Imtiaz Bushra, Tuppurainen Marjo, Tiihonen Miia, Kivipelto Miia, Soininen Hilkka, Hartikainen Sirpa, Tolppanen Anna-Maija
Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland.
Bone and Cartilage Research Unit, Clinical Research Center, University of Eastern Finland, Kuopio, Finland Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland.
J Alzheimers Dis. 2014;42(2):575-81. doi: 10.3233/JAD-140336.
Association between oophorectomy and/or hysterectomy and dementia in context of hormone therapy (HT) use is ambiguous.
To assess whether oophorectomy, hysterectomy, and hysterectomy with bilateral oophorectomy are related to risk of Alzheimer's disease (AD), whether the possible indication for surgery plays a role, and if the associations are modified by HT.
Our nationwide register based case-control (1 : 1) study included all women with clinically-verified AD diagnoses, residing in Finland on December 31, 2005 (n of cases = 19,043, n of controls = 19,043). AD cases, diagnosed according to NINCS-ADRDA and the DSM-IV criteria, were identified from Special Reimbursement Register. Information on HT use was collected from national prescription register, and data on surgery and uterine/ovarian/cervical cancer were obtained from the hospital discharge register. Most of the women (91.8%) were over 51 years of age when the surgery was performed.
Oophorectomy, hysterectomy, and hysterectomy with bilateral oophorectomy were associated with lower risk of AD (OR/95% CI: 0.85/0.75-0.97, 0.89/0.81-0.97 and 0.85/0.75-0.98, respectively) among women without the history of uterine/ovarian/cervical cancer, although the absolute risk difference was small. The association was not evident in women with uterine/ovarian/cervical cancer history (3.00/0.20-44.87 for all surgeries). The associations were not modified by HT use, which was independently associated with AD risk, with longer use showing protective association.
Our findings indicate that oophorectomy with or without hysterectomy after commencement of natural menopause is not an important determinant of AD risk in older age and support the critical window hypothesis for HT use.
在激素疗法（HT）使用的背景下，卵巢切除术和/或子宫切除术与痴呆之间的关联尚不明确。
评估卵巢切除术、子宫切除术以及双侧卵巢切除的子宫切除术是否与阿尔茨海默病（AD）风险相关，手术的可能指征是否起作用，以及这些关联是否会因HT而改变。
我们基于全国登记的病例对照（1:1）研究纳入了所有在2005年12月31日居住在芬兰且临床确诊为AD的女性（病例数 = 19,043，对照数 = 19,043）。根据NINCS - ADRDA和DSM - IV标准诊断的AD病例从特殊报销登记中识别出来。HT使用信息从国家处方登记中收集，手术以及子宫/卵巢/宫颈癌的数据从医院出院登记中获取。大多数女性（91.8%）在进行手术时年龄超过51岁。
在没有子宫/卵巢/宫颈癌病史的女性中，卵巢切除术、子宫切除术以及双侧卵巢切除的子宫切除术与较低的AD风险相关（OR/95%CI分别为：0.85/0.75 - 0.97、0.89/0.81 - 0.97和0.85/0.75 - 0.98），尽管绝对风险差异较小。在有子宫/卵巢/宫颈癌病史的女性中这种关联不明显（所有手术的OR为3.00/0.20 - 44.87）。这些关联未因HT使用而改变，HT使用独立与AD风险相关，使用时间越长显示出保护关联。
我们的研究结果表明，自然绝经后进行或未进行子宫切除术的卵巢切除术并非老年AD风险的重要决定因素，并支持HT使用的关键窗口期假说。
