Lenhardt R, Hopf H W, Marker E, Akça O, Kurz A, Scheuenstuhl H, Sessler D I
Department of Anesthesia and General Intensive Care, University of Vienna, Austria.
Arch Surg. 2000 Jan;135(1):71-4. doi: 10.1001/archsurg.135.1.71.
Women deposit more collagen after major abdominal surgery than men.
A post hoc analysis of data obtained from 2 prospective, randomized, double-blind clinical trials.
University hospital general surgical service.
One hundred sixteen patients undergoing colon resection.
Protein and hydroxyproline (collagen) deposition during the first 7 postoperative days in expanded polytetrafluoroethylene implants positioned subcutaneously.
On univariate analysis, men and women deposited comparable amounts of collagen (257 +/- 120 vs 281 +/- 117 ng/mm, respectively). When potential confounding factors were entered into a generalized mixed-effects model, only the interaction between age and sex was a significant factor (P = .047). Collagen deposition decreased with age in men, being 317 +/- 133 ng/mm in men younger than 45 years, but only 238 +/- 113 ng/mm in those older than 45 years (P = .03). In contrast, collagen deposition was virtually identical in women younger than 45 years (280 +/- 133 ng/mm) and in those older than 45 years (281 +/- 110 ng/mm). Only 3 of these women were receiving hormone replacement therapy.
Collagen deposition after surgery decreased significantly with age in men, while remaining unchanged in women. Younger men and women deposited similar amounts of collagen. Therefore, older men made less collagen after surgery than older women, perhaps explaining the consistent observation that wound dehiscence is twice as common in men than in women. Our results differ from previous studies conducted in healthy, nonsurgical volunteers, which showed that (1) young women made significantly more collagen than young men and (2) collagen deposition was reduced in postmenopausal women, but deposition returned to premenopausal values with hormone replacement therapy. Differences between our results and those reported previously likely stem from the populations studied. In particular, multiple perioperative factors decrease collagen deposition, which apparently obscures the differences observed previously in healthy, unstressed volunteers.
腹部大手术后女性比男性沉积更多的胶原蛋白。
对从2项前瞻性、随机、双盲临床试验获得的数据进行事后分析。
大学医院普通外科。
116例行结肠切除术的患者。
术后第1个7天内皮下放置的膨体聚四氟乙烯植入物中蛋白质和羟脯氨酸（胶原蛋白）的沉积情况。
单因素分析显示，男性和女性沉积的胶原蛋白量相当（分别为257±120 ng/mm和281±117 ng/mm）。当将潜在的混杂因素纳入广义混合效应模型时，只有年龄与性别的相互作用是一个显著因素（P = 0.047）。男性的胶原蛋白沉积随年龄增长而减少，45岁以下男性为317±133 ng/mm，而45岁以上男性仅为238±113 ng/mm（P = 0.03）。相比之下，45岁以下女性（280±133 ng/mm）和45岁以上女性（281±110 ng/mm）的胶原蛋白沉积几乎相同。这些女性中只有3人接受激素替代疗法。
手术后胶原蛋白沉积在男性中随年龄显著下降，而在女性中保持不变。年轻男性和女性沉积的胶原蛋白量相似。因此，老年男性术后产生的胶原蛋白比老年女性少，这可能解释了一直以来观察到的伤口裂开在男性中比女性中常见两倍的现象。我们的结果与之前在健康非手术志愿者中进行的研究不同，之前的研究表明：（1）年轻女性产生的胶原蛋白明显多于年轻男性；（2）绝经后女性的胶原蛋白沉积减少，但激素替代疗法可使沉积恢复到绝经前水平。我们的结果与之前报道的结果之间的差异可能源于所研究的人群。特别是，多种围手术期因素会减少胶原蛋白沉积，这显然掩盖了之前在健康、无压力的志愿者中观察到的差异。
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