Does gender difference influence outcome?
Does gender difference influence outcome?
复制标题
DOI：
10.1097/00005373-200211000-00013
复制
发表时间：
2002-11-01
影响因子：
--
通讯作者：
Miller, PR
中科院分区：
文献类型：
--
作者：
Croce, MA;Fabian, TC;Miller, PR
背景资料：最近的实验室研究表明，免疫反应在雄性和雌性啮齿动物之间存在差异，一些临床研究表明败血症的发病率和死亡率存在性别差异。这些差异出现是因为有害的睾酮和有益的雌激素效应;已建议对男性受试者进行睾酮阻断和/或雌激素给药的临床试验。我们评估了性别对创伤patients.Methods的各种结果的影响：创伤患者超过52个月的时间内确定的创伤登记。排除了早期死亡。结局包括死亡率、肺炎（支气管肺泡灌洗液中大于或等于10（5）个菌落形成单位/mL）、急性呼吸窘迫综合征、菌血症、呼吸机天数、重症监护室和住院时间。患者按损伤机制、性别、年龄（假设小于或等于40岁的女性为绝经前，大于50岁的女性为绝经后）和损伤严重程度分层。其中男性12 756人（73%），女性4 833人（27%）。在性别和年龄组方面，穿透伤后的结局无差异。在损伤严重度评分16 - 24组中，小于或等于40的女性生存率更高，但这些患者的损伤程度在统计学上较轻。总体而言，男性往往有更多的感染并发症，但女性在感染面前的生存率较低。逻辑回归并未将性别视为死亡率的独立预测因素。结论：尽管在亚组分析中女性具有生存优势，但死亡率没有总体差异。然而，患肺炎的妇女的死亡率高于男子。进一步了解潜在的机制是必要的激素操纵研究之前。
Background: Recent laboratory studies have demonstrated that immune responses differ between male and female rodents, and some clinical studies have suggested gender differences regarding incidence and mortality from sepsis. The differences appear because of both deleterious testosterone and beneficial estrogen effects; clinical trials of testosterone blockage and/or estrogen administration for male subjects have been suggested. We evaluated the effect of gender on various outcomes in trauma patients.Methods: Trauma patients over a 52-month period were identified from the trauma registry. Early deaths were excluded. Outcomes included mortality, pneumonia (greater than or equal to 10(5) colony-forming units/mL in bronchoalveolar lavage effluent), acute respiratory distress syndrome, bacteremia, ventilator days, and intensive care unit and hospital length of stay. Patients were stratified by injury mechanism, gender, age (assuming women less than or equal to 40 were premenopausal and those > 50 were postmenopausal), and injury severity.Results: There were 18,133 patients identified, and 544 were excluded because of early death. There were 12,756 (73%) men and 4,833 (27%) women. There were no outcome differences after penetrating injury with respect to gender and age group. There was a survival advantage for women less than or equal to 40 in the Injury Severity Score 16 to 24 group, but these patients had statistically less severe injury. Overall, men tended to have more infectious complications, but women had lower survival in the face of infection. Logistic regression did not identify gender as an independent predictor of mortality.Conclusion: Although there was a survival advantage for women in subgroup analysis, there was no overall difference in mortality. Women with pneumonia, however, had a higher mortality than men. Further understanding of potential mechanisms is necessary before hormonal manipulation studies.