绝经后会发生什么？（WHAM）：一项关于绝经前降低风险双侧输卵管卵巢切除术后24个月认知情况的前瞻性对照研究。
What happens after menopause? (WHAM): A prospective controlled study of cognition 24 months after premenopausal risk-reducing salpingo-oophorectomy.
作者信息
Maki Pauline M, Rubin Leah H, Krejany Efrosinia O, Brand Alison, Hickey Martha
机构信息
Departments of Psychiatry, Psychology, and Obstetrics and Gynecology, University of Illinois Chicago, Chicago, IL, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Neurology, Psychiatry and Behavioral Sciences, and Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Gynecol Oncol. 2025 Feb;193:141-147. doi: 10.1016/j.ygyno.2025.01.008. Epub 2025 Jan 28.
OBJECTIVE
Women with BRCA1/2 pathogenic variants considering risk-reducing bilateral oophorectomy (RRSO) may be concerned about potential effects of surgical menopause on cognition. Whether RRSO affects cognition and whether hormone therapy (HT) modifies this effect remains uncertain. This study aimed to prospectively measure the effect of premenopausal RRSO on cognition and the modifying effects of HT up to 24 months.
METHODS
The design was a prospective, multisite (4 sites in Australia), 24-month observational study. Participants were premenopausal BRCA1/2 carriers (n = 83) planning RRSO referred from gynecology-oncology and familial cancer centers and a premenopausal comparison group (n = 98) not planning oophorectomy or pregnancy who self-referred. Baseline data were collected within 8 weeks of eligibility screening, and RRSO was scheduled between baseline and 3 months. Of 687 screened, 181 were analysed. Cognitive performance (verbal learning and memory, psychomotor speed, fluency) was assessed at baseline, 3, 12 and 24 months with the a priori outcomes of verbal learning and memory.
RESULTS
After RRSO, 65 % initiated HT. In multivariable models of group differences in cognitive performance over time, RRSO and comparison groups showed similar performance improvements except for verbal learning. The RRSO group showed a small, statistically significant lower improvement in verbal learning vs comparisons, after adjustment for HT and other factors (p = 0.03). After RRSO, verbal learning was higher in HT users vs non-users (p = 0.04).
CONCLUSIONS AND RELEVANCE
Over 24 months RRSO minimally impacted cognition except for a small adverse effect on verbal learning, partly offset by HT.
TRIAL REGISTRATION
Australian and New Zealand Clinical Trials Registry (anzctr.org.au); Identifier #: ACTRN12615000082505; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363554&isReview=true.
目的
考虑行降低风险的双侧卵巢切除术（RRSO）的携带BRCA1/2致病变异的女性可能会担心手术绝经对认知的潜在影响。RRSO是否会影响认知以及激素疗法（HT）是否会改变这种影响仍不确定。本研究旨在前瞻性地测量绝经前RRSO对认知的影响以及HT长达24个月的调节作用。
方法
该设计为一项前瞻性、多中心（澳大利亚4个地点）、为期个月的观察性研究。参与者为绝经前BRCA1/2携带者（n = 83），她们是从妇科肿瘤学和家族癌症中心转诊来计划行RRSO的，以及一个绝经前对照组（n = 98），该组未计划行卵巢切除术或怀孕，是自我转诊的。在符合条件的筛查后8周内收集基线数据，RRSO安排在基线和3个月之间进行。在687名筛查者中，对181名进行了分析。在基线、3个月、12个月和24个月时评估认知表现（言语学习和记忆、精神运动速度、流畅性），将言语学习和记忆作为先验结果。
结果
RRSO后，65%的人开始使用HT。在认知表现随时间变化的组间差异的多变量模型中，RRSO组和对照组除言语学习外表现出相似的改善。在调整HT和其他因素后，RRSO组在言语学习方面的改善与对照组相比有小幅但具有统计学意义的降低（p = 0.03）。RRSO后，使用HT的人在言语学习方面高于未使用者（p = 0.04）。
结论及相关性
在24个月内，RRSO对认知的影响极小，除了对言语学习有轻微不良影响，HT可部分抵消这种影响。
试验注册
澳大利亚和新西兰临床试验注册中心（anzctr.org.au）；标识符#：ACTRN12615000082505；网址：https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363554&isReview=true 。 24
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