绝经后女性雌激素水平与缺血性脑卒中相关性的Meta分析
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摘要
目的明确绝经后妇女雌激素水平与缺血性脑卒中是否具有相关性。方法检索PubMed、知网、维普、万方数据库中有关女性绝经后雌激素水平与缺血性脑卒中的病例对照研究,由2位研究者分别对文献进行筛选、资料提取,根据Newcastle-ottawa量表进行质量评价,并采用Stata 12软件进行数据分析。结果此研究共纳入15篇病例对照研究,共1 368名患者被纳入此研究,Meta分析结果示病例组雌激素水平低于对照组(SMD=-1.37,95%CI:-2.08～-0.67),且差异具有统计学意义(P<0.05),敏感性分析示病例组和对照组的雌激素水平差异结果可靠。结论绝经后女性雌激素水平与缺血性脑卒中的发生之间具有相关性,女性绝经后雌激素水平的下降可能与缺血性脑卒中的发生有关。
Objective To determine the relationship between estrogen levels in postmenopausal women and ischemic stroke. Methods Search in database including PubMed, CNKI, VIP, and Wanfang database to identify the case control studies of estrogen levels in postmenopausal women and ischemic stroke. Two reviewers selected and extracted data, Then conducted quality evaluation according to Newcastle-ottawa scale, Last carried out a data analysis by stata 12 software. Results The study participants included 15 case-control study, a total of 1 368 patients were included in this study, Meta analysis results in cases of estrogen levels lower than the control group(SMD=-1.37, 95%CI:-2.08～-0.67), and the difference has significant statistical significance(P<0.05), the estrogen level of sensitivity analysis in case group and control group differences result is reliable. Conclusion It is correlated between estrogen levels in postmenopausal women and ischemic stroke, and the low level of female postmenopausal estrogen is related to the risk of ischemic stroke.
Objective To determine the relationship between estrogen levels in postmenopausal women and ischemic stroke. Methods Search in database including PubMed, CNKI, VIP, and Wanfang database to identify the case control studies of estrogen levels in postmenopausal women and ischemic stroke. Two reviewers selected and extracted data, Then conducted quality evaluation according to Newcastle-ottawa scale, Last carried out a data analysis by stata 12 software. Results The study participants included 15 case-control study, a total of 1 368 patients were included in this study, Meta analysis results in cases of estrogen levels lower than the control group(SMD=-1.37, 95%CI:-2.08～-0.67), and the difference has significant statistical significance(P<0.05), the estrogen level of sensitivity analysis in case group and control group differences result is reliable. Conclusion It is correlated between estrogen levels in postmenopausal women and ischemic stroke, and the low level of female postmenopausal estrogen is related to the risk of ischemic stroke.
引文
[1]吴江.神经病学[M].3版.北京:人民卫生出版社,2015:179-187.
[2] Satue E, Vila-Corcoles A, Ochoa-Gondar O, et al. Incidence and risk conditions of ischemic stroke in older adults[J]. Acta Neurol Scand, 2016,134(4):250-257.
[3] Lv Y, Fang X, Asmaro K, et al. Five-year Prognosis after Mild to Moderate Ischemic Stroke by Stroke Subtype:A Multi-Clinic Registry Study[J]. PLoS One, 2013,8(11):e75019.
[4] Baba Y, Ishikawa S, Amagi Y, et al. Premature menopause is associated with increased risk of cerebral infarction in Japanese women[J]. Menopause, 2010,17(3):506-510.
[5] Arnao V, Acciarresi M, Cittadini E, et al. Stroke incidence, prevalence and mortality in women worldwide[J]. Int J Stroke, 2016,11(3):287-301.
[6]曹莲香,贾建平.绝经后妇女缺血性脑卒中患者性激素变化及其意义[J].当代医学,2014,20(15):86.
[7]黄继良,王柏川,郑飞鸣,等.绝经后妇女性激素水平变化在脑梗死发病中所起的作用[J].医学理论与实践,2001,14(3):197-199.
[8]李娜,张春时.绝经后脑梗死患者性激素及血脂变化的研究.现代神经疾病杂志[J].2002,2(4):230-232.
[9]朱春明,王立.老年女性动脉粥样硬化性血栓性脑梗死患者性激素及血脂变化的研究[J].中国危重病急救医学,1999,1(13):1-5.
[10]田蕾.绝经后女性血浆雌二醇水平与脑梗死的相关性研究[J].中国实用神经疾病杂志,2015,18(21):65-66.
[11]张效霞,李义召,卢林,等.不同性别脑梗塞性激素、血脂与脂蛋白亚组分的变化及相关性[J].中国误诊学杂志,2005,5(5):840-843.
[12]刘传颂,戴瑞宁,傅佳.绝经后雌激素与女性急性脑梗死发病关系的探讨[J].中风与神经疾病杂志,2013,30(8):710-712.
[13]刘晓红,周维智,林琳,等.绝经期女性脑梗死患者雌激素水平与血脂关系研究[J].中华神经医学杂志,2003,2(4):297-299.
[14]杜小鹏.女性脑梗塞患者性激素的变化[J].浙江实用医学,2001,6(4):24.
[15]赵伟,潘燕.缺血性脑血管病雌激素测定及其意义探讨[J].中原医刊,2004,31(8):6-7.
[16]张蕾.西宁地区老年女性脑梗死患者血清雌激素水平与血脂、梗死面积的相关分析[J].高原医学杂志,2012,22(1):36-38.
[17]么冬爱,张晓琴,章军建.性激素对绝经后妇女脑梗死的影响[J].临床荟萃,2001,16(8):340-341.
[18]王晓鹏,李春岩,耿连霞,等.性激素水平与脑梗死及相关关系的研究[J].脑与神经病杂志,2003,11(3):158-160.
[19]李桂强.性激素与老年脑梗死关系的初步研究[J].现代康复,2000,4(9):1344-1345.
[20]周伯荣,许治强,刘宇明,等.脑梗死患者血清雌激素水平与血脂、梗死面积的相关分析[J].医师进修杂志,2002,25(11):18-20.
[21]沈铿,马丁.妇产科学[M].3版.北京:人民卫生出版社,2015:7-24.
[22] Koellhoffer EC, McCullough LD. The Effects of Estrogen in Ischemic Stroke[J]. Transl Stroke Res, 2013,4(4):390-401.
[23] Lu Q, Schnitzler GR, Vallaster CS, et al. Unliganded estrogen receptor alpha regulates vascular cell function and gene expression[J]. Mol Cell Endocrinol, 2017,15(442):12-23.
[24]邱灿华,陈建文,李红宇,等.钙通道在雌激素对大鼠血压调节中的作用及机制探讨[J].当代医学,2013,19(28):20-22.
[25] Matthews KA, Crawford SL, Chae CU, et al. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition?[J]. Journal of the American College of Cardiology, 2009,54(25):2366-2373.
[26] Zhang ZL, Qin P, Liu Y, et al. Alleviation of Ischaemia-reperfusion Injury by Endogenous Estrogen Involves Maintaining Bcl-2 Expression via the ERαSignalling Pathway[J]. Brain Res, 2017,15(1661):15-23.
[27] Lan YL,Zhao J, Li S. Estrogen receptors'neuroprotective effect against glutamate-induced neurotoxicity[J]. Neurol Sci, 2014,35(11):1657-1662.
[28] Aguirre C, Jayaraman A, Pike C, et al. Progesterone inhibits estrogen-mediated neuroprotection against excitotoxicity by down-regulating estrogen receptor-β[J]. Biol Reprod, 2010,82(4):706-713.
[2] Satue E, Vila-Corcoles A, Ochoa-Gondar O, et al. Incidence and risk conditions of ischemic stroke in older adults[J]. Acta Neurol Scand, 2016,134(4):250-257.
[3] Lv Y, Fang X, Asmaro K, et al. Five-year Prognosis after Mild to Moderate Ischemic Stroke by Stroke Subtype:A Multi-Clinic Registry Study[J]. PLoS One, 2013,8(11):e75019.
[4] Baba Y, Ishikawa S, Amagi Y, et al. Premature menopause is associated with increased risk of cerebral infarction in Japanese women[J]. Menopause, 2010,17(3):506-510.
[5] Arnao V, Acciarresi M, Cittadini E, et al. Stroke incidence, prevalence and mortality in women worldwide[J]. Int J Stroke, 2016,11(3):287-301.
[6]曹莲香,贾建平.绝经后妇女缺血性脑卒中患者性激素变化及其意义[J].当代医学,2014,20(15):86.
[7]黄继良,王柏川,郑飞鸣,等.绝经后妇女性激素水平变化在脑梗死发病中所起的作用[J].医学理论与实践,2001,14(3):197-199.
[8]李娜,张春时.绝经后脑梗死患者性激素及血脂变化的研究.现代神经疾病杂志[J].2002,2(4):230-232.
[9]朱春明,王立.老年女性动脉粥样硬化性血栓性脑梗死患者性激素及血脂变化的研究[J].中国危重病急救医学,1999,1(13):1-5.
[10]田蕾.绝经后女性血浆雌二醇水平与脑梗死的相关性研究[J].中国实用神经疾病杂志,2015,18(21):65-66.
[11]张效霞,李义召,卢林,等.不同性别脑梗塞性激素、血脂与脂蛋白亚组分的变化及相关性[J].中国误诊学杂志,2005,5(5):840-843.
[12]刘传颂,戴瑞宁,傅佳.绝经后雌激素与女性急性脑梗死发病关系的探讨[J].中风与神经疾病杂志,2013,30(8):710-712.
[13]刘晓红,周维智,林琳,等.绝经期女性脑梗死患者雌激素水平与血脂关系研究[J].中华神经医学杂志,2003,2(4):297-299.
[14]杜小鹏.女性脑梗塞患者性激素的变化[J].浙江实用医学,2001,6(4):24.
[15]赵伟,潘燕.缺血性脑血管病雌激素测定及其意义探讨[J].中原医刊,2004,31(8):6-7.
[16]张蕾.西宁地区老年女性脑梗死患者血清雌激素水平与血脂、梗死面积的相关分析[J].高原医学杂志,2012,22(1):36-38.
[17]么冬爱,张晓琴,章军建.性激素对绝经后妇女脑梗死的影响[J].临床荟萃,2001,16(8):340-341.
[18]王晓鹏,李春岩,耿连霞,等.性激素水平与脑梗死及相关关系的研究[J].脑与神经病杂志,2003,11(3):158-160.
[19]李桂强.性激素与老年脑梗死关系的初步研究[J].现代康复,2000,4(9):1344-1345.
[20]周伯荣,许治强,刘宇明,等.脑梗死患者血清雌激素水平与血脂、梗死面积的相关分析[J].医师进修杂志,2002,25(11):18-20.
[21]沈铿,马丁.妇产科学[M].3版.北京:人民卫生出版社,2015:7-24.
[22] Koellhoffer EC, McCullough LD. The Effects of Estrogen in Ischemic Stroke[J]. Transl Stroke Res, 2013,4(4):390-401.
[23] Lu Q, Schnitzler GR, Vallaster CS, et al. Unliganded estrogen receptor alpha regulates vascular cell function and gene expression[J]. Mol Cell Endocrinol, 2017,15(442):12-23.
[24]邱灿华,陈建文,李红宇,等.钙通道在雌激素对大鼠血压调节中的作用及机制探讨[J].当代医学,2013,19(28):20-22.
[25] Matthews KA, Crawford SL, Chae CU, et al. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition?[J]. Journal of the American College of Cardiology, 2009,54(25):2366-2373.
[26] Zhang ZL, Qin P, Liu Y, et al. Alleviation of Ischaemia-reperfusion Injury by Endogenous Estrogen Involves Maintaining Bcl-2 Expression via the ERαSignalling Pathway[J]. Brain Res, 2017,15(1661):15-23.
[27] Lan YL,Zhao J, Li S. Estrogen receptors'neuroprotective effect against glutamate-induced neurotoxicity[J]. Neurol Sci, 2014,35(11):1657-1662.
[28] Aguirre C, Jayaraman A, Pike C, et al. Progesterone inhibits estrogen-mediated neuroprotection against excitotoxicity by down-regulating estrogen receptor-β[J]. Biol Reprod, 2010,82(4):706-713.