保留卵巢的子宫切除术可能不能预防代谢综合征

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切除子宫, 即使卵巢不受影响, may place women at greater risk for a constellation of cardiovascular risk factors known as metabolic syndrome, 新的研究表明.

的 发现, presented last month at the 美国心脏协会's 科学会议 conference in Philadelphia, call into question the long-held belief that ovary-sparing hysterectomies could protect a woman from heart-related risks associated with removing the uterus. 的 research is considered preliminary until full 发现 are published in a peer-reviewed journal.

“接受子宫切除术的女性可能没有意识到她们有患心血管疾病的风险,资深研究员和心脏病专家Dr. 艾琳Michos, director of women's cardiovascular health research and an associate professor of medicine at Johns Hopkins School of Medicine in Baltimore. “他们可能需要更多的关注来检查他们的心脏健康, 即使卵巢被保留了下来."

据估计，美国约有2000万女性.S. 做过子宫切除手术吗. It is the leading gynecological procedure in the nation and is done to treat a variety of conditions, 比如卵巢, 子宫癌或子宫颈癌, 肌瘤, 子宫内膜异位, 或者阴道大量出血. 先前的研究与更年期提前有关, 是由子宫切除术引起的, 患心血管疾病的风险更高, 特别是中风.

为了防止额外的风险, 子宫可以切除，但卵巢不能切除, 然后继续产生雌激素和其他激素. Preserving the ovaries if a hysterectomy is performed during childbearing years had been thought to offer some protection from cardiovascular disease by delaying menopause. 但越来越多的研究对这一假设提出了质疑.

例如，a 2018年的研究 in Menopause found women 35 or younger who had ovary-sparing hysterectomies nonetheless faced a 4.心脏衰竭的风险增加了6倍.患心脏病的风险增加了5倍. But there is little data about the relationship between ovary-sparing hysterectomies and metabolic syndrome, a cluster of conditions that raises a person's risk for heart disease and stroke. 包括大腰围, 高血压, 高血糖, 高甘油三酯和低“好”高密度脂蛋白胆固醇. 当一个人至少有三种以上的症状时，就被诊断为代谢综合征.

在新的研究中, researchers looked at an ethnically diverse group of women from six locations across the U.S. – Baltimore; Chicago; Forsyth County, North Carolina; Los Angeles; St. Paul, Minnesota; and New York City. 3的一半多一点,367名女性, 谁的平均年龄是59岁, 说她们要么切除了子宫，要么切除了卵巢, 或两个. 超过10年的随访, researchers compared the women's risk for developing metabolic syndrome to that of women who had not had their uterus or ovaries removed.

整体, 有子宫的女性, ovaries 或两个 removed were more likely to develop metabolic syndrome than those without such histories. 仅切除子宫的女性的风险要高出52%, compared to a 38% greater risk for women who had both the uterus and ovaries removed.

患有代谢综合征的女性年龄较大, 更有可能超重, 少运动, more likely to have given birth to three or more children and more likely to be menopausal than those who did not develop metabolic syndrome. Those who had been on hormone therapy were less likely to develop metabolic syndrome.

"的re is a perception that ovary-sparing hysterectomies are safer for women's cardiovascular health,心脏病专家Dr. 拉克斯梅塔, who holds the Sarah Ross Soter endowed chair for women's cardiovascular health research at 的 Ohio State University Wexner Medical Center in Columbus. “病人被告知，‘我们会保留你的卵巢，以保护你的心脏.' But this study suggests that the idea that ovarian preservation is helping is not true.

“人们对女性的身体做出了决定, 我们需要确保我们有正确的数据来做出这些决定,梅赫塔说, 谁没有参与这项研究.

Why ovary-sparing hysterectomies may be contributing to cardiovascular risk remains unclear. Michos said it could be that having a hysterectomy reduces blood flow to the ovaries, 哪些会导致它们的功能出现问题.

"It is also possible that it is not the isolated surgical procedure that predisposes a woman to the higher risk for metabolic syndrome,首席研究员Dr. Eric Broni, a postdoctoral fellow in the division of maternal fetal medicine at the University of Pennsylvania in Philadelphia. 而, 他说, it could be that a woman already had risk factors for metabolic syndrome that simply weren't showing signs or causing symptoms yet. "Probably, these risk factors were unmasked and aggravated by the surgical procedure."

不管是什么原因, the 发现 suggest women who need hysterectomies should carefully consider their options and pay close attention to heart health risk factors, 梅塔说.

“不管女性做的是哪种类型的子宫切除术, she needs to stay on top of her cardiovascular risk factors prior to her surgery, 在她手术之后和她的余生,她说.

“无论是因果关系还是共同风险因素的结果，都存在联系. 这些女性应该进行良好的心血管筛查, 包括血压, 检查了血糖和血脂, 还有健康的生活方式,梅塔说.

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