手术对认知功能无影响：丹麦中年双胞胎的纵向研究。

No impact of surgery on cognitive function: a longitudinal study of middle-aged Danish twins.

机构信息

The Unit of Epidemiology, Biostatistics and Biodemography, Danish Twin Registry, Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense C, Denmark.

出版信息

Ann Epidemiol. 2018 Feb;28(2):95-101.e1. doi: 10.1016/j.annepidem.2017.12.004. Epub 2017 Dec 19.

DOI:10.1016/j.annepidem.2017.12.004

PMID:29277552

Abstract

PURPOSE

To examine the association between exposure to surgery and 10-year change in cognitive functioning.

METHODS

Among 2351 middle-aged twins, a 10-year change in composite cognitive scores derived from five cognitive tests was compared between 903 (38%) twins exposed to surgery classified as major, minor, knee and hip replacement, and other, and a reference group of 1448 (62%) twins without surgery, using linear regression models adjusted for socioeconomic factors. Genetic and shared environmental confounding was addressed in intrapair analyses of 48 monozygotic and 74 dizygotic same-sexed twin pairs.

RESULTS

In individual-level analyses, twins with major surgery (mean difference, -0.37; 95% CI, -0.76 to 0.02) or knee and hip replacement surgery (mean difference, -0.54; 95% CI, -1.30 to 0.22) had a tendency of a negligibly higher rate of decline in cognitive score than the reference group. In the intrapair analyses, the surgery-exposed twin had a higher rate of cognitive decline than the co-twin in 55% (95% CI, 45% to 63%) of the pairs. The mean difference in cognitive decline within pairs was -0.21 (95% CI, -0.81 to 0.39).

CONCLUSIONS

No significant associations were found between exposure to surgery and change in cognitive score either in individual-level or in intrapair analyses.

摘要

目的

探讨手术暴露与认知功能 10 年变化之间的关系。

方法

在 2351 对中年双胞胎中，比较了暴露于手术（分为主要手术、小手术、膝关节和髋关节置换术及其他手术）的 903 对（38%）双胞胎与未接受手术的 1448 对（62%）双胞胎在 5 项认知测试组成的综合认知评分上的 10 年变化，使用线性回归模型调整了社会经济因素。在 48 对同卵双胞胎和 74 对异卵双胞胎的同对子内分析中，解决了遗传和共同环境混杂的问题。

结果

在个体水平分析中，主要手术（平均差异，-0.37；95%CI，-0.76 至 0.02）或膝关节和髋关节置换手术（平均差异，-0.54；95%CI，-1.30 至 0.22）的双胞胎认知评分下降速度略快于对照组。在同对子内分析中，55%（95%CI，45%至 63%）的对子中，手术暴露的双胞胎认知下降速度快于同胞。对子内认知下降的平均差异为-0.21（95%CI，-0.81 至 0.39）。