首發(fā)圍絕經(jīng)期抑郁癥病人血清雌激素水平動態(tài)變化及其與認知功能的相關(guān)性

蘇曉云 賀繼平 張曉宇 張麗娜 楊芯雨

基金項目 2022年度呂梁市科學計劃項目，編號：2022SHFZ25

作者簡介 蘇曉云，副教授，碩士，E?mail：694137579@qq.com

引用信息 蘇曉云，賀繼平，張曉宇，等.首發(fā)圍絕經(jīng)期抑郁癥病人血清雌激素水平動態(tài)變化及其與認知功能的相關(guān)性[J].護理研究，2024，38（13）：2302?2310.

Dynamic changes in serum oestrogen levels and their association with cognitive function in patients with first perimenopausal depression

SU Xiaoyun， HE Jiping， ZHANG Xiaoyu， ZHANG Li'na， YANG Xinyu

Fenyang College of Shanxi Medical University， Shanxi 032200 China

Corresponding Author? SU Xiaoyun， E?mail：694137579@qq.com

Abstract? Objective：To investigate the dynamic changes of serum oestrogen levels in patients with first?episode perimenopausal depression （PMD） and their correlation with cognitive function.Methods：127 patients with first?episode PMD who visited Shanxi Fenyang Hospital? from December 2021 to December 2022 were selected to be included in the PMD group，and 200 perimenopausal women who underwent a physical examination at our hospital during the same period were selected to be included in the control group.General information was collected and levels of sex hormones （oestrone （E1），oestradiol（E2），serum prolactin （PRL）），follicle?stimulating hormone （FSH），and luteinising hormone （LH），and norepinephrine （NE），dopamine （DA），brain?derived neurotrophic factor （BDNF），and 5?hydroxytryptophan （5?HT） were measured in both groups at the time of visit；sex hormone and neurotransmitter levels were measured at different time points （at the time of consultation，3 months，6 months and 12 months after consultation） and cognitive function was assessed using the Montreal Cognitive Assessment Scale（MoCA） in the PMD group；sex hormone and neurotransmitter levels were analysed in relation to cognitive function using pearson's correlation；and risk factors affecting PMD were analysed using either unifactorial or multifactorial logistic regression equations；patients were divided into a cognitively impaired group （n=94） and a cognitively normal group （n=33） based on their MoCA scores at 12 months after the consultation，and clinical data and serological indices were compared between the two groups； the risk factors analysed using multifactorial logistic regression modelling.Results：The levels of E1，E2，NE，DA，BDNF，and 5?HT in the PMD group were significantly lower than those in the control group（P<0.05）；and the levels of PRL，F(xiàn)SH，and LH in the women in the PMD group were significantly higher than those in the control group（P<0.05）.With the increase of time，the levels of E1，E2，NE，DA，BDNF，and 5?HT in PMD patients showed a trend of gradual decrease，and there was a significant difference in the comparison between time points （P<0.05）；with the increase of time， the levels of PRL，F(xiàn)SH，and LH in patients in the PMD group showed a trend of gradual increase，and there was a significant difference in the comparison between time points （P<0.05）.After gradual exclusion of confounders with covariance，there was still an independent correlation between hormone indicators and the risk of cognitive impairment in patients with PMD （all P<0.001）.Conclusion：Different levels of sex hormones and neurotransmitter factors all affect the occurrence of PMD，and there is a certain correlation between the level of cognitive functioning and sex hormones and neurotransmitter factors of perimenopausal women. Sex hormone dynamic level monitoring can be carried out on perimenopausal women in order to intervene in PMD at an earlier stage.

Keywords??? perimenopausal depression， PMD；estrogen；cognitive function；influencing factors；investigation and research

摘要? 目的：探究首發(fā)圍絕經(jīng)期抑郁癥病人血清雌激素水平動態(tài)變化及其與認知功能的相關(guān)性。方法：選取2021年12月—2022年12月于山西省汾陽醫(yī)院就診的首發(fā)圍絕經(jīng)期抑郁癥病人127例納入圍絕經(jīng)期抑郁癥組，選取同期于我院進行體檢的200名圍絕經(jīng)期婦女納入對照組。收集兩組女性的一般資料，并于就診時和就診后3個月、6個月及12個月檢測兩組性激素［雌酮（E1）、雌二醇（E2）、血清催乳素（PRL）、卵泡刺激素（FSH）和黃體生成素（LH）］、神經(jīng)遞質(zhì)因子［去甲腎上腺素（NE）、多巴胺（DA）、腦源性神經(jīng)營養(yǎng)因子（BDNF）和5?羥色胺（5?HT）］水平；并使用蒙特利爾認知評估量表（MoCA）評估病人的認知功能，根據(jù)病人就診后12個月認知功能評分將病人分為認知障礙組（n=94）和認知正常組（n=33），比較兩組病人臨床資料與血清學指標，并使用多因素Logistic回歸模型分析認知功能的影響因素。結(jié)果：圍絕經(jīng)期抑郁癥組婦女E1、E2、NE、DA、BDNF、5?HT水平低于對照組（P<0.05），PRL、FSH、LH水平高于對照組（P<0.05）。隨時間進展，圍絕經(jīng)期抑郁癥病人E1、E2、NE、DA、BDNF、5?HT水平呈現(xiàn)逐漸降低趨勢，且各時間點間比較差異有統(tǒng)計學意義（P<0.05）；隨時間進展，圍絕經(jīng)期抑郁癥組病人PRL、FSH、LH水平呈現(xiàn)逐漸上升趨勢，且各時間點間比較差異有統(tǒng)計學意義（P<0.05）。逐步排除混雜因素后，激素指標與圍絕經(jīng)期抑郁癥病人認知障礙風險仍有相關(guān)性（P<0.001）。結(jié)論：不同性激素及神經(jīng)遞質(zhì)因子水平會影響圍絕經(jīng)期抑郁癥的發(fā)生，且圍絕經(jīng)期婦女認知功能與性激素、神經(jīng)遞質(zhì)因子水平有一定的相關(guān)性，建議對圍絕經(jīng)期婦女進行性激素動態(tài)水平監(jiān)測，以對圍絕經(jīng)期抑郁癥進行早期干預(yù)。

關(guān)鍵詞? 圍絕經(jīng)期抑郁癥；雌激素；認知功能；影響因素；調(diào)查研究

doi：10.12102/j.issn.1009-6493.2024.13.008

當女性處于圍絕經(jīng)期時，卵巢功能逐年衰減，導(dǎo)致女性雌激素分泌減少，嚴重者會造成女性器官或組織發(fā)生退行性病變，最終導(dǎo)致圍絕經(jīng)期綜合征（perimenopausal syndrome，PMS）[1?2]。圍絕經(jīng)期抑郁癥（perimenopausal depression，PMD）是PMS常見的心理癥狀之一，通常指在女性卵巢功能發(fā)生衰退至女性絕經(jīng)后1年內(nèi)，病人出現(xiàn)對事物毫無興趣、情緒抑郁及不思飲食，并持續(xù)性存在[3?4]。……