更年期激素治疗和痴呆症:全国范围的,嵌套的病例控制研究
Nelsan Pourhadi1,2, Lina S Mørch2, Ellen A Holm3,4
1Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
BMJ (Clinical research ed.)
|June 28, 2023
概括
更年期激素治疗,特别是雌激素-孕激素治疗,与痴呆症的风险增加有关. 这种关联即使在治疗时间较短和早期开始时也是如此,这强调了潜在的长期风险.
科学领域:
- 生殖健康和内分泌学
- 神经科学与衰老问题
背景情况:
- 更年期激素治疗 (MHT) 广泛用于更年期期间的症状管理.
- MHT对认知健康的长期影响,特别是痴呆风险,需要进一步阐明.
研究的目的:
- 调查更年期荷尔蒙疗法使用与痴呆症发展之间的关联.
- 检查激素治疗的类型,持续时间和开始时的年龄如何影响痴呆风险.
主要方法:
- 在丹麦进行了一项全国性嵌套病例控制研究,利用国家卫生登记册.
- 在2000年至2018年期间,在50至60岁的女性中发现了5589例痴呆病例和55890例年龄匹配对照.
- 调整后的危险比率 (HR) 以95%的置信区间 (CI) 为所有原因的痴呆症计算.
主要成果:
- 与非使用者相比,雌激素-孕激素治疗与所有原因痴呆率的增加有关 (HR 1.24;95% CI 1.17-1.33).
- 随着MHT使用时间的延长,痴呆的风险增加,从HR 1.21 (95% CI 1.09-1.35) ≤1年到HR 1.74 (95% CI 1.45-2.10) >12年.
- 在连续和循环治疗方案以及在55岁或更年轻时开始MHT的妇女中,相关性持续存在,并观察到阿尔茨海默病.
结论:
- 更年期激素治疗,特别是雌激素-孕激素类型,与痴呆症的发展有关,包括阿尔茨海默病.
- 即使在早期发病 (≤55岁) 和MHT持续时间不同的情况下,也观察到痴呆风险增加.
- 需要进一步的研究来确认因果关系,并了解使用MHT的女性潜在的潜在倾向.
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