女性接受更年期激素治疗不会增加痴呆风险
英国诺丁汉大学Yana Vinogradova团队研究了使用更年期激素治疗与痴呆风险之间的相关性。相关研究成果于2021年9月30日发表于《英国医学杂志》上。
为了评估不同类型和持续时间的更年期激素治疗导致痴呆的风险，研究组使用英国临床实践研究数据链（CPRD），利用住院、死亡率和社会剥夺数据的所有链接，进行了一项双嵌套的病例对照研究。
研究组招募了118501名年龄在55岁及以上的女性，1998至2020年期间被初步诊断为痴呆症，按年龄、一般实践和索引日期匹配至497416名对照女性。主要结局为从一般实践、死亡率和医院记录中诊断的痴呆症；经人口统计学、吸烟状况、饮酒、共病、家族史和其他处方调整的更年期激素治疗的优势比。
总体来说，16291名（14%）被诊断为痴呆症的女性和68726名（14%）对照组女性在指数日期前三年以上使用过更年期激素治疗。没有观察到与绝经期激素治疗相关的痴呆风险增加。在年龄小于80岁且仅服用雌激素治疗10年及以上的病例和对照组中，发现痴呆症的总体风险降低，校正后的优势比为0.85。在使用雌激素-孕激素治疗5-9年和10年或更长时间的女性中，发现患阿尔茨海默病的风险增加。这分别相当于每10万人-年中增加5例和7例 。研究组还提供了所研究的具体孕激素的详细风险关联。
这项研究对不同时间接受不同类型更年期激素治疗的女性患痴呆和阿尔茨海默病的风险进行了估计，结果显示总体上并没有增加患痴呆症的风险。
附：英文原文
Title: Use of menopausal hormone therapy and risk of dementia: nested case-control studies using QResearch and CPRD databases
Author: Yana Vinogradova, Tom Dening, Julia Hippisley-Cox, Lauren Taylor, Michael Moore, Carol Coupland
Issue&Volume: 2021/09/30
Abstract:
Objective To assess the risks of developing dementia associated with different types and durations of menopausal hormone therapy.
Design Two nested case-control studies.
Setting UK general practices contributing to QResearch or the Clinical Practice Research Datalink (CPRD), using all links to hospital, mortality, and social deprivation data.
Participants 118501 women aged 55 and older with a primary diagnosis of dementia between 1998 and 2020, matched by age, general practice, and index date to 497416 female controls.
Main outcome measures Dementia diagnoses from general practice, mortality, and hospital records; odds ratios for menopausal hormone treatments adjusted for demographics, smoking status, alcohol consumption, comorbidities, family history, and other prescribed drugs.
Results Overall, 16291 (14%) women with a diagnosis of dementia and 68726 (14%) controls had used menopausal hormone therapy more than three years before the index date. Overall, no increased risks of developing dementia associated with menopausal hormone therapy were observed. A decreased global risk of dementia was found among cases and controls younger than 80 years who had been taking oestrogen-only therapy for 10 years or more (adjusted odds ratio 0.85, 95% confidence interval 0.76 to 0.94). Increased risks of developing specifically Alzheimer’s disease were found among women who had used oestrogen-progestogen therapy for between five and nine years (1.11, 1.04 to 1.20) and for 10 years or more (1.19, 1.06 to 1.33). This was equivalent to, respectively, five and seven extra cases per 10000 woman years. Detailed risk associations for the specific progestogens studied are also provided.
Conclusion This study gives estimates for risks of developing dementia and Alzheimer’s disease in women exposed to different types of menopausal hormone therapy for different durations and has shown no increased risks of developing dementia overall. It has shown a slightly increased risk of developing Alzheimer’s disease among long term users of oestrogen-progestogen therapies.
DOI: 10.1136/bmj.n2182
Source: https://www.bmj.com/content/374/bmj.n2182