10月21日，《新英格兰医学杂志》发表了英国伊丽莎白女王医院学校的William Stewart团队的一项新成果，他们研究了前职业足球运动员的神经退行性疾病死亡率。

据悉，参加接触性运动的优秀运动员往往存在神经退行性疾病。前职业足球运动员神经退行性疾病的发病率尚未明确。

研究组进行了一项回顾性的研究，对7676名前职业足球运动员（苏格兰球员数据库）和23028名普通人群对照组（性别、年龄、社会剥夺程度均与球员匹配）的神经退行性疾病死亡率和用于治疗痴呆症的药物进行比较。

18年间，1180名前足球运动员（15.4%）死亡，对照组为3807名（16.5%）。70岁以前，前运动员的全因死亡率低于对照组，但在70岁之后却高于对照组。前运动员的缺血性心脏病死亡率和肺癌死亡率均显著低于对照组。前足球运动员中神经退行性疾病为主要原因的死亡率为1.7%，显著高于对照组（0.5%）。

因神经退行性疾病而死亡的前运动员中，其死亡证明上各疾病亚型差异较大，其中阿尔兹海默病死亡率最高，帕金森病最低，但均显著高于对照组。与对照组相比，前运动员服用老年痴呆症相关药物更频繁。守门员和外场球员间神经退行性疾病所致死亡率没有显著差异，但守门员更少服用痴呆相关药物。

在这项回顾性的流行病学分析中，苏格兰前职业足球运动员的神经退行性疾病死亡率和服用痴呆相关药物的频率显著高于对照组，但其他常见疾病死亡率却显著低于对照组。该结论仍需在前瞻性配对队列试验中进行证实。

附：英文原文

Title: Neurodegenerative Disease Mortality among Former Professional Soccer Players

Author: Daniel F. Mackay, Ph.D., Emma R. Russell, M.Sc., Katy Stewart, Ph.D., John A. MacLean, M.B., Ch.B., Jill P. Pell, M.D., and William Stewart, M.B., Ch.B., Ph.D.

Issue&Volume: 2019-10-21

Abstract: 

BACKGROUND
Neurodegenerative disorders have been reported in elite athletes who participated in contact sports. The incidence of neurodegenerative disease among former professional soccer players has not been well characterized.

METHODS
We conducted a retrospective cohort study to compare mortality from neurodegenerative disease among 7676 former professional soccer players (identified from databases of Scottish players) with that among 23,028 controls from the general population who were matched to the players on the basis of sex, age, and degree of social deprivation. Causes of death were determined from death certificates. Data on medications dispensed for the treatment of dementia in the two cohorts were also compared. Prescription information was obtained from the national Prescribing Information System.

RESULTS
Over a median of 18 years, 1180 former soccer players (15.4%) and 3807 controls (16.5%) died. All-cause mortality was lower among former players than among controls up to the age of 70 years and was higher thereafter. Mortality from ischemic heart disease was lower among former players than among controls (hazard ratio, 0.80; 95% confidence interval [CI], 0.66 to 0.97; P=0.02), as was mortality from lung cancer (hazard ratio, 0.53; 95% CI, 0.40 to 0.70; P<0.001). Mortality with neurodegenerative disease listed as the primary cause was 1.7% among former soccer players and 0.5% among controls (subhazard ratio [the hazard ratio adjusted for competing risks of death from ischemic heart disease and death from any cancer], 3.45; 95% CI, 2.11 to 5.62; P<0.001). Among former players, mortality with neurodegenerative disease listed as the primary or a contributory cause on the death certificate varied according to disease subtype and was highest among those with Alzheimer’s disease (hazard ratio [former players vs. controls], 5.07; 95% CI, 2.92 to 8.82; P<0.001) and lowest among those with Parkinson’s disease (hazard ratio, 2.15; 95% CI, 1.17 to 3.96; P=0.01). Dementia-related medications were prescribed more frequently to former players than to controls (odds ratio, 4.90; 95% CI, 3.81 to 6.31; P<0.001). Mortality with neurodegenerative disease listed as the primary or a contributory cause did not differ significantly between goalkeepers and outfield players (hazard ratio, 0.73; 95% CI, 0.43 to 1.24; P=0.24), but dementia-related medications were prescribed less frequently to goalkeepers (odds ratio, 0.41; 95% CI, 0.19 to 0.89; P=0.02).

CONCLUSIONS
In this retrospective epidemiologic analysis, mortality from neurodegenerative disease was higher and mortality from other common diseases lower among former Scottish professional soccer players than among matched controls. Dementia-related medications were prescribed more frequently to former players than to controls. These observations need to be confirmed in prospective matched-cohort studies. 

DOI: 10.1056/NEJMoa1908483

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1908483