Slewa-Younan S, van den Berg S, Baguley I J, Nott M, Cameron I D
Rehabilitation Studies Unit, Faculty of Medicine, University of Sydney, NSW 2006, Australia.
J Neurol Neurosurg Psychiatry. 2008 Nov;79(11):1197-201. doi: 10.1136/jnnp.2008.147983.
A clear understanding of the impact sex differences play in clinical traumatic brain injury (TBI) outcome remains elusive. Animal research suggests that females have better functional outcomes following TBI than males. Therefore, this paper aims to systematically review all studies that have examined sex differences in functional outcome measures following moderate to severe TBI in humans. It was predicted that women would exhibit better functional outcome than men.
A predefined study selection criteria was adopted to screen studies eligible for inclusion. A comprehensive and systematic search of various databases, up to the end of April 2007, was undertaken. Two independent reviewers screened studies for eligibility. Selected studies were assessed for methodological quality.
13 studies were included. Because of the heterogeneity of the functional outcome measures and lack of appropriate statistical information, a qualitative analysis was performed. More than half of the papers were considered high quality. Strong evidence was found to suggest that women do not have better functional outcome than men following moderate to severe TBI.
The results of this review are contrary to the suggestions from animal literature. Consideration of factors such as the woman patient's hormonal status at the time of injury and other sources of heterogeneity such as age and injury severity should be addressed in future prospective studies.
对于性别差异在临床创伤性脑损伤（TBI）预后中所起的作用，目前仍缺乏清晰的认识。动物研究表明，创伤性脑损伤后雌性动物的功能预后优于雄性。因此，本文旨在系统回顾所有研究人类中重度创伤性脑损伤后功能预后指标性别差异的研究。研究预测女性的功能预后将优于男性。
采用预先设定的研究选择标准筛选符合纳入条件的研究。截至2007年4月底，对多个数据库进行了全面系统的检索。两名独立评审员筛选研究的合格性。对入选研究进行方法学质量评估。
纳入13项研究。由于功能预后指标的异质性以及缺乏适当的统计信息，进行了定性分析。超过半数的论文被认为质量较高。有力证据表明，中重度创伤性脑损伤后女性的功能预后并不优于男性。
本综述结果与动物文献中的观点相反。未来的前瞻性研究应考虑诸如受伤时女性患者的激素状态以及年龄和损伤严重程度等其他异质性来源等因素。
