Heffernan Daithi S, Dossett Lesly A, Lightfoot Michelle A, Fremont Richard D, Ware Lorraine B, Sawyer Robert G, May Addison K
Division of Trauma and Surgical Critical Care, Department of Surgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island 02903, USA.
J Trauma. 2011 Oct;71(4):878-83; discussion 883-5. doi: 10.1097/TA.0b013e31822c0d31.
The acute respiratory distress syndrome (ARDS) is a proinflammatory condition that often complicates trauma and critical illness. Animal studies have shown that both gender and sex hormones play an important role in inflammatory regulation. Human data are scant regarding the role of gender and sex hormones in developing ARDS. Our objective was to describe gender and hormonal differences in patients who develop ARDS in a large cohort of critically injured adults.
A prospective cohort study of adult trauma patients requiring intensive care unit admission for at least 48 hours was performed. Demographic and clinical data were collected prospectively, and sex hormones were assayed at study entry (48 hours). The primary outcome was the development of ARDS. Multivariate logistic regression was used to determine the adjusted odds of death associated with differences in gender.
Six hundred forty-eight patients met entry criteria, and 180 patients developed ARDS (31%). Women were more likely to develop ARDS (35% vs. 25%, p=0.02). This association remained after adjusting for age, mechanism of injury, injury severity, and blood product transfusion (odds ratio, 1.6; 95% confidence interval: 1.1-2.4; p=0.02). Of patients with ARDS, there was no difference in mortality related to gender (22% mortality in women with ARDS vs. 20% in men; p=not significant). A proinflammatory sex hormone profile (low testosterone and high estradiol) was associated with ARDS in both men and women.
Women are more likely than men to develop ARDS after critical injury. Despite the increased incidence in ARDS, the mortality in patients with ARDS does not differ according to gender. The inflammatory properties of sex hormones may contribute to ARDS, but they do not fully explain observed gender differences.
急性呼吸窘迫综合征（ARDS）是一种常并发于创伤和危重病的促炎状态。动物研究表明，性别和性激素在炎症调节中均发挥重要作用。关于性别和性激素在ARDS发生中的作用，人类数据较少。我们的目的是描述一大群严重受伤的成年患者中发生ARDS的患者的性别和激素差异。
对需要入住重症监护病房至少48小时的成年创伤患者进行前瞻性队列研究。前瞻性收集人口统计学和临床数据，并在研究开始时（48小时）检测性激素。主要结局是ARDS的发生。采用多因素逻辑回归确定与性别差异相关的调整后死亡几率。
648例患者符合入选标准，180例患者发生ARDS（31%）。女性发生ARDS的可能性更高（35%对25%，p=0.02）。在调整年龄、损伤机制、损伤严重程度和血液制品输注后，这种关联仍然存在（优势比，1.6；95%置信区间：1.1-2.4；p=0.02）。在发生ARDS的患者中，与性别相关的死亡率没有差异（ARDS女性患者死亡率为22%，男性为20%；p无统计学意义）。促炎性性激素谱（低睾酮和高雌二醇）在男性和女性中均与ARDS相关。
严重受伤后，女性比男性更易发生ARDS。尽管ARDS发病率增加，但ARDS患者的死亡率不存在性别差异。性激素的炎症特性可能导致ARDS，但不能完全解释观察到的性别差异。
