Berry Cherisse, Ley Eric J, Tillou Areti, Cryer Gil, Margulies Daniel R, Salim Ali
Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
J Trauma. 2009 Nov;67(5):950-3. doi: 10.1097/TA.0b013e3181ba3354.
Male and female nervous systems respond differently to traumatic brain injury (TBI) and in vivo research relates this difference to neuroprotection from female sex hormones. Attempts to replicate female sex hormone-related neuroprotection in clinical studies have been unsuccessful. The objective of this study was to determine whether gender or menopausal status affects mortality in patients with moderate to severe TBI.
A retrospective review of all patients with isolated moderate to severe TBI was undertaken using data from the National Trauma Database version 6.2 (2000-2005). Isolated TBI was defined as head Abbreviated Injury Score >/=3 in patients without significant extracranial injuries (Abbreviated Injury Score <3 for other anatomic regions). Demographics, Injury Severity Score, and outcomes (mortality, intensive care unit and hospital length of stay, and complications) were compared. The population was stratified into age subgroups: 14 to 45 years (premenopausal), 46 to 55 years (perimenopausal), and older than 55 years (postmenopausal). Logistic regression analysis was used to determine the relationship among female gender, mortality, and development of complications after moderate to severe TBI.
A total of 72,294 patients with moderate to severe TBI were evaluated. Females showed a significantly lower risk in both mortality (adjusted odds ratios [AOR], 0.82; 95% confidence intervals [CI], 0.77-0.87; p < 0.0001) and in developing any type of complications (AOR, 0.88; 95% CI, 0.84-0.93; p < 0.0001) than the male population after adjusting for differences in patient characteristics. After age stratification, perimenopausal women (46-55 years) and postmenopausal women (older than 55 years) showed a significantly lower risk in mortality (AOR, 0.76; 95% CI, 0.63-0.92; p < 0.0044 and AOR, 0.79; 95% CI, 0.73-0.86; p < 0.0001, respectively). There was no difference in mortality in premenopausal women compared with their male age-matched counterparts (AOR, 1.09; 95% CI, 0.99-1.21; p = 0.0917).
Female gender is independently associated with reduced mortality and decreased complications after TBI. As peri- and postmenopausal women demonstrated improved survival, and premenopausal women did not, estrogen unlikely confers neuroprotection in women after TBI. Future TBI treatment may benefit with further research focused on why peri- and postmenopausal women show decreased mortality after TBI.
男性和女性的神经系统对创伤性脑损伤（TBI）的反应不同，体内研究表明这种差异与女性性激素的神经保护作用有关。在临床研究中试图复制与女性性激素相关的神经保护作用并未成功。本研究的目的是确定性别或绝经状态是否会影响中度至重度TBI患者的死亡率。
使用国家创伤数据库6.2版（2000 - 2005年）的数据，对所有孤立性中度至重度TBI患者进行回顾性研究。孤立性TBI定义为在无明显颅外损伤（其他解剖区域的简明损伤评分<3）的患者中头部简明损伤评分≥3。比较人口统计学、损伤严重程度评分和结局（死亡率、重症监护病房和住院时间以及并发症）。将人群分为年龄亚组：14至55岁（绝经前）、46至55岁（围绝经期）和55岁以上（绝经后）。采用逻辑回归分析确定女性性别、死亡率以及中度至重度TBI后并发症发生之间的关系。
共评估了72,294例中度至重度TBI患者。在调整患者特征差异后，女性在死亡率（调整后的优势比[AOR]，0.82；95%置信区间[CI]，0.77 - 0.87；p < 0.0001）和发生任何类型并发症方面（AOR，0.88；95% CI，0.84 - 0.93；p < 0.0001）的风险均显著低于男性人群。年龄分层后，围绝经期女性（46 - 55岁）和绝经后女性（55岁以上）在死亡率方面的风险显著较低（AOR分别为0.76；95% CI，0.63 - 0.92；p < 0.0044和AOR，0.79；95% CI，0.73 - 0.86；p < 0.0001）。绝经前女性与年龄匹配的男性相比，死亡率无差异（AOR，1.09；95% CI，0.99 - 1.21；p = 0.0917）。
女性性别与TBI后死亡率降低和并发症减少独立相关。由于围绝经期和绝经后女性生存率提高，而绝经前女性未出现这种情况，雌激素不太可能在TBI后的女性中发挥神经保护作用。未来的TBI治疗可能会受益于进一步研究围绝经期和绝经后女性TBI后死亡率降低的原因。
