基于庫欣病患者模型的長期高濃度皮質醇暴露對認知功能的影響及內鏡經蝶切除術療效分析

【中圖分類號】 R651 【文獻標志碼】 A 【文章編號】 1672-7770（2025）03-0271-07

Abstract： ObjectiveTo investigate the effects long-term high concentration cortisol exposure on cognitive function in patients with Cushing's disease（CD）and the efficacy endoscopic transsphenoidal resection. MethodsA total 1O7 first-time CD patients admitted to the Department Neurosurgery， Hospital from January 2O17 to September 2024， as well as 84 age，gender，and education matched healthy controls were included prospectively.All patients received standard surgical treatment. Cognitive function was meticulously evaluated preoperatively and at three months postoperatively using the minimum mental state examination （MMSE） and Montreal cognitive assessment（ MoCA） scales by independent assessors，comparing the cognitive improvements between the groups. ResultsPatients with CD exhibited lower scores on both MMSE and MoCA assessments compared to the health group， particularly in memory， attention and calculation，recall，and language abilities. Following surgery，which alleviated the high cortisol levels，there was a significant enhancement in cognitive function among CD patients. Postoperatively，patients demonstrated increased scores on both MMSE and MoCA，as well as improved performance in all assessed cognitive domains，with notable advancements in memory， attention and calculation，recall，and language.Conclusions Long-term high concentration cortisol exposure significantly impairs cognitive function，and endoscopic transsphenoidal surgery to mitigate this exposure can lead to substantial cognitive improvements.

Key words： Cushing's disease； cognitive function； transsphenoidal surgery

皮質醇作為應激反應中的關鍵激素，在調節(jié)生理和心理應激反應中扮演著至關重要的角色。它影響神經遞質的釋放、細胞信號傳導以及神經營養(yǎng)因子的表達，對維持認知功能至關重要。隨著年齡的增長和慢性生活壓力的累積，下丘腦-垂體-腎上腺（hypothalamic-pituitary-adrenal，HPA）軸可能會失調，導致機體持續(xù)分泌高水平的皮質醇。這種狀態(tài)超出了正常生理范圍，可能誘發(fā)大腦慢性炎癥和神經毒性，損害正常的人腦結構和功能，導致認知功能減退，甚至可能進展為阿爾茨海默癥[1-3]。臨床前研究表明長期高濃度皮質醇暴露與海馬體萎縮、神經元損傷以及神經發(fā)生減少有關，這些都是認知功能下降的潛在機制[4]。因此，了解長期高濃度皮質醇對認知功能的影響，對于制定有效的預防和干預措施具有重要意義。目前，缺乏成熟的慢性應激模型來全面模擬人腦在長期壓力下的反應。CD患者由于HPA軸的異常激活，皮質醇持續(xù)處于高水平狀態(tài)，是一個內源性皮質醇增高的理想人體模型，這為我們提供了一個獨特的機會來探索慢性應激過度激活HPA軸對認知功能的長期影響。本研究前瞻性納入解放軍總醫(yī)院神經外科2017年1月—2024年9月收治的107例初次發(fā)病的庫欣病（Cushingdisease，CD）患者作為研究模型，通過在評估手術前及手術后3個月患者認知功能的變化，探討長期高濃度皮質醇暴露對人腦認知功能的影響，以及手術解除高濃度皮質醇暴露之后認知功能的潛在恢復能力[5-7]。……