Bindl Lutz, Buderus Stephan, Dahlem Peter, Demirakca Sueha, Goldner Martin, Huth Ralf, Kohl Martina, Krause Martin, Kühl Peter, Lasch Peter, Lewandowski Klaus, Merz Ulrich, Moeller Jens, Mohamad Yehya, Peters Mark, Porz Wolfgang, Vierzig Anne, Rüchard Jochen, Scharf Jochem, Varnholt Verena
University Childrens Hospital, Adenauerallee 119, 53113 Bonn, Germany.
Intensive Care Med. 2003 Oct;29(10):1770-3. doi: 10.1007/s00134-003-1948-z. Epub 2003 Aug 15.
Male gender predisposes to severe sepsis and septic shock. This effect has been ascribed to higher levels of testosterone. The ESPNIC ARDS database was searched, to determine if there was evidence of a similar male preponderance in severe sepsis in prepubertal patients in spite of low levels of male sex hormones at this age. A total of 72 patients beyond neonatal age up to 8 years of age with sepsis were identified. The male/female (M/F) ratio was 1.7 (1.0;2.7) and differed significantly from non-septic ARDS patients in this age group [n = 209; M/F = 1.0 (0.8;1.3)]. The highest M/F-ratio was observed in the first year of life. The gender-ratio was the same as reported in adult patients with sepsis. In infants between 1 month and 12 months of age, the ratio was 2.8 (1.2;6.1) (Chi2= 5.6; P< 0.01), in children from 1 year to 8 years of age it was 1.2 (0.7;2.2) (n.s.). In a subgroup of patients with severe sepsis or septic shock, caused by other bacteria than Neisseria meningitidis, the M/F-ratio was 2.1 (1.2;3.6) (Chi2= 4.9; P<0.05), while in patients with meningococcal sepsis (n=20) the M/F-ratio was 1.0 (0.4;2.3). In prepubertal ARDS patients with sepsis an increased frequency of male patients is found, comparable to adults. No male preponderance exists in patients with ARDS due to meningococcal septic shock. Since levels of testosterone and other sex hormones are extremely low at this age, we conclude that factors others than testosterone are involved in the male preponderance in severe sepsis.
男性更容易发生严重脓毒症和脓毒性休克。这种影响被认为与较高水平的睾酮有关。检索ESPNIC急性呼吸窘迫综合征（ARDS）数据库，以确定尽管青春期前患者的男性性激素水平较低，但在严重脓毒症中是否存在类似的男性优势证据。共确定了72例新生儿期以上至8岁患有脓毒症的患者。男性/女性（M/F）比例为1.7（1.0；2.7），与该年龄组的非脓毒症ARDS患者有显著差异[n = 209；M/F = 1.0（0.8；1.3）]。在生命的第一年观察到最高的M/F比例。性别比例与成年脓毒症患者的报告相同。在1个月至12个月大的婴儿中，该比例为2.8（1.2；6.1）（卡方= 5.6；P<0.01），在1岁至8岁的儿童中为1.2（0.7；2.2）（无统计学意义）。在由脑膜炎奈瑟菌以外的其他细菌引起的严重脓毒症或脓毒性休克患者亚组中，M/F比例为2.1（1.2；3.6）（卡方= 4.9；P<0.05），而在脑膜炎球菌脓毒症患者（n = 20）中，M/F比例为1.0（0.4；2.3）。在患有脓毒症的青春期前ARDS患者中，男性患者的频率增加，与成年人相当。因脑膜炎球菌脓毒性休克导致ARDS的患者不存在男性优势。由于这个年龄段的睾酮和其他性激素水平极低，我们得出结论，除睾酮外的其他因素与严重脓毒症中的男性优势有关。
