杨开超 耿磊 朱晓光 戎柳 吴蔚 赵钢 封启明

DOI：10.3760/cma.j.issn.1671-0282.2015.03.016

基金項目：上海市国际科技合作基金项目（12410710700）

作者单位：200233 上海，上海交通大学附属第六人民医院急诊科

通信作者：封启明，Email：fengqiming04@126.com

【摘要】目的 探究不同年龄段女性严重创伤患者与同龄男性病死率差异的特点，探索严重创伤患者预后性别差异的潜在机制。方法 回顾性分析上海交通大学附属上海市第六人民医院急性创伤急救中心EICU 2010年1月至2012年12月收治的成年严重钝性创伤患者，按年龄将其分为18岁≤年龄<45岁、45岁≤年龄≤55岁及年龄>55岁三个亚组，比较各组患者预后性别差异的特点，多元logistic回归模型分析性别因素与患者病死率的独立相关性。结果 女性创伤患者粗病死率明显低于男性（5.0% vs.9.1%， P<0.05）。回归分析结果显示，女性严重创伤患者病死率比男性低79%（OR=0.21，95%CI：0.07～0.64，P=0.006）。而且这种性别差异只存在于18岁≤年龄≤45岁患者中（女性vs.男性 OR=0.15，95%CI：0.04～0.67，P=0.012），在45岁≤年龄≤55岁（OR=1.10，95%CI：0.36～2.82，P=0.980）及年龄>55岁（OR=0.67，95%CI：0.21～2.15，P=0.504）的患者中，女性病死率与男性相比均差异无统计学意义。结论 女性严重创伤患者病死率明显低于男性患者，且这种性别差异是源于18岁≤年龄≤45女性创伤患者病死率明显低于同龄男性，该结果表明性激素水平可能是创伤患者预后性别差异的一个重要影响因素。

【关键词】创伤;性激素;损伤严重度;年龄;住院病死率

Sex hormone levels may be an important factor influencing the gender dimorphism in prognosis of severe trauma patients

Yang Kaichao，Geng Lei，Zhu Xiaoguang，Rong Liu，Wu Wei，Zhao Gang，Feng Qiming. Department of Emergerncy， Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital， Shanghai 200233， China

Corresponding author：Feng Qiming，Email：fengqiming04@126.com

【Abstract】Objective To describe the association between age and the sex-based outcome difference and analyze the potential mechanism responsible for sex-based outcome difference in severe trauma patients. Methods A retrospective analysis derived from the Emergency Intensive Care Unit of the acute trauma center of the Shanghai Municipal Sixth Peoples Hospital during the 2010-2013 period was performed to identify sex-based outcome differences after severe blunt trauma. The study cohort of patients was then stratified by age： （1） 18 years ≤ age <45 years， （2） 45 years ≤ age ≤ 55 years， and （3） age>55 years. Crude and adjusted odds ratios （ORs） were calculated to evaluate the association between gender and the hospitalized mortality， both overall and subgroups according to age categories.Results A total of 987 severe trauma patients met our inclusion criteria were enrolled in this study. Crude mortality was higher in male severe trauma patients （male 9.1% vs. female 5.0%， P< 0.05）. Multiple logistic regression revealed that females had a 79% decrease in hospitalized mortality compared with males（OR=0.21，95%CI：0.07-0.64，P=0.006）. This difference was most distinct in patients with age<45 years， （OR=0.15，95%CI：0.04-0.67，P= 0.012）. There is no significant difference between genders in mortality of trauma patients with 45 years ≤ age ≤ 55 years and age>55 years. Conclusions The present study revealed a statistical significant association between gender and mortality among severe blunt trauma patients， particularly in patients with age<45 years. These results may highlight the importance of sex hormones in outcomes of severe trauma.

【Key words】Trauma; Sex hormone; Injury severity; Age; Hospitalized mortality

随着当今社会的不断发展，交通伤及坠落伤等高能量创伤发生率逐年上升，严重创伤患者比例不断增加[1]。随着医疗水平的提高及急救技术的不断改善，严重创伤患者早期病死率有所下降，但患者后期严重并发症如感染、脓毒症及MODS的发生率却始终居高不下[2]，患者总病死率并没有得到明显改善。近年来，性别因素对患者预后的影响作用越来越受到人们的关注。……