Nerhood R C
Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA.
Postgrad Med. 2001 Mar;109(3):167-70, 173-4, 178. doi: 10.3810/pgm.2001.03.1770.
Alzheimer's disease, CAD, and osteoporosis significantly affect the health and well-being of senior citizens in the United States. The fact that women have a longer life expectancy than men has led to the hypothesis that estrogen in some way imparts protection against these disease processes. Available data on the possible negative effect of estrogen on the development and progression of Alzheimer's disease are provocative but inconclusive. Thus, for the time being, they must remain no more than the basis of an attractive hypothesis. In contrast, available data suggest that ERT and HRT can reduce the risk of CAD, but this effect seems more preventive than therapeutic. Addition of a progestational agent to an estrogen regimen may blunt this effect. Although the medical literature contains very few data that address the issue of duration of therapy, logic would suggest that cessation of therapy would result in the loss of a protective effect. With regard to osteoporosis, ERT and HRT have clear beneficial effects in that they increase BMD and decrease fracture risk. There is good evidence that duration of therapy may be more important than dosage and that these effects rapidly dissipate with cessation of therapy. Finally, as with all medical interventions, ERT or HRT must be individualized for each patient. Although actual health hazards are few, adverse effects are common and the emotion-charged, ever-evolving issue of the negative impact of ERT and HRT on breast cancer risk must always be considered before such therapy is instituted.
阿尔茨海默病、冠心病和骨质疏松症严重影响美国老年人的健康和幸福。女性预期寿命比男性长这一事实引发了一种假说，即雌激素在某种程度上能提供针对这些疾病进程的保护作用。关于雌激素对阿尔茨海默病发展和进展可能产生的负面影响的现有数据具有启发性，但尚无定论。因此，目前这些数据不过是一个有吸引力的假说的基础而已。相比之下，现有数据表明，雌激素替代疗法（ERT）和激素替代疗法（HRT）可降低冠心病风险，但这种作用似乎更多是预防性的而非治疗性的。在雌激素治疗方案中添加孕激素可能会削弱这种作用。尽管医学文献中涉及治疗持续时间问题的数据很少，但从逻辑上讲，停止治疗可能会导致失去保护作用。关于骨质疏松症，ERT和HRT具有明显的有益作用，即它们可增加骨密度并降低骨折风险。有充分证据表明，治疗持续时间可能比剂量更重要，而且停止治疗后这些作用会迅速消失。最后，与所有医疗干预措施一样，ERT或HRT必须针对每位患者进行个体化治疗。尽管实际的健康危害很少，但不良反应很常见，而且在开始这种治疗之前，必须始终考虑ERT和HRT对乳腺癌风险的负面影响这一充满情感且不断演变的问题。
