| Research background:Menopause is an important biological event in the female life process.With the decrease of sex hormones,there are significant changes in many metabolic processes and the occurrence of many diseases.The advent of hormone replacement therapy(HRT)has improved the outcome of many short﹣term and long﹣term adverse events after menopause.With the further development of research,the relationship between HRT and plasma homocysteine levels has attracted a lot of attention.Hcy is known cardiovascular disease and independent risk factors for thromboembolic disease,its associated with the development of many diseases in the body,it seems that more and more test shows that Hcy levels associated with hormone levels in the body,however,researches at home and abroad show that the effects of HRT on plasma Hcy levels are inconsistent in healthy postmenopausal women,and the relationship between the two is still controversial.Objective:Using meta﹣analysis method to evaluate randomized controlled trias(RCTs)which show the relationship between hormone replacement therapy and plasma homocysteine levels in healthy postmenopausal women,to explore the effect of HRT on Hcy metabolism and provide more theoretical evidence for the clinical application of HRT.Method:A systematic computer search was conducted on PubMed,Cochrane Library,Embase,Web of Science,Medline,CNKI,Wanfang Abstracts and VIP to find the Chinese and English RCTs on the relationship between menopausal hormone therapy and homocysteine published between January 1990 and March 2020.Literatures were screened according to relevant standards,and the Cochrane risk of bias assessment tool was used for quality evaluation,finally,the extracted data was analyzed using RevMan 5.3 software.Results:A total of 16 English RCTs were included,including 655 subjects in the HRT group and 618 subjects in the placebo/blank control group.The results of meta﹣analysis showed:Compared with the untreated group,plasma homocysteine levels in postmenopausal women with hormone replacement therapy significantly decreased(MD=﹣1.69,95%CI:[﹣2.35,﹣1.02],P<0.00001),with statistically significant differences.Among them,the oral hormone replacement therapy(MD=﹣1.91,95%CI: [﹣2.73,﹣1.10],P<0.00001)and the non﹣oral hormone replacement therapy(MD=﹣0.88,95%CI: [﹣1.75,﹣0.00],P=0.05)can both reduce the level of Hcy,and the effects are roughly the same(MD=﹣0.09,95%CI:[﹣0.74,0.55],P=0.77>0.05).Both the single estrogen group(MD=﹣1.84,95%CI:[﹣2.88,﹣0.81],P=0.0005)and the combined pregnancy group(MD=﹣1.59,95%CI:[﹣2.48,﹣0.71],P=0.0004)also reduced the blood Hcy level,and the progesterone group did not seem to have significant adverse effects on the reduction of Hcy metabolism in estrogen(MD=﹣0.21,95%CI:[﹣0.71,0.29],P=0.41>0.05).HRT did not seem to be subject to regional restrictions.After administration,Hcy levels in populations in different regions all showed a downward trend,and the effects ranged from strong to weak in the north American group,the Asian group,the South American group,and the European group(MD=﹣3.15,﹣2.80,﹣1.59,﹣0.89),which may be related to dietary habits and common hormone types.Conclusion:For postmenopausal women without other risk factors,hormone replacement therapy can effectively reduce homocysteine levels in the blood circulation,which is a new manifestation of the beneficial effect of hormone replacement therapy.HRT may provide a protective effect in the occurrence of related diseases by reducing the level of Hcy. |
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