最大限度雄激素阻断治疗后前列腺癌患者的认知功能状况及其影响因素分析

Analysis of cognitive function and its influenced factors in patients with prostate cancer aftermaximalanOrogen blockade therapy

目的探讨最大限度雄激素阻断治疗后前列腺癌患者认知功能状况及其影响因素，为早期制定预防策略提供新思路。方法2013年1月至2015年10月采用蒙特利尔认知功能评估表（MoCA）、医院焦虑抑郁量表（HAD）、社会支持评定量表（SSRS）及自行设计的调查问卷对56例接受最大限度雄激素阻断（maximaandrogenblockade，MAB）治疗≥6个月和37例接受根治性前列腺切除术治疗的前列腺癌患者进行认知功能测试及各项观察指标收集，以MoCA评分26分为界，分为认知功能障碍组40例，正常组53例，对两组患者的各项观察指标进行比较，对不同治疗方式患者的认知功能变化情况进行分析，对影响患者认知功能状况的因素应用多因素Logistic回归分析进行筛选。结果认知功能障碍组与正常组在接受MAB治疗比例[80．0％（32／40）vs．45．3％（24／53）]、年龄（73．7岁VS．62．6岁）、独居状况[32．5％（13／40）vs．13．2％（7／53）]、抑郁症状[87．5％（35／40）VS．62．3％（33／53）]、社会支持水平（32．5分vs．41．1分）和睾酮降低者比例[95．0％（38／40）vs．45．3％（24／53）]等方面差异有统计学意义（P〈0．05）。MAB组与根治性手术组相比，睾酮水平[（0．27±0．15）nmoL／LV8．（12．14±1．86）nmol／L]，视空间与执行功能[（4．18±0．79）分vs．（4．54±0．56）分]、注意[（4．73±0．99）分vs．（5．16±0．79）分]、延迟记忆[（3．75±1．21）分vs．（4．30±1．05）分]评分及MoCA总分[（26．13±1．48）分vs．（27．27±1．39）分]上差异有统计学意义（P〈0。05）。多因素回归分析结果显示，年龄（OR=1．183，95％C1l-135＋1．223）、抑郁症状（OR=1．092，95％CI1．047—1．149）、社会支持水平（OR=0．897，95％C10．838—0．956）、睾酮水平（OR=2．105，95％CI1．369～4．083）是认知功能障碍的影响因素。结论MAB治疗6个月后前列腺癌患者的认知功能障碍发生率较高，年龄、抑郁症状、社会支持水平和睾酮水平与认知功能障碍的发生有关。

Objective To investigate the cognitive function of patients with prostate cancer after maximal androgen blockade therapy and its influenced factors, and to provide a new way for early prevention strategy. Methods Montreal cognitive assessment （MoCA）, hospital anxiety depression scale （HAD）, social support rating scale （SSRS） and self-designed questionnaire were used in 56 cases treated with maximum androgen blockade therapy for more than six months and 37 cases who underwent radical prostatectomy treatment to evaluate their cognitive function and collect the observation indexes between January 2013 and October 2015. Based on MoCA score, all patients were divided into cognitive dysfunction group （n =40） and normal cognitive function group （n =53）. The observation indexes in two goups were compared and cognitive function with different treatment in two groups were analyzed. The changes on the influencing factors of cognitive function in patients were filtered using multivariable logistic regression analysis. Results In the cognitive dysfunction group and normal group, the proportion of MAB treatment was 80.0% （32/40） vs. 45.3 % （24/53）. the are was 73.7 vs. 73.7 years, the uronortion of solitary was32. 5% （13/40） vs. 13.2% （7/53）, the proportion of depressive symptoms was 87.5% （35/40） vs. 62. 3% （33/53）, the social support level was 32. 5 vs. 41.1 and the proportion of testosterone decreased was 95.0% （38/40） vs. 45.3% （24/53）. All events showed statistically significant differences （ P 〈 0. 05）. Compared MAB treatment group with radical surgical treatment group, the testosterone level was （0. 27 ± 0. 15 ） vs. （ 12. 14 ± 1.86） nmol/L, visual space and executive function score was 4. 18 ± 0. 79 vs. 4. 54 ±0. 56, attention score was 4. 73 ＋0. 99 vs. 5. 16 ±0. 79, delayed memory score was 3.75 ± 1. 21 vs. 4. 30 ±1.05 and MoCA score was 26. 13± 1.48 vs. 27.27 ± 1.39, which all showed the statistically significant difference （P 〈 0. 05 ）. The results of multiple regression analysis showed that age （ OR = 1. 183, 95 % CI 1. 135-1. 223）, depressive symptoms （OR = 1. 092, 95 % C1 1. 047±1. 149）, social support （OR = 0. 897, 95% CI 0. 838±0. 956 ）, testosterone （ OR = 2. 105, 95% CI 1. 369±4. 083 ） were the influenced factors of cognitive dysfunction. Conclusions The incidence of cognitive dysfunction in patients with prostate cancer after maximal androgen blockade therapy more than six months was higher than others. Age, depression, social support level and testosterone levels were related to the occurrence of cognitive dysfunction.