Biegon Anat
Department of Radiology and Neurology, Stony Brook University School of Medicine, Stony Brook, NY, United States.
Front Neurol. 2021 Feb 10;12:576366. doi: 10.3389/fneur.2021.576366. eCollection 2021.
Published epidemiological studies of traumatic brain injury (TBI) of all severities consistently report higher incidence in men. Recent increases in the participation of women in sports and active military service as well as increasing awareness of the very large number of women who sustain but do not report TBI as a result of intimate partner violence (IPV) suggest that the number of women with TBI is significantly larger than previously believed. Women are also grossly under-represented in clinical and natural history studies of TBI, most of which include relatively small numbers of women, ignore the role of sex- and age-related gonadal hormone levels, and report conflicting results. The emerging picture from recent studies powered to detect effects of biological sex as well as age (as a surrogate of hormonal status) suggest young (i.e., premenopausal) women are more likely to die from TBI relative to men of the same age group, but this is reversed in the 6th and 7th decades of life, coinciding with postmenopausal status in women. New data from concussion studies in young male and female athletes extend this finding to mild TBI, since female athletes who sustained mild TBI are significantly more likely to report more symptoms than males. Studies including information on gonadal hormone status at the time of injury are still too scarce and small to draw reliable conclusions, so there is an urgent need to include biological sex and gonadal hormone status in the design and analysis of future studies of TBI.
已发表的关于各种严重程度创伤性脑损伤（TBI）的流行病学研究一致报告称男性发病率更高。近期，女性参与体育运动和现役军人的人数有所增加，同时人们也越来越意识到，因亲密伴侣暴力（IPV）而遭受创伤性脑损伤但未报告的女性数量众多，这表明创伤性脑损伤女性患者的数量比此前认为的要多得多。在创伤性脑损伤的临床和自然史研究中，女性的代表性也严重不足，其中大多数研究纳入的女性数量相对较少，忽视了与性别和年龄相关的性腺激素水平的作用，且报告的结果相互矛盾。最近有研究专门检测生物学性别以及年龄（作为激素状态的替代指标）的影响，新出现的情况表明，年轻（即绝经前）女性相对于同年龄组男性更有可能死于创伤性脑损伤，但在60多岁和70多岁时情况则相反，这与女性绝经后的状态相符。年轻男女运动员脑震荡研究的新数据将这一发现扩展到了轻度创伤性脑损伤，因为遭受轻度创伤性脑损伤的女性运动员比男性更有可能报告更多症状。目前包含受伤时性腺激素状态信息的研究仍然太少且规模太小，无法得出可靠结论，因此迫切需要在未来创伤性脑损伤研究的设计和分析中纳入生物学性别和性腺激素状态。
