Reid Susan M, Meehan Elaine, Gibson Catherine S, Scott Heather, Delacy Michael J
Developmental Disability & Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, VIC, Australia.
Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
Dev Med Child Neurol. 2016 Feb;58 Suppl 2:43-9. doi: 10.1111/dmcn.13021. Epub 2016 Jan 14.
Males typically outnumber females in cerebral palsy (CP) cohorts. To better understand this 'male disadvantage' and provide insight into causal pathways to CP, this study used 1983 to 2009 Australian CP and population birth cohorts to identify associations and trends with respect to biological sex and CP.
Within birth gestation groups, sex ratios were calculated to evaluate any male excess in the CP cohort compared with livebirths, neonatal deaths, neonatal mortality and survival rates, neonatal survivors, and CP rates in survivors. Sex- and gestation-specific trends in neonatal mortality, CP rates, and CP sex ratios were assessed by plotting their annual frequencies and fitting quadratic curves.
Over-representation of males in preterm live births partly explained the male excess in the CP cohort after preterm birth, especially at 28 to 31 weeks. Higher CP rates in male neonatal survivors also contributed to the male excess in CP, particularly at <28 and 37+ weeks. Higher neonatal mortality rates in males at all gestations had little impact on the CP sex ratio. There was no clearly discernible change over time in the CP sex ratio.
Gestation-specific associations between sex and CP provide insight into causal pathways to CP and suggest sex-specific differences in response to neuroprotective strategies.
在脑瘫（CP）队列中，男性人数通常多于女性。为了更好地理解这种“男性劣势”并深入了解脑瘫的病因途径，本研究使用了1983年至2009年澳大利亚脑瘫和人口出生队列来确定生物学性别与脑瘫之间的关联和趋势。
在出生孕周组内，计算性别比，以评估脑瘫队列中与活产、新生儿死亡、新生儿死亡率和生存率、新生儿幸存者以及幸存者中的脑瘫发生率相比，男性是否过多。通过绘制新生儿死亡率、脑瘫发生率和脑瘫性别比的年度频率并拟合二次曲线，评估按性别和孕周划分的新生儿死亡率、脑瘫发生率和脑瘫性别比的趋势。
早产活产中男性比例过高部分解释了早产后脑瘫队列中男性过多的现象，尤其是在28至31周时。男性新生儿幸存者中较高的脑瘫发生率也导致了脑瘫患者中男性过多，特别是在<28周和37 +周时。各孕周男性较高的新生儿死亡率对脑瘫性别比影响不大。脑瘫性别比随时间没有明显变化。
性别与脑瘫之间特定孕周的关联为脑瘫的病因途径提供了见解，并表明在对神经保护策略的反应中存在性别差异。
