Khan Mohammad
Department of Microbiology, College of Medicine, Chichiri, Blantyre, Malawi.
Clin Exp Gastroenterol. 2012;5:213-7. doi: 10.2147/CEG.S36569. Epub 2012 Nov 12.
The phenomenon of consistent male dominance in typhoid ileal perforation (TIP) is not well understood. It cannot be explained on the basis of microbial virulence, Peyer's patch anatomy, ileal wall thickness, gastric acidity, host genetic factors, or sex-linked bias in hospital attendance. The cytokine response to an intestinal infection in males is predominantly proinflammatory as compared with that in females, presumably due to differences in the sex hormonal milieu. Sex hormone receptors have been detected on lymphocytes and macrophages, including on Peyer's patches, inflammation of which (probably similar to the Shwartzman reaction/Koch phenomenon) is the forerunner of TIP, and is not excluded from the regulatory effects of sex hormones. Hormonal control of host-pathogen interaction may override genetic control. Environmental exposure to Salmonella typhi may be more frequent in males, presumably due to sex-linked differences in hygiene practices and dining-out behavior. A plausible explanation of male dominance in TIP could include sex-linked differences in the degree of natural exposure of Peyer's patches to S. typhi. An alternative explanation may include sexual dimorphism in host inflammatory response patterns in Peyer's patches that have been induced by S. typhi. Both hypotheses are testable.
伤寒性回肠穿孔（TIP）中持续存在的男性主导现象尚未得到充分理解。这无法基于微生物毒力、派尔集合淋巴结解剖结构、肠壁厚度、胃酸度、宿主遗传因素或就医中的性别关联偏差来解释。与女性相比，男性对肠道感染的细胞因子反应主要是促炎的，这可能是由于性激素环境的差异。在淋巴细胞和巨噬细胞上已检测到性激素受体，包括在派尔集合淋巴结上，而派尔集合淋巴结的炎症（可能类似于施瓦茨曼反应/科赫现象）是TIP的先兆，并且不排除性激素的调节作用。宿主与病原体相互作用的激素控制可能会超越基因控制。男性可能更频繁地接触伤寒杆菌，这可能是由于卫生习惯和外出就餐行为中的性别关联差异。对TIP中男性主导的一个合理的解释可能包括派尔集合淋巴结对伤寒杆菌自然暴露程度的性别关联差异。另一种解释可能包括伤寒杆菌诱导的派尔集合淋巴结中宿主炎症反应模式的性别二态性。这两种假设都是可检验的。
