育龄期女性全子宫切除术后认知功能变化的前瞻性研究

Impact of total hysterectomy on cognitive function of women of reproductive age:a prospective study

目的探讨育龄期女性行全子宫切除术对认知功能的影响。方法选择2017年3月至2018年1月在东南大学附属中大医院妇科因子宫非恶性疾病行全子宫切除的育龄期女性患者58例为全子宫切除组;同期行单纯子宫肌瘤剔除的育龄期女性患者60例为对照组。在术前、术后1个月及术后1年时分别对两组患者进行认知功能评估[简易智能精神状态量表(MMSE)及蒙特利尔认知评估量表(MoCA)]、改良Kupperman绝经指数评分、血清抗米勒管激素(AMH)及脑源性神经营养因子(BDNF)的检测。结果MoCA量表评估下全子宫切除组术后1年时认知功能障碍发生率与对照组比较差异无统计学意义(χ^(2)=0.295,P=0.587);MMSE量表评估下两组均未出现认知功能障碍患者。全子宫切除组患者术后1年的绝经症状发生率显著高于对照组(P=0.006),也显著高于自身术后1个月(P=0.008)及术前(P=0.002)。全子宫切除组患者术后1年的血清AMH及BDNF水平均显著低于对照组(P<0.001);与术前相比,全子宫切除组患者的血清AMH及BDNF水平在术后1个月及术后1年时均进行性下降(P<0.001)。结论育龄期行全子宫切除的女性在术后1年认知功能尚未出现显著变化,但已出现了卵巢功能及神经营养因子的显著下降。

Objective To investigate the impact of total hysterectomy on cognitive function in women of reproductive age.Methods A total of 58 women of reproductive age,who underwent total hysterectomy for non-malignant diseases from March 2017 to January 2018 in the Department of Gynecology of Zhongda Hospital,Southeast University,were included as the total hysterectomy group,while 60 subjects who underwent myomectomy at the same time were included as control group.Questionnaire survey including Mini-Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA)and modified Kupperman menopausal index scoring were conducted before operation,1 month and 1 year after operation,and serum AMH and BDNF were assessed.Results(1)There was no statistically significant difference in the incidence of cognitive dysfunction between the control group and the total hysterectomy group at 1 year after operation as assessed by MoCA scale(P=0.587).There were no patients with cognitive impairment in the two groups assessed by MMSE scale.(2)Compared to the control group,the incidence of menopausal symptoms in the total hysterectomy group in 1 year after operation was significantly higher(P=0.006).Within the total hysterectomy group,the incidence of menopausal symptoms in 1 year after operation was significantly higher than that in 1 month after operation(P=0.008)and preoperation(P=0.002).(3)Serum AMH and BDNF levels in the total hysterectomy group was significantly lower than those in the control group at 1 year after operation(P<0.001).Within the total hysterectomy group,serum AMH and BDNF levels decreased progressively in 1 month after operation and 1 year after operation compared to those before operation(P<0.001).Conclusion There is no significant change in the cognitive function of the women of reproductive age who undergo total hysterectomy in 1 year after the operation;however;there are significant decreases in ovarian function and neurotrophic factor.