕酮（注射剂，9/18061（0.05%）比11/90305（0.01%），5.55（2.27至13.56）），和普罗孕酮（83/18061（0.5%）对225/90305（0.2%），2.39（1.85至3.09））。这种额外风险是由长期使用（≥1年）引起的。结果显示黄体酮、地屈孕酮或左炔诺孕酮宫内系统对颅内脑膜瘤没有额外风险。无法得出关于地诺孕素或羟孕酮的结论，因为接受这些药物的人数较少。醋酸环丙孕酮（891/18061（4.9%）v256/90305（0.3%），比值比19.21（95%置信区间16.61至22.22））、醋酸诺美孕酮（925/18061（5.1%）v1121/90305（1.2%），4.93（4.50至5.41））、和醋酸氯地孕酮（628/18061（3.5%）V 946/90305（1.0%），3.87（3.48至4.30）），用作使用的阳性对照。

结论

研究发现，长期使用甲孕酮、醋酸甲羟孕酮和普罗孕酮会增加颅内脑膜瘤的风险。注射醋酸甲羟孕酮（一种广泛使用的避孕药）的风险增加，以及左炔诺孕酮宫内系统的安全性是重要的新发现。

英文原文如下：

Abstracts

OBJECTIVE  To assess the risk of intracranial meningioma associated with the use of selected progestogens.

DESIGN  National case-control study.

SETTING  French National Health Data System (ie, Système National des Données de Santé).

PARTICIPANTS  Of 108 366 women overall, 18 061 women living in France who had intracranial surgery for meningioma between 1 January 2009 and 31 December 2018 (restricted inclusion periods for intrauterine systems) were deemed to be in the case group. Each case was matched to five controls for year of birth and area of residence (90 305 controls).

MAIN OUTCOME MEASURES  Selected progestogens were used: progesterone, hydroxyprogesterone, dydrogesterone, medrogestone, medroxyprogesterone acetate, promegestone, dienogest, and intrauterine levonorgestrel. For each progestogen, use was defined by at least one dispensation within the year before the index date (within three years for 13.5 mg levonorgestrel intrauterine systems and five years for 52 mg). Conditional logistic regression was used to calculate odds ratio for each progestogen meningioma association.

RESULTS  Mean age was 57.6 years (standard deviation 12.8). Analyses showed excess risk of meningioma with use of medrogestone (42 exposed cases/18 061 cases (0.2%) v 79 exposed controls/90 305 controls (0.1%), odds ratio 3.49 (95% confidence interval 2.38 to 5.10)), medroxyprogesterone acetate (injectable, 9/18 061 (0.05%) v 11/90 305 (0.01%), 5.55 (2.27 to 13.56)), and promegestone (83/18 061 (0.5%) v 225/90 305 (0.2 %), 2.39 (1.85 to 3.09)). This excess risk was driven by prolonged use (≥one year). Results showed no excess risk of intracranial meningioma for progesterone, dydrogesterone, or levonorgestrel intrauterine systems. No conclusions could be drawn concerning dienogest or hydroxyprogesterone because of the small number of individuals who received these drugs. A highly increased risk of meningioma was observed for cyproterone acetate (891/18 061 (4.9%) v 256/90 305 (0.3%), odds ratio 19.21 (95% confidence interval 16.61 to 22.22)), nomegestrol acetate (925/18 061 (5.1%) v 1121/90 305 (1.2%), 4.93 (4.50 to 5.41)), and chlormadinone acetate (628/18 061 (3.5%) v 946/90 305 (1.0%), 3.87 (3.48 to 4.30)), which were used as positive controls for use.

CONCLUSIONS  Prolonged use of medrogestone, medroxyprogesterone acetate, and promegestone was found to increase the risk of intracranial meningioma. The increased risk associated with the use of injectable medroxyprogesterone acetate, a widely used contraceptive, and the safety of levonorgestrel intrauterine systems are important new findings.

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。