摘要
目的研究白细胞介素-1受体相关激酶-1（IRAK-1）基因多态性与创伤患者预后性别差异相关性。方法采用前瞻性队列研究方法，分析2013年1月至12月入住上海市第六人民医院急诊重症监护室的360例成年钝性创伤患者。其中排除重症颅脑损伤及高位颈椎损伤患者，记录其余患者基本资料，观察预后结局。采用多因素Logistic回归模型分析性别因素与院内感染（NI）、多器官功能衰竭（MOF）及病死率的相关性。根据年龄、性别、体质量指数、损伤严重度及致伤机制等指标，对NI、MOF及死亡患者进行配对，分别比较NI组与非NI组、MOF组与非MOF组、死亡组与存活组之间IRAK-1基因型的差异性。结果入选的360例患者中，IRAK-1C／C基因型患者268例（74．4％），其中男性患者C／C基因型比例高达82．3％。控制混杂因素，男性患者MOF的发生率约是女性的4倍（OR=3．855，95％CI：1．329～11．181，P=0．013），病死率约是女性的6倍（OR=5．742，95％CI：1．429—23．066，P=0．014），但在NI的发生率上男女性别差异无统计学意义（OR=2．117，95％CI：0．932～4．807，P=0．073）。将NI、MOF及死亡患者分别配对比较，MOF组（P=0．014）及死亡组（P=0．008）患者中IRAK-1C／C基因型比例显著增高，而NI组差异无统计学意义（P=0．418）。结论创伤患者预后存在性别差异，女性患者发生MOF与死亡的风险显著低于男性患者。而男性患者中IRAK-1C／C基因型占极大比例（82．3％），这可能是影响创伤预后性别差异的重要因素。
Objective To investigate the correlation between IL-1 receptor associated kinase-1 （IRAK-1） polymorphism and the difference in outcomes of casualties between genders. Methods A prospective cohort study was performed over a 12-month period in the emergency intensive care unit of Shanghai Sixth People＇s Hospital in 2013. A total of 360 adult victims with blunt injury were enrolled, whereas patients with severe traumatic brain injury and complete cervical spinal cord injuries were excluded. Data including demographics, injury characteristics and outcomes of each victim were collected. Logistic regression was used to identify the risk factors for developing adverse outcomes associated with gender, such as nosocomial infection （NI）, multiple organ failure （MOF） and in-hospital mortality, According to age, sex, body mass index, injury severity score and cause of injury, they were matched with NI, MOF and mortality to compare the differences of IRAK-1 polymorphism between NI group and non-NI group, between MOF group and non-MOF group and between survival group and non-survival group. Results In an enrolled cohort of 360 patients, the IRAK-1 wild type （C/C） was mostly common （74.4%）, especially in those male patients （82. 3% ）. After controlling important confounders, the incidence of MOF in male was significantly higer in more than three-fold （ OR = 3. 855, 95% CI： 1. 329 - 11. 181, P = 0. 013 ） and mortality in five-fold （ OR = 5. 742, 95% CI： 1. 429 - 23. 066, P = 0. 014 ） comparied with female patients. After comparing the data of matched groups, the incidence of IRAK-1 wild type （ C/C ） was significant higher in MOF group （ P = 0. 014） and non-survivor group （ P = 0. 008）. However, no significant changes of IRAK-1 was observed in NI group （ P = 0. 418 ）. Conclusions There are obvious differences in adverse outcomes of casualties between gender after blunt trauma. Female has a significant lower risk in developing MOF and mortality than male. Meanwhile, the IRAK-1
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2016年第5期598-604,共7页
Chinese Journal of Emergency Medicine
基金
国家临床重点专科建设项目（2013-544）
