对更年期荷尔蒙治疗对认知效应的系统审查和元分析
Caroline Andy1, Matilde Nerattini2, Steven Jett2
1Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States.
Frontiers in endocrinology
|March 19, 2024
概括
更年期激素治疗 (MHT) 对认知的影响取决于配方和时间. 仅用雌激素治疗改善了全球认知能力,而雌激素-孕激素治疗显示出混合的结果,突出了对个性化方法的需求.
科学领域:
- 神经科学是一个神经科学.
- 内分泌学 在内分泌学.
- 老年学是指老年学的学科.
背景情况:
- 临床前研究表明雌激素具有神经保护作用.
- 更年期激素治疗 (MHT) 在认知功能中的作用仍在争论中.
- 了解MHT对认知的影响对于绝经后妇女的健康至关重要.
研究的目的:
- 使用元分析系统地评估MHT对认知功能的影响.
- 研究MHT的制定和启动时间如何影响认知结果.
- 为MHT在认知支持中的有争议作用提供基于证据的见解.
主要方法:
- 进行了34项随机对照试验的随机效应元分析.
- 包括14914名接受MHT和12679名接受安慰剂的参与者的数据.
- 利用多层次元回归来分析配方和时间效应.
主要成果:
- MHT对认知领域得分没有整体影响.
- 仅用雌激素治疗手术更年期的治疗改善了全球认知能力 (SMD=1.575).
- 中年开始的雌激素治疗改善了口头记忆 (SMD=0.394);晚年开始没有影响.
- 自发更年期的雌激素-孕激素治疗与认知能力下降有关 (MMSE得分,SMD=-1.853).
- 较长的MHT持续时间 (>1年) 与视觉记忆的恶化有关.
结论:
- MHT对认知的影响取决于时间,并因配方而异.
- 仅用雌激素治疗可能有利于全球认知,特别是在经过手术更年期后.
- 雌激素-孕激素治疗的效果是复杂的,有潜在的风险的认知能力下降,如果启动迟.
- 需要对更大,更均的样本进行进一步的研究,以澄清MHT在认知健康中的作用.
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