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題名 | 荷爾蒙補充療法和停經婦女認知功能=Hormone Replacement Therapy and Cognitive Function |
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作者 | 黃鈞平; 洪啟宗; 黃奕燦; | 書刊名 | Acta Neurologica Taiwanica |
卷期 | 15:4 民95.12 |
頁次 | 頁273-277 |
分類號 | 418.276 |
關鍵詞 | 荷爾蒙補充療法; 失智症; 輕度認知功能障礙; 阿茲海默症; Hormone replacement therapy; Women's health initiative; Women's health initiative memory study; Mild cognitive impairment; Alzheimer's disease; |
語文 | 中文(Chinese) |
中文摘要 | 觀察性研究指出賀爾蒙補充療法可以改善認知功能,但是隨機臨床試驗報告卻不多又得不到結論。WHIMS (Women's Health Initiative Memory Study)是多中心、隨機雙盲臨床試驗,美國國家衛生研究院主導之婦女健康關懷WHI (Women's Health Initiative hormone therapy trials)的一部分研究計劃,主要比較和評估停經婦女單獨使用雌激素或結合雌激素和黃體素治療是否能降低所有原因的失智症和輕度認知功能障礙試驗。研究以65歲以上停經婦女為對象,分為二分支:其中一支是有子宮的停經婦女共4,532名,使用結合雌激素和黃體素治療或給予安慰劑;另外一支是無子宮的停經婦女共2,947名,單獨使用雌激素治療或給予安慰劑。結果顯示,雌激素單獨或合併使用黃體素不但不能預防失智症或降低認知功能。反而大體上會增加失智症和認知功能降低的危險。將雌激素單獨或合併使用黃體素之資料一起分析時,可能失智症總危險性增高76%(危險比,1.76;95%信賴區間,1.19-2.60;P=.005)。賀爾蒙補充療法不應處方給予65歲以上更年期婦女,來改善認知功能或預防失智症。WHIMS之結果是否可延伸適用於65歲以下停經婦女尚不清楚,因此我們建議將WHIMS之結果警告較年青的停經婦女。但是要認知在這些較年青的停經婦女失智症的絕對危險性很低,同時賀爾蒙補充療法臨床利大於弊。 |
英文摘要 | Observational studies have suggested that postmenopausal hormone replacement therapy (HRT) may improve cognitive function, but data from randomized clinical trials have been sparse and inconclusive. The effects of HRT on dementia and mild cognitive impairment were assessed in a subgroup of participants in the Women's Health Initiative Memory Study (WHIMS) (a multicenter, randomized, double-blind, placebo-controlled clinical trial). There were two study arms, one involved 4,532 postmenopausal women who received continuous combined estrogen (conjugated equine estrogens [CEE] plus medroxyprogesterone acetate [MPA]) or placebo, and the other involved 2,947 hysterectomized women randomized to continuous unopposed CEE or placebo. All participants were aged 65 years or older. CEE with or without MPA did not protect against (but substantially increased the risk of) dementia of any cause or cognitive decline. Incidence of probable dementia in the estrogen-alone trial was statistically similar to that in the estrogen plus progestin trial. When data from both trials were pooled, the overall risk for probable dementia was increased by 76% (HR, 1.76; 95% CI, 1.19 to 2.60; P = 0.005). A second report from WHIMS suggested that cognitive decline in women aged 65 years and older was greater in those receiving hormone therapy than in those receiving placebo (HR, 1.25; 95% CI, 0.97-1.60). The WHIMS results clearly indicate that CEE with or without MPA should not be used to prevent dementia or enhance cognition in women older than 65 years. |
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