中国循证医学杂志

中国循证医学杂志

月经状况与乳腺癌相关性的 Meta 分析

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目的 系统评价女性月经状况与乳腺癌发生的相关性。 方法 计算机检索 The Cochrane Library(2016 年 4 期)、PubMed、EMbase、CNKI、WanFang Data、VIP 和 ScienceDirect 数据库,搜集月经状况与乳腺癌相关的病例-对照研究,检索时限均为建库至 2016 年 6 月 1 日。由 2 位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用 Stata 12.0 软件进行 Meta 分析。 结果 共纳入 83 个研究,包括 48 811 例患者和 57 268 例对照。Meta 分析结果显示:乳腺癌与初潮年龄≤13 岁[OR=1.17,95%CI(1.12,1.24)]和月经不规律[OR=1.98,95%CI(1.62,2.41)]具有相关性,但其与痛经史、月经周期≥30 天、月经经期>7 天的相关性无统计学意义。按照样本量进行亚组分析结果显示,样本量大小是痛经史的主要异质性来源,去除小样本研究后,相关性具有统计学意义[OR=1.47,95%CI(1.36,1.59)]。按照对照来源进行的亚组分析结果显示,乳腺癌与初潮年龄≤13 岁、月经不规律与乳腺癌的相关性在对照来源是社区的研究中相关性具有统计学意义,但在对照来源是医院的研究中相关性无统计学意义。按照研究人群进行亚组分析结果显示,乳腺癌与初潮年龄≤13 岁、月经不规律的相关性在中国人和外国人之间均有统计学意义。 结论 女性初潮年龄≤13 岁、月经不规律、有痛经史可能是乳腺癌发病的危险因素。受纳入研究的数量和质量的限制,上述结论尚需要更多研究予以证实。

Objective To systematically review the association between menstrual condition and the risk of breast cancer. Methods We searched The Cochrane Library (Issue 4, 2016), PubMed, EMbase, CNKI, WanFang Data, VIP and ScienceDirect databases from inception to June 1st 2016 to collect case-control studies about the association between menstrual condition and breast cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using Stata12.0 software. Results Eighty-three studies involving 48 811 breast cancer patients and 57 268 controls were finally included. The results of meta-analysis showed that breast cancer was associated with age at menarche≤13 years old (OR=1.17, 95%CI 1.12 to 1.24) and irregular menstruation (OR=1.98, 95%CI 1.62 to 2.41), but was not associated with history of dysmenorrhea, cycle time≥30 days and period of time>7 days. Further subgroup analysis showed that the sample size was one of the main source of heterogeneity for history of dysmenorrheal analysis, and breast cancer was associated with the history of dysmenorrhea after removing small-sampled studies (OR=1.47, 95%CI 1.36 to 1.59). The association between breast cancer and age at menarche≤13 years old, irregular menstruation was statistically significant in community control, but not in hospital control. The association between breast cancer and age at menarche≤13 years old, irregular menstruation were statistically significant both in Chinese and foreign population. Conclusion Early age at menarche, irregular menstruation and history of dysmenorrhea may be risk factors of breast cancer. Due to the limitation of quality and quanity of included studies, the above conclusions need more researches to verify.

关键词: 乳腺癌; 月经; 病例-对照研究; 女性; Meta 分析

Key words: Breast cancer; Menstruation; Case-control; Female; Meta-analysis

引用本文: 刘也, 熊文婧, 刘洋, 翦耀文, 付由户, 杨慧仙, 让蔚清. 月经状况与乳腺癌相关性的 Meta 分析. 中国循证医学杂志, 2017, 17(4): 418-428. doi: 10.7507/1672-2531.201612054 复制

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