阿茲海默氏症之女性荷爾蒙治療

The Role of Estrogen in the Treatment of Alzheimer’s Disease

女性荷爾蒙動情激素的使用對更年期及更年期後的婦女有許多益處，在醫學上早已有許多研究證實其可減輕更年期的生理及心理的不適症狀，降低心血管疾病的發生率和預防骨質疏鬆症的發生等。但有關動情激素在智能及阿茲海默氏症方面的作用則尚未有定論。雖然動物實驗中發現動情激素可經由改變神經傳導物質、刺激神經突觸的生長、增加腦血流等機轉來改善智能的表現，但在流行病學及臨床研究上有關動情激素與智能關係的研究結果則尚不一致。經由資料整合分析後的數據顯示動情激素可能可降低罹患阿茲海默氏症的危險性。至於將動情激素用於阿茲海默氏症之治療效果上，則尚未有大規模研究的成果發表。幾個小型且無安慰劑做控制組的研究顯示動情激素對阿茲海默氏症的治療似有效果，但我們在台北榮總所做的研究卻未見明顯的效果。動情激素是否可用來預防或治療阿茲海默氏症還需等待大規模研究的成果出爐才能有定論。

Estrogen replacement therapy is widely used among postmenopausal women to relieve the symptoms of postmenopausal syndrome, to prevent osteoporosis, and to reduce the risk of cardiovascular diseases. However, the role of estrogen in prevention or treatment of Alzheimer’s disease(AD) is still inconclusive. Some animal studies have found that estrogen might improve cognitive performance through several mechanisms, including stimulation of neurite outgrowth, modulation of neurotransmitters, and improving cerebral perfusion. However, the results of clinical investigations in the prevention or treatment of AD patient with estrogen are inconsistent. Some studies reported that women who received estrogen had a lower risk in development of AD, but others not. Meta-analysis of these studies suggests a 29% decreased the risk of developing dementia among estrogen users. Several small non-blind and non-randomized estrogen trials revealed that estrogen improved cognitive and psychological symptoms in female AD patients. However, our estrogen trial conducted in Taipei Veterans General Hospital did not disclose significant benefit effect in AD patients. Large randomized trial of estrogen therapy is needed to evaluate the role of estrogen in the treatment of AD.