Paganini-Hill A, Henderson V W
Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles 90031.
Am J Epidemiol. 1994 Aug 1;140(3):256-61. doi: 10.1093/oxfordjournals.aje.a117244.
The authors explored the possibility that estrogen loss associated with menopause may contribute to the development of Alzheimer's disease by using a case-control study nested within a prospective cohort study. The Leisure World Cohort includes 8,877 female residents of Leisure World Laguna Hills, a retirement community in southern California, who were first mailed a health survey in 1981. From the 2,529 female cohort members who died between 1981 and 1992, the authors identified 138 with Alzheimer's disease or other dementia diagnoses likely to represent Alzheimer's disease (senile dementia, dementia, or senility) mentioned on the death certificate. Four controls were individually matched by birth date (+/- 1 year) and death date (+1 year) to each case. The risk of Alzheimer's disease and related dementia was less in estrogen users relative to nonusers (odds ratio = 0.69, 95 percent confidence interval 0.46-1.03). The risk decreased significantly with increasing estrogen dose and with increasing duration of estrogen use. Risk was also associated with variables related to endogenous estrogen levels; it increased with increasing age at menarche and (although not statistically significant) decreased with increasing weight. This study suggests that the increased incidence of Alzheimer's disease in older women may be due to estrogen deficiency and that estrogen replacement therapy may be useful for preventing or delaying the onset of this dementia.
作者通过一项嵌套在前瞻性队列研究中的病例对照研究，探讨了与绝经相关的雌激素流失可能导致阿尔茨海默病发生的可能性。休闲世界队列包括加利福尼亚州南部一个退休社区——休闲世界拉古纳希尔斯的8877名女性居民，她们于1981年首次收到一份健康调查问卷。在1981年至1992年间死亡的2529名女性队列成员中，作者确定了138名患有阿尔茨海默病或其他可能代表阿尔茨海默病的痴呆诊断（死亡证明上提到的老年痴呆症、痴呆症或衰老）。每个病例按出生日期（±1年）和死亡日期（+1年）分别与4名对照进行匹配。与未使用雌激素的人相比，使用雌激素的人患阿尔茨海默病及相关痴呆症的风险较低（比值比=0.69，95%置信区间0.46-1.03）。风险随着雌激素剂量的增加和雌激素使用时间的延长而显著降低。风险还与内源性雌激素水平相关的变量有关；初潮年龄越大，风险越高，体重增加时风险降低（尽管无统计学意义）。这项研究表明，老年女性中阿尔茨海默病发病率的增加可能是由于雌激素缺乏，雌激素替代疗法可能有助于预防或延缓这种痴呆症的发作。
