Breitner J C, Gau B A, Welsh K A, Plassman B L, McDonald W M, Helms M J, Anthony J C
Department of Psychiatry, Duke University Medical Center, Durham, NC 27710.
Neurology. 1994 Feb;44(2):227-32. doi: 10.1212/wnl.44.2.227.
We conducted a co-twin control study among 50 elderly twin pairs with onsets of Alzheimer's disease (AD) separated by 3 or more years. Twenty-three male pairs (46%) were screened from the (U.S.) National Academy of Sciences-National Research Council Registry (NAS-NRC Registry) of World War II veteran twins; others (mostly women) had responded to advertisements or were referred from AD clinics. Twenty-six pairs (52%) were monozygous. The onset of AD was inversely associated with prior use of corticosteroids or ACTH (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.06 to 0.95; p = 0.04). Similar but weaker trends were present among pairs discordant for history of arthritis or for prior daily use of nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin. The association was strongest when we combined use of steroids/ACTH or NSAIDs post hoc into a single variable of anti-inflammatory drugs (AIs) (OR, 0.24; CI, 0.07 to 0.74; p = 0.01). The inverse relation was strong in female (volunteer) twin pairs but was not present in the younger men from the NAS-NRC Registry. AIs had typically been taken for arthritis or related conditions, but a similar result was apparent after controlling statistically for the arthritis variable (OR, 0.08; CI, 0.01 to 0.69; p = 0.02). AIs have been proposed as a means of retarding the progression of AD symptoms, and these data suggest that AIs may also prevent or delay the initial onset of AD symptoms. Because of limitations in the case-control method, our results require corroboration with hypothesis-driven research designed to control bias and confounding.
我们对50对老年双胞胎进行了一项共双胞胎对照研究，这些双胞胎患阿尔茨海默病（AD）的发病时间间隔为3年或更长时间。23对男性双胞胎（46%）是从（美国）国家科学院 - 国家研究委员会二战退伍军人双胞胎登记处（NAS - NRC登记处）筛选出来的；其他双胞胎（大多为女性）是对广告做出回应或由AD诊所转诊而来。26对（52%）是同卵双胞胎。AD的发病与先前使用皮质类固醇或促肾上腺皮质激素（ACTH）呈负相关（优势比[OR]，0.25；95%置信区间[CI]，0.06至0.95；p = 0.04）。在关节炎病史或先前每日使用非甾体抗炎药（NSAIDs）或阿司匹林不一致的双胞胎对中，也存在类似但较弱的趋势。当我们将类固醇/ACTH或NSAIDs的使用事后合并为一个抗炎药物（AIs）单一变量时，这种关联最为强烈（OR，0.24；CI，0.07至0.74；p = 0.01）。这种负相关在女性（志愿者）双胞胎对中很强，但在NAS - NRC登记处的年轻男性中不存在。AIs通常用于治疗关节炎或相关病症，但在对关节炎变量进行统计学控制后，类似结果仍然明显（OR，0.08；CI，0.01至0.69；p = 0.02）。AIs已被提议作为延缓AD症状进展的一种方法，这些数据表明AIs也可能预防或延迟AD症状的初始发作。由于病例对照方法存在局限性，我们的结果需要通过旨在控制偏差和混杂因素的假设驱动研究来证实。
