基于认知储备理论探讨异位妊娠急性应激对患者早期认知功能的损害及神经炎症机制OA

Objective:To explore the impact of acute stress on early cognitive function in patients with ectopic pregnancy(EP)based on the cognitive reserve theory,and to analyze the role of neuroinflammation in this process.Methods:A prospective cohort study was conducted in hospital from January in 2022 to December in 2023,included 98 EP patients(EP group)and 98 age-and education-matched healthy women(HC group).Acute stress levels,cognitive function,and serum neuroinflammatory markers(IL-1β,IL-6,TNF-α,HMGB1)were assessed preoperatively,at 7 days postoperatively,and at 3 months postoperatively in the EP group.Cognitive reserve was evaluated using an education-occupation composite index.Statistical analyses included repeated-measures ANOVA,correlation analysis,and multiple linear regression.Results:Preoperative stress physiological indicators and IES-R scores were significantly higher in the EP group than in the HC group(all P<0.01).Cognitive performance across all domains significantly declined at 7 days postoperatively compared to preoperative levels and the HC group(all P<0.01),with attention/processing speed and episodic memory most severely impaired.At 3 months postoperatively,partial recovery was observed,but attention/processing speed(DSST:52.89±9.12 vs.58.34±8.67)and episodic memory(RAVLT delayed recall:9.12±2.45 vs.10.45±2.34)remained below preoperative baseline(all P<0.05).Neuroinflammatory markers peaked at 7 days postoperatively,with IL-6,TNF-α,and HMGB1 levels remaining elevated at 3 months(all P<0.05).Correlation analysis showed that cognitive impairment at 7 days was positively correlated with preoperative cortisol(r=0.512)and postoperative HMGB1(r=0.634),and negatively correlated with cognitive reserve index(r=-0.421).Multiple regression indicated that HMGB1 at 7 days(β=-0.354,P<0.01)and cognitive reserve index(β=0.285,P<0.01)were significant predictors of attention function at 3 months.Patients with higher cognitive reserve exhibited milder inflammatory responses and better cognitive recovery.Conclusions:Acute stress in EP leads to early and widespread cognitive impairment,partially persisting up to 3 months postoperatively.Sustained neuroinflammation mediated by HMGB1 may be a key mechanism linking stress and cognitive dysfunction.Higher cognitive reserve appears to confer cerebral protection by modulating inflammatory responses and facilitating functional compensation.