阿尔茨海默病患者性激素水平变化及其意义

背景女性阿尔茨海默病(Alzheimer disease,AD)的患病率较男性明显增高,雌激素替代治疗可预防和/或延缓AD的发生,因此推测AD的发病与雌激素缺乏有一定的关系.目的探讨AD患者血清性激素,特别是雌激素水平的变化及其意义.设计11病例-对照研究.地点和对象实验地点为西安交通大学第一医院神经内科.所有研究对象均来源于西安地区老年期痴呆患病率调查人群中确诊的AD患者和健康老年人.AD组27例,平均年龄(71.9±10.8)岁,男9例,女18例.对照组严格按照11配对的原则,选择与AD患者同性别,年龄相差小于3岁、同等文化程度、同一居住地,没有认知损害和精神症状的27例健康老人作为对照.干预两组均在清晨空腹800～900采集静脉血3 mL,用放射免疫法测定性激素.主要观察指标血清性激素水平(包括血清促卵泡生成素、促黄体生成素、泌乳素、孕酮、睾酮和雌二醇).血清雌二醇水平与AD患者痴呆的严重程度及简明精神状态检查表(MMSE)分值的相关性.结果血清促卵泡生成素、促黄体生成素、泌乳素、孕酮、睾酮水平在两组间比较差异没有显著性意义(P＞0.05);AD组血清雌二醇水平(119.54±44.15)μg/L]比对照组(154.55±63.62)μg/L]明显低(t=2.756,P＜0.05);血清雌二醇水平与AD患者痴呆的严重程度呈正相关(r=0.412,P=0.013);在AD组,血清雌二醇水平与MMSE分值呈正相关(r=0.59,P=0.25),但无统计学意义的相关关系.结论雌激素水平降低可能是AD发病的危险因素之一.

Variation and significance of sex hormone levels in Alzheimer's disease patients

BACKGROUND: The incidence of Alzheimer' s disease(AD) obviously increases in females than in males. Estrogen replacement can prevent and /or delay AD onset. Therefore, it can be presumed that AD onset has a certain relationship with the deficiency of estrogen.OBJECTIVE: To discuss the variation and significance of serum sex hormone levels, especially estrogen levels in AD patients.DESIGN: A case-control study at a ratio of 1: 1.SETTING and PARTICIPANTS: The study was completed in Neurology Department of the First Affiliated Hospital of Xi' an Jiaotong University. AD patients and healthy elderly from the population of the survey of the incidence of elderly dementia in Xi'an area were enrolled. There were 27 cases in AD group with a mean age of(71.9 ± 10. 8) years old, in which there were 9males and 18 females. There were 27 healthy elders in control group, which were selected strictly according to 1:1 matching policy of same sex, age difference less than 3 years old, same education background, same residences, no cognitive damage and psychiatric symptoms.INTERVENTIONS: 3 mL of venous bloods were drawn at 8.00 - 9.00a. m. with empty stomach in both groups. Sex hormones were assayed by radioimmunology.MAIN OUTCOME MEASURES: Serum sex hormone levels were measured, including serum follicle-stimulating hormone (FSH), luteinizint hormone(LH), prolactin(PRL), progesterone(P), testosterone(T), and estradiol(E2) . The correlations between serum estradiol level and the severity of AD were analyzed, as well as between serum estradiol level and scores of mini-mental state examination(MMSE).RESULTS: There were no significant differences in the levels of serum FSH,LH, PRL, P and T between the two groups( P ＞ 0. 05). The serum E2 level in the AD group (119.54 ± 44. 15) μg/L] was significantly lower than that of the control group (154.55 ± 63.62) μg/L, t = 2. 756, P ＜ 0. 05] . There was a significant positive correlation between serum E2 level and the severity of AD ( r = 0. 412, P = 0. 013 ). In the AD group, the serum level of E2 was positively correlated with MMSE scores ( r = 0. 59, P = 0. 25) but without statistical significance.CONCLUSION: The decrease of estrogen level may be one of the risk factor in AD onset.