Cumming R G, Mitchell P
Department of Public Health and Community Medicine, University of Sydney, Australia.
Am J Epidemiol. 1997 Feb 1;145(3):242-9. doi: 10.1093/oxfordjournals.aje.a009097.
The relation between estrogen (endogenous and exogenous) and cataract is unclear, with one large population-based study recently suggesting a protective effect of estrogen replacement therapy. The study reported in this paper, the Blue Mountains Eye Study, was conducted in Australia in 1992-1993 and involved 2,072 women aged 49-97 years. Subjects were recruited from a defined geographic area; the participation rate was 83 percent. Eye examination included photographs of the lens, which were graded for presence and severity of cortical, nuclear, and posterior subcapsular cataracts. Later age at menarche was associated with increased prevalence of all three types of cataract, but there were no associations with age at menopause, number of children, or use of the oral contraceptive pill. Among all women, there was no association between hormone replacement therapy and cataract. However, current users of hormone replacement therapy aged 65 years and over, among whom the duration of use was likely to have been longer than in younger current users, had lower prevalence of cortical cataract than did never users; the odds ratio adjusted for numerous potential confounders was 0.4 (95 percent confidence interval 0.2-0.8). The prevalence of posterior subcapsular cataract was increased in current users of hormone replacement therapy who had had a nonsurgical menopause; the adjusted odds ratio was 2.1 (95 percent confidence interval 1.1-4.1). The results of this study support the hypothesis that estrogen and/or progestin may be involved in cataract development. The effect of hormone replacement therapy on the lens needs to be evaluated in the laboratory and in further observational epidemiologic studies.
雌激素（内源性和外源性）与白内障之间的关系尚不清楚，最近一项基于大规模人群的研究表明雌激素替代疗法具有保护作用。本文所报道的研究，即蓝山眼研究，于1992年至1993年在澳大利亚开展，涉及2072名年龄在49至97岁之间的女性。研究对象从一个特定地理区域招募；参与率为83%。眼部检查包括晶状体照片，根据皮质性、核性和后囊下白内障的存在情况及严重程度进行分级。月经初潮年龄较晚与所有三种类型白内障的患病率增加相关，但与绝经年龄、子女数量或口服避孕药的使用无关。在所有女性中，激素替代疗法与白内障之间无关联。然而，65岁及以上的激素替代疗法当前使用者，其使用时间可能比年轻的当前使用者更长，其皮质性白内障的患病率低于从未使用者；经多种潜在混杂因素调整后的优势比为0.4（95%置信区间0.2 - 0.8）。在经历过非手术绝经的激素替代疗法当前使用者中，后囊下白内障的患病率有所增加；调整后的优势比为2.1（95%置信区间1.1 - 4.1）。本研究结果支持雌激素和/或孕激素可能参与白内障形成的假说。激素替代疗法对晶状体的影响需要在实验室和进一步的观察性流行病学研究中进行评估。
