The relationship between gender-related diffrenoe in immune response and DHEA following surgical stress

目的：探讨大手术后循环性激素和炎性细胞因子水平是否存在性别差异。方法：对29例因胃癌行胃切除术的患者（男，n = 21，女，n = 8）、42例因结直肠癌行结直肠手术的患者（男，n = 26，女，n = 16）和21例因食管癌行胸腹手术的患者（男，n = 17，女，n = 4）进行循环17β-雌二醇、睾酮、脱氢表雄酮和炎症因子的测定。结果：女性组出现严重并发症的比例明显低于男性组。男性组炎性细胞因子和CRP水平明显高于女性组。术后并发症男性组17β-雌二醇/睾酮比值明显高于对照组。男性术后并发症组与对照组DHEA水平无差异。手术后，循环脂联素水平下降，瘦素水平上升。脂联素和瘦素水平的变化与17β-雌二醇-睾酮比和睾酮水平显著相关。结论：性激素调控下的脂肪细胞功能障碍可能导致大手术后并发症的发生。这些结果已经在外科相关会议上公布。提交了两篇原创论文“脂肪细胞功能下降是结直肠癌手术后感染的危险因素”和“术前给药类固醇减少了重大手术创伤后免疫反应的性别差异”。

Object : To determine whether gender differences are observed in circulating sex hormone and inflammatory cytokine levels following major surgery.Method : Twenty-nine patients (male ; n = 21, female ; n = 8) who underwent gastrectomy for gastric cancer, 42 patients (male ; n = 26, female ; n = 16) who underwent colorectal surgery for colorectal cancer, and 21 patients (male ; n = 17, female ; n = 4) who underwent thoracic-abdominal surgery for esophageal cancer were measured the circulating 17β-estradial, testosterone, DHEA and inflammatory cytokines.Results : The percentage of patients in female group who had severe complications was significantly lower than the corresponding percentage of the male group. Inflammatory cytokines and CRP levels in male group increased significantly compared to the female group. The 17β-estradiol-to-testostrone ratio in the postoperative complication of male group was significantly higher in the control male group. There were no differences in DHEA levels between the postoperative complication and control groups in male.After surgery, the circulating adiponectin levels decreased and leptin levels increased. The alteration of adiponectin and leptin levels were significantly correlated with the 17β-estradiol-to-testostrone ratio and testosterone levels.Conclusion : Our data revealed that the adipocyte dysfunction under the regulation of sex hormones might develop postoperative complications after major surgery.These results were already presented in the surgical-related meeting. Two original papers "Depressed adipocyte function is a risk factor for postoperative infection following colorectal cancer surgery" and "Gender-related difference in immune responses following major surgical trauma are diminished by preoperative steroid administration" were submitted.