丹麦哥本哈根大学医院Nelsan Pourhadi团队研究了绝经期激素治疗和老年痴呆症的相关性。2023年6月28日出版的《英国医学杂志》发表了这项成果。

为了根据激素治疗的类型、使用时间和使用时的年龄，来评估更年期激素治疗的使用与痴呆症发展之间的关系，研究组通过丹麦国家登记册，进行了一项全国范围的嵌套病例对照研究。2000年至2018年间，50-60岁的所有丹麦女性中发现了5589例痴呆症发病病例和55890例年龄匹配的对照组，这些女性没有痴呆病史或更年期激素治疗禁忌症。主要结局为通过首次诊断或首次使用痴呆症特异性药物定义的全因痴呆症的95%置信区间校正后的风险比。

与从未接受过治疗的人相比，接受过雌激素-孕激素治疗的人患全因痴呆的比率增加（危险比1.24）。使用持续时间的增加产生了更高的危险比，从使用一年或一年以下的1.21增至使用12年以上的1.74不等。对于持续（1.31）和周期性（1.24）方案，雌激素-孕激素治疗与痴呆的发展呈正相关。在55岁及以下接受治疗的女性（1.24）中，这种关联仍然存在。仅限于晚发性痴呆症（1.21）和阿尔茨海默病（1.22（1.07至1.39））时，这种发现仍然存在。

研究结果表明，即使在55岁及以下接受治疗的女性中，更年期激素治疗也与全因痴呆症和阿尔茨海默病的发展呈正相关。持续治疗和周期性治疗的痴呆症发病率增加相似。需要进一步的研究来确定这些发现是否代表了更年期激素治疗对痴呆风险的实际影响，或者它们是否反映了需要这些治疗的女性的潜在倾向。

附：英文原文

Title: Menopausal hormone therapy and dementia: nationwide, nested case-control study

Author: Nelsan Pourhadi, Lina S Mrch, Ellen A Holm, Christian Torp-Pedersen, Amani Meaidi

Issue&Volume: 2023/06/28

Abstract:

Objectives To assess the association between use of menopausal hormone therapy and development of dementia according to type of hormone treatment, duration of use, and age at usage.

Design Nationwide, nested case-control study.

Setting Denmark through national registries.

Participants 5589 incident cases of dementia and 55890 age matched controls were identified between 2000 and 2018 from a population of all Danish women aged 50-60 years in 2000 with no history of dementia or contraindications for use of menopausal hormone therapy.

Main outcome measures Adjusted hazard ratios with 95% confidence intervals for all cause dementia defined by a first time diagnosis or first time use of dementia specific medication.

Results Compared with people who had never used treatment, people who had received oestrogen-progestogen therapy had an increased rate of all cause dementia (hazard ratio 1.24 (95% confidence interval 1.17 to 1.33)). Increasing durations of use yielded higher hazard ratios, ranging from 1.21 (1.09 to 1.35) for one year or less of use to 1.74 (1.45 to 2.10) for more than 12 years of use. Oestrogen-progestogen therapy was positively associated with development of dementia for both continuous (1.31 (1.18 to 1.46)) and cyclic (1.24 (1.13 to 1.35)) regimens. Associations persisted in women who received treatment at the age 55 years or younger (1.24 (1.11 to 1.40)). Findings persisted when restricted to late onset dementia (1.21 (1.12 to 1.30)) and Alzheimer’s disease (1.22 (1.07 to 1.39)).

Conclusions Menopausal hormone therapy was positively associated with development of all cause dementia and Alzheimer’s disease, even in women who received treatment at the age of 55 years or younger. The increased rate of dementia was similar between continuous and cyclic treatment. Further studies are warranted to determine whether these findings represent an actual effect of menopausal hormone therapy on dementia risk, or whether they reflect an underlying predisposition in women in need of these treatments.

DOI: 10.1136/bmj-2022-072770

Source: https://www.bmj.com/content/381/bmj-2022-072770