妇科癌症患者化疗后与认知功能障碍相关的研究

A Study of Chemotherapy-Related Cognitive Impairment in Gynecologic Cancer Patients

摘要: 目的：1) 分析妇科癌症患者化疗后的认知功能状态。2) 分析化疗后认知功能障碍差异程度的相关因素。方法：2009年至2011年，妇科病房53名妇科癌症患者(Group A)入选本研究，年龄为18岁至66岁，其中患宫颈癌22例，卵巢癌24例，及其他妇科癌症7例。其中接受TP方案辅助化疗47例，接受其他方案化疗6例。化疗病人分组,根据他们的年龄(pre-perimenopausal <45岁和post-perimenopausal期 ≥45岁)，教育水平(低教育不到9年的教育和高等教育超过9年的教育)，类型的癌症(宫颈癌、卵巢癌、其他癌症)，类型的化疗方案(TP方案,其他方案)。对照组分为两组，非化学疗法的患者(B组)和健康对照组(C组)。根据患者的化疗情况分成5个研究组，对照组分为2组。采用2个主观问卷调查(Everyday Memory Questionnaires及CAMDEX)和1个客观问题测试(Random Number Test)，根据问题答案对错计分，判断受试对象的认知功能受损情况。问题测试在患者未接受任何治疗前(T1)和患者接受两次或者以上化疗疗程后3~4周后(T2)进行测试。患者的测试结果与对照组进行比较。结果：1) 资料显示化疗患者比非化疗患者和健康对照组出现更多的认知问题。2) 在化疗前后自身对照研究中发现，化疗后认知功能障碍与化疗前的有统计学差异(p = 0.039)。3) 妇科癌症患者化疗后认知功能障碍，在围绝经前组和围绝经后组间，有统计学差异(p = 0.031)。4) 妇科癌症患者化疗后认知功能障碍，在文化程度高组和文化程度低组间，有统计学差异(p = 0.010)。5) 妇科癌症患者化疗后认知功能障碍，在宫颈癌组和卵巢癌组间，没有统计学差异(p = 0.304)。结论：1) 妇科癌症患者化疗后认知功能障碍与健康人组、非化疗病人组有统计学差异。2) 在化疗前后自身对照研究中发现，化疗后患者认知功能障碍与化疗前的有统计学差异。3) 妇科癌症患者化疗后认知功能障碍，在围绝经前组和围绝经后组间有统计学差异。4) 妇科癌症患者化疗后认知功能障碍，在文化程度高组和文化程度低组间有统计学差异。5) 妇科癌症患者TP方案化疗后认知功能障碍，在宫颈癌组和卵巢癌组间没有统计学差异。

Abstract: Objectives: 1) To evaluate post-chemotherapy cognitive functions in gynecology oncology patients; 2) To analyze the factors that influence memory impairment in those patients. Methods: The expe-rimental group (Group A) consisted of 53 patients admitted between year 2009-2011, with age ranging from 18 - 66 years old, suffering from cervical cancer (n = 22), ovarian cancer (n = 24), and other gynecologic cancer types grouped together (n = 7), treated with adjuvant TP regimen chemotherapy (n = 47) or other regimen chemotherapy grouped together (n = 6). The chemothe-rapy patients are grouped according to their age (pre-perimenopausal <45 years old and post-pe- rimenopausal period ≥45 years old), education level (lower educated of less than 9 years of edu-cation and higher educated of more than 9 years of education), types of cancer (cervical cancer, ovarian cancer, other cancer), types of chemotherapy regimen received (TP regimen, other regi-men). The control group is divided into 2 groups, non-chemotherapy patients (Group B) and heal- thy controls (Group C). According to patients’ chemotherapy is divided into five group, control group is divided into 2 groups. Using two subjective questionnaires (Everyday Memory Questionnaires and CAMDEX) and 1 objective problems Test (Random Number Test), right and wrong points according to the problem, determine subjects of cognitive function damage. Problems before test in patients who did not receive any treatment (T1) and patients received two or more than 3 to 4 weeks after chemotherapy regimen (T2) after the test. The patient test results comparing with control group. Results: 1) The data show that chemotherapy patients have more cognitive problems than chemotherapy patients and healthy controls. 2) Found in its own control study before and after chemotherapy, the cognitive dysfunction after chemotherapy and before chemotherapy is statistically significant (p = 0.039). 3) Gynecological cancer after chemotherapy in patients with cognitive dysfunction, and in the scarf premenopausal and postmenopausal group, has statistical difference (p = 0.031). 4) Gynecological cancer after chemotherapy in patients with cognitive dys-function, and in the cultural level between high and low degree of cultural groups, is statistically significant (p = 0.010). 5) Gynecological cancer after chemotherapy in patients with cognitive dys-function, between cervical cancer and ovarian cancer group, has no statistical difference (p = 0.304). Conclusions: 1) There was a statistically significant difference of cognitive impairment prevalence between chemotherapy patients and non-chemotherapy control groups. 2) Among chemotherapy patients participated in baseline cognitive assessment, there was a statistically significant difference in cognitive impairment prevalence between pre- and post-chemotherapy assessment. 3) Among chemotherapy patients, there was a statistically significant difference in cognitive impairment prevalence between pre-perimenopausal patients and post-perimenopausal patients. 4) Among chemotherapy patients, there was a statistically significant difference in cognitive impairment prevalence between lower educated patients and higher educated patients. 5) Among TP regimen chemotherapy patients, there was no statistically significant difference in cognitive impairment prevalence between ovarian cancer patients and cervical cancer patients.