Tang M X, Jacobs D, Stern Y, Marder K, Schofield P, Gurland B, Andrews H, Mayeux R
Gertrude H Serglevsky Center, Columbia University, New York, NY 10032, USA.
Lancet. 1996 Aug 17;348(9025):429-32. doi: 10.1016/S0140-6736(96)03356-9.
Oestrogen use by postmenopausal women has many health benefits, but findings on the effect of oestrogen in Alzheimer's disease are conflicting. Oestrogen promotes the growth and survival of cholinergic neurons and could decrease cerebral amyloid deposition, both of which may delay the onset or prevent Alzheimer's disease. To investigate whether use of oestrogen during the postmenopausal period affects the risk of Alzheimer's disease, we studied 1124 elderly women who were initially free of Alzheimer's disease, Parkinson's disease, and stroke, and who were taking part in a longitudinal study of ageing and health in a New York City community.
Relative risks and age-at-onset distributions were calculated from simple and adjusted Cox proportional hazards models. Standard annual clinical assessments and criterion-based diagnoses were used in follow-up (range 1-5 years).
Overall, 156 (12.5%) women reported taking oestrogen after onset of menopause. The age at onset of Alzheimer's disease was significantly later in women who had taken oestrogen than in those who did not and the relative risk of the disease was significantly reduced (9/156 [5.8%] oestrogen users vs 158/968 [16.3%] nonusers; 0.40 [95% Cl 0.22-0.85], p < 0.01), even after adjustment for differences in education, ethnic origin, and apolipoprotein-E genotype. Women who had used oestrogen for longer than 1 year had a greater reduction in risk; none of 23 women who were taking oestrogen at study enrolment has developed Alzheimer's disease.
Oestrogen use in postmenopausal women may delay the onset and decrease the risk of Alzheimer's disease. Prospective studies are needed to establish the dose and duration of oestrogen required to provide this benefit and to assess its safety in elderly postmenopausal women.
绝经后女性使用雌激素对健康有诸多益处，但关于雌激素对阿尔茨海默病影响的研究结果相互矛盾。雌激素可促进胆碱能神经元的生长和存活，并可能减少脑淀粉样蛋白沉积，这两者都可能延迟阿尔茨海默病的发病或预防该病。为了研究绝经后使用雌激素是否会影响患阿尔茨海默病的风险，我们对1124名老年女性进行了研究，这些女性最初没有患阿尔茨海默病、帕金森病和中风，她们参与了纽约市一个社区的衰老与健康纵向研究。
从简单和校正的Cox比例风险模型计算相对风险和发病年龄分布。随访期间（1 - 5年）采用标准年度临床评估和基于标准的诊断。
总体而言，156名（12.5%）女性报告在绝经后开始使用雌激素。使用雌激素的女性患阿尔茨海默病的发病年龄明显晚于未使用雌激素的女性，且该病的相对风险显著降低（9/156 [5.8%] 使用雌激素者 vs 158/968 [16.3%] 未使用者；0.40 [95% Cl 0.22 - 0.85]，p < 0.01），即使在对教育程度、种族和载脂蛋白E基因型的差异进行校正之后也是如此。使用雌激素超过1年的女性风险降低幅度更大；研究入组时正在使用雌激素的23名女性中无人患阿尔茨海默病。
绝经后女性使用雌激素可能会延迟阿尔茨海默病的发病并降低其风险。需要进行前瞻性研究以确定提供这种益处所需的雌激素剂量和持续时间，并评估其在老年绝经后女性中的安全性。
