女性生育因素对主、客观认知功能的影响：基于平阴队列的横断面分析
he Association between Female Reproductive Factors and Subjective and Objective Cognitive Function：a Cross-sectional Analysis from the Pingyin Cohort
背景 目前关于生育因素与认知功能的研究结论尚不一致，且缺少有关女性生育因素与主观认知功能 的研究。目的 探究女性生育因素与主、客观认知功能的关联，为认知功能下降及痴呆症的早期预防和干预提供理论 依据。方法 于2023年7月在济南市平阴县3个乡镇以多阶段整群随机抽样法抽取45~70岁的中老年人进行调研， 最终获得有效样本2 165例。一般信息问卷为自行编制，收集社会人口统计学信息、既往病史、生活方式、女性生育 因素等信息。分别采用主观认知下降自测量表（SCD-Q9）和蒙特利尔认知评估基础量表（MoCA-B）测量研究对象的 主、客观认知功能。通过人体测量获得身高、体质量等信息，通过血液检测获得研究对象的载脂蛋白 e4（APOE e4） 等位基因分型。采用多因素 Logistic 回归探讨女性生育因素对主、客观认知功能的影响。采用局部加权回归（Loess） 分析女性初潮年龄、绝经年龄、生育期长度与 MoCA-B 得分的非线性关联。结果 纳入女性 1 044 人，其中 SCD-Q9 得分异常率为 48.37%（505/1 044），MoCA-B 得分异常率为 67.43%（704/1 044）。多因素 Logistic 回归分析结果显示， 生育 3 个及以上的女性比生育 1 个及以下的女性主观认知下降的风险更低（OR=0.59，95%CI=0.36~0.98）；母乳喂养 时长 18 岁（OR=1.91，95%CI=1.09~3.35）、绝经年龄≤ 45 岁（OR=1.61，95%CI=1.00~2.62）、生育期 >40 年（OR=1.56， 95%CI=1.07~2.29）或≤30年（OR=2.22，95%CI=1.05~4.72）均与较差的客观认知功能有关（P<0.05）。经 Loess 分析， 可见初潮年龄、绝经年龄以及生育期长度与 MoCA-B 得分之间近似呈倒“J”型关系。结论 子女数量较少（≤1个）、 较短母乳喂养时长（18岁、早绝经（≤45岁）、生育期过长或 过短均与较差的客观认知功能有关。应关注女性生育因素对认知功能的影响，以延缓认知功能下降的进程。
Background The association between female reproductive factors and cognitive function was unclear there still lack studies on female reproductive factors and subjective cognitive function. Objective Exploring the relationship between female reproductive factors and subjective or objective cognitive functionand providing theoretical basis for the prevention and intervention of cognitive decline and dementia. Methods The baseline survey was conducted in July 2023 in PinyinJinanin three townships. After using a multi-stage cluster random sampling method2 165 valid participants aged 45~70 were recruited at baseline. We collected sociodemographic datamedical historieslifestyle factorsand female reproductive factors through a self-designed comprehensive questionnaire. The subjective and objective cognitive function of participants were evaluated by the Subjective Cognitive Decline-Questionnaire 9SCD-Q9 and Montreal Cognitive Assessment Scale-BasicMoCA-Brespectively. In additionwe also collected anthropometric dataincluded height and weight and blood samplesto get APOE e4 alleles. Multivariate Logistic regression and Local weighted regressionLoess were used to analyze the influence of female reproductive factors on cognitive function and to detect potential nonlinear relationships between age at menarcheage at menopauselength of reproductive period and MoCA-B scores. Results A total of 1 044 women were included in this study. The prevalence of abnormal SCD-Q9 scores was 48.37%505/1 044while the prevalence of abnormal MoCA-B scores was 67.43%704/1 044. Women who had 3 or more children had a lower risk of subjective cognitive decline compared with those who had 1 or fewer childrenOR=0.5995%CI=0.36-0.98. Women with a breastfeeding duration18 yearsOR=1.9195%CI=1.09-3.35age at menopause 45 yearsOR=1.6195%CI=1.00-2.62and reproductive period >40 yearsOR=1.5695%CI=1.07-2.29 or 30 years OR=2.2295%CI=1.05-4.72 were all associated with poorer objective cognitive functionP<0.05. Loess analysis revealed an inverted "J-shaped" relationship between age at menarcheage at menopausereproductive period and MoCA-B scores. Conclusion Women with fewer children 1 and shorter breastfeeding duration18 yearsearly menopause 45 yearsand excessively long or short reproductive periods are all associated with poorer objective cognitive function. We should pay attention to the influence of female reproductive factors on cognitive function in order to delay the process of cognitive decline.
王琪、于瑞洪、李美玲、朱东山、王晓祎、付春迎
10.12114/j.issn.1007-9572.2024.0213
妇产科学神经病学、精神病学预防医学
女性生育因素认知功能主观认知功能客观认知功能横断面研究
王琪,于瑞洪,李美玲,朱东山,王晓祎,付春迎.女性生育因素对主、客观认知功能的影响：基于平阴队列的横断面分析[EB/OL].(2024-08-30)[2025-05-24].https://chinaxiv.org/abs/202408.00273.点此复制
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