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资料 / 核实记录追加：第 2 节第 43 条，绝经前后潮热盗汗去妇科评估激素治疗
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追加：第 2 节第 43 条，绝经前后潮热盗汗去妇科评估激素治疗

2026-10-07。issue #86 读者提到更年期，评估后认为本书缺绝经激素治疗这一块。追加在节末，没有插在中间；同时挂进节首导览「看牙、吃药和别的习惯」一块。

摘要全部经 Europe PMC REST（resultType=core）取得；Manson 2017 的分年龄组数字取自 PMC 全文 https://pmc.ncbi.nlm.nih.gov/articles/PMC5728370/（Europe PMC 的 fullTextXML 接口对这篇返回 500，改走 pmc.ncbi.nlm.nih.gov 带代理取得）。

1. 潮热疗效：Cochrane 2004

  • URL：https://doi.org/10.1002/14651858.CD002978.pub2（PMID 15495039）
  • 已确认：MacLennan AH, Broadbent JL, Lester S, Moore V。「24 trials meeting the selection criteria were included in the review. Study participants totaled 3,329.」纳入的是至少 3 个月的双盲安慰剂对照口服激素试验。
  • 原文：「There was a significant reduction in the weekly hot flush frequency for HT compared to placebo (WMD -17.92, 95% CI -22.86 to -12.99). This was equivalent to a 75% reduction in frequency (95% CI 64.3 to 82.3) for HT relative to placebo. Symptom severity was also significantly reduced compared to placebo (OR 0.13, 95% CI 0.07 to 0.23).」
  • 原文：「In women who were randomised to placebo treatment, a 57.7% (95% CI 45.1 to 67.7) reduction in hot flushes was observed between baseline and end of study.」
  • 原文结论：「Oral HT is highly effective in alleviating hot flushes and night sweats.」

2. WHI 雌孕激素联用试验主结果（2002）

  • URL：https://doi.org/10.1001/jama.288.3.321（PMID 12117397）
  • 已确认：「16608 postmenopausal women aged 50-79 years with an intact uterus」「after a mean of 5.2 years of follow-up」。
  • 原文：「CHD, 1.29 (1.02-1.63) with 286 cases; breast cancer, 1.26 (1.00-1.59) with 290 cases; stroke, 1.41 (1.07-1.85) with 212 cases; PE, 2.13 (1.39-3.25) with 101 cases; colorectal cancer, 0.63 (0.43-0.92) …; hip fracture, 0.66 (0.45-0.98)」；「0.98 (0.82-1.18) for total mortality」。
  • 原文：「Absolute excess risks per 10 000 person-years attributable to estrogen plus progestin were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10 000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures.」
  • 条目写「每 1 万名女性每年」对应原文的 per 10 000 person-years。说人话里「乳腺癌、血栓、中风……各多出约 8 个人」对应 8 例浸润性乳腺癌、8 例肺栓塞、8 例中风；冠心病是 7 例，说人话没写。

3. WHI 两项试验延长随访（2013）

  • URL：https://doi.org/10.1001/jama.2013.278040（PMC3963523）
  • 原文：「cumulatively, there were 168 vs 216, respectively, cases of breast cancer diagnosed (HR, 0.79; 95% CI, 0.65-0.97)」（单用雌激素组，研究对象是切除了子宫的女性）。
  • 原文：「13 years of cumulative follow-up until September 30, 2010」，条目写「累计跟踪 13 年」即出自这句。
  • 原文结论：「do not support use of this therapy for chronic disease prevention, although it is appropriate for symptom management in some women.」
  • 同篇雌孕激素组累计乳腺癌 HR 1.28（1.11–1.48），没写进条目，2002 年那个数已能说明方向。

4. WHI 18 年死亡率（2017）

  • URL：https://doi.org/10.1001/jama.2017.11217（PMC5728370）
  • 原文（摘要）：「All-cause mortality was 27.1% in the hormone therapy group vs 27.6% in the placebo group (hazard ratio [HR], 0.99 [95% CI, 0.94-1.03]) in the overall pooled cohort」。
  • 原文（正文 Age-Stratified Analyses）：「Comparing hormone therapy with placebo, the HRs in the pooled cohort during the intervention phase were 0.69 (95% CI, 0.51-0.94) for women aged 50 to 59 years, 1.04 (95% CI, 0.87-1.25) for women aged 60 to 69 years, and 1.13 (95% CI, 0.94-1.36) for women aged 70 to 79 years (P value for trend by age = 0.01)」；「The trends by age were not statistically significant during cumulative follow-up (HR, 0.89 [95% CI, 0.79-1.01] for women aged 50 to 59 years …; P value for trend = 0.06)」。
  • 注意：分组是按入组时的年龄，不是按绝经年限。正文说按绝经年限分层的结果「generally similar to the age-stratified analyses, but statistically…」不显著，所以条目只写年龄，没写「绝经 10 年内」的数字。

5. Cochrane 2017 长期激素治疗

  • URL：https://doi.org/10.1002/14651858.CD004143.pub5（PMC6465148）
  • 原文：「One trial analysed subgroups of 2839 relatively healthy women 50 to 59 years of age who were taking combined continuous HT and 1637 who were taking oestrogen-only HT versus similar-sized placebo groups. The only significantly increased risk reported was for venous thromboembolism in women taking combined continuous HT: Their absolute risk remained low, at less than 1/500. However, other differences in risk cannot be excluded, as this study was not designed to have the power to detect differences between groups of women within 10 years of menopause.」
  • 原文：「Women over 65 years of age who were relatively healthy and taking continuous combined HT showed an increase in the incidence of dementia (after 4 years' use: from 9 per 1000 to 11 to 30 per 1000).」
  • 原文（结论，备注里的禁忌和孕激素那两句出自这里）：「HT may be unsuitable for some women, including those at increased risk of cardiovascular disease, increased risk of thromboembolic disease (such as those with obesity or a history of venous thrombosis) or increased risk of some types of cancer (such as breast cancer, in women with a uterus). The risk of endometrial cancer among women with a uterus taking oestrogen-only HT is well documented.」
  • 原文（结论）：「HT is not indicated for primary or secondary prevention of cardiovascular disease or dementia … Although HT is considered effective for the prevention of postmenopausal osteoporosis, it is generally recommended as an option only for women at significant risk for whom non-oestrogen therapies are unsuitable.」

6. 美国预防服务工作组 2022

  • URL：https://doi.org/10.1001/jama.2022.18625（PMID 36318127）
  • 原文：「The USPSTF recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal persons. (D recommendation) The USPSTF recommends against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal persons who have had a hysterectomy. (D recommendation).」
  • 原文：「concludes with moderate certainty that the use of combined estrogen and progestin … has no net benefit」。
  • 推荐的适用人群是「Asymptomatic postmenopausal persons who are considering hormone therapy for the primary prevention」，不管为症状用药的人，所以和本条「有症状去评估」不冲突。

没取到、没引的

  • 中华医学会妇产科学分会绝经学组《中国绝经管理与绝经激素治疗指南 2023 版》：DOI 10.3760/cma.j.cn112141-20221118-00706 在 doi.org 能解析，跳到 yiigle.com；但 yiigle 和 rs.yiigle.com 的文章页无论 curl、无头 Chrome 带不带代理，都只返回 AWS 人机验证页（Human Verification），期刊官网 zhfckzz.yiigle.com 的往期目录也是前端加载、拿不到条目链接。原文没取到，按规则不引。2018 版同站，没有再试。
  • 「45 岁以后」这个年龄线没有找到能逐字核对的出处，标题改写成「绝经前后」。
  • 激素类药物在国内是否全部为处方药，没有逐字核对药监文件，条目只写「合适的再开处方」「别自己去买」，没有写成法规断言。

收益量级与证据等级

  • 证据等级 A：疗效来自 24 项随机试验的 Cochrane 汇总，风险来自 WHI 两项大型随机试验及其 18 年随访。标「争议」：WHI 的人群平均 63 岁、用的是单一口服方案，年轻女性的低风险只来自分组分析，且 18 年时不显著；Cochrane 也明说试验不足以判断绝经 10 年内女性的风险。
  • 收益定「大」：本条的主要收益是症状，按死亡率口径（含健康终点）的阈值，潮热次数比安慰剂少约 75%，远超 20%。总死亡率没有变化，风险一侧是每年每万人个位数的绝对增加。备注已写明「终点是症状，不是总死亡率」。主任务如认为症状不该按健康终点套阈值，可改为「中」。
  • 成本：钱=少（门诊挂号加处方药，没有核到全国统一价格，按常见门诊药费判断）；时间=中（一次门诊数小时，加定期复查）；毅力=否。