Introduction: Female athletes are underrepresented in concussion research, and few studies have investigated associations of ovarian hormones with concussion outcomes. This study explored associations of concussion with levels and variability of progesterone, estradiol, and their ratio (P/E) and examined relationships of hormone levels with clinical measures and recovery after concussion in CARE Consortium female athletes and cadets.Methods: Female participants enrolled (n = 749) at pre-injury baseline. Participants with concussion (mean age 19.34 years; n = 130, 90 athletes, 40 non-athlete cadets) completed one or more visits at non-standardized times of day: immediately post-injury, 24-hours post-injury, upon initiating the return-to-play protocol (Init RTP), and seven days following unrestricted return-to-play (PRTP). Controls (mean age 19.85 years; n = 67, 61 athletes, 6 non-athlete cadets) completed similar visits. Linear mixed models and general linear models tested associations of hormone levels and/or variation with concussion status, symptoms, and recovery, controlling for self-reported birth control use at pre-injury baseline.Results: Female participants with concussion had higher progesterone levels relative to controls on average across all visits (mean difference (ln ng/mL) (standard error) MD = 0.26(0.08), t(193) = 3.03, p = 0.003). Those with concussion had elevated estradiol at 24 hours (MD = 0.27(0.09), t(506) = 3.04, p = 0.02), Init RTP (MD = 0.38(0.09), t(508) = 4.29, p < 0.001), and PRTP (MD = 0.30(0.09), t(515) = 3.25, p = 0.01) relative to pre-injury baseline, and compared to controls at Init RTP (MD = 0.35(0.12), t(429) = 2.78, p = 0.006). Concussed participants had a lower range of estradiol over 7-28 days than controls (B(SE) = -0.24(0.09), F(1,145) = 6.43, p = 0.01). Acutely after concussion, estradiol was positively associated with Brief Symptom Inventory Global Severity Index scores (B(SE) = 0.29(0.12), F(1,102) = 5.60, p = 0.02). No significant relationships were found between hormones and recovery.Conclusions: These results, which warrant further research, suggest ovarian hormones may be associated with concussion and psychological symptom severity post-concussion.

中文翻译：

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与脑震荡相关的黄体酮和雌二醇水平以及女运动员和学员的临床结果和恢复。


简介：女运动员在脑震荡研究中的代表性不足，很少有研究调查卵巢激素与脑震荡结果的关联。本研究探讨了脑震荡与孕酮、雌二醇水平和变异性及其比率 （P/E） 的关联，并检查了激素水平与 CARE 联盟女运动员和学员脑震荡后临床测量和恢复的关系。方法：在受伤前基线时入组的女性参与者 （n = 749）。脑震荡参与者（平均年龄 19.34 岁;n = 130,90 名运动员，40 名非运动员学员）在一天中的非标准化时间完成了一次或多次就诊：受伤后立即、受伤后 24 小时、启动重返赛场方案 （Init RTP） 后 7 天以及不受限制地重返赛场 （PRTP） 后 7 天。对照组 （平均年龄 19.85 岁;n = 67,61 名运动员，6 名非运动员学员）完成了类似的访问。线性混合模型和一般线性模型测试了激素水平和/或变化与脑震荡状态、症状和恢复的关联，控制了受伤前基线时自我报告的节育措施使用情况。结果：在所有就诊中，患有脑震荡的女性参与者相对于对照组的平均孕激素水平较高 （平均差 （ln ng/mL）（标准误差） MD = 0.26（0.08），t（193） = 3.03，p = 0.003）。脑震荡患者在 24 小时时雌二醇升高 （MD = 0.27（0.09），t（506） = 3.04，p = 0.02），初始 RTP （MD = 0.38（0.09），t（508） = 4.29，p < 0.001）和 PRTP （MD = 0.30（0.09），t（515） = 3.25，p = 0.01） 相对于受伤前基线，并与初始 RTP 的对照组相比 （MD = 0.35（0.12），t（429） = 2.78，p = 0.006）。脑震荡参与者在 7-28 天内的雌二醇范围低于对照组 （B（SE） = -0.24（0.09），F（1,145） = 6.43，p = 0.01）。脑震荡急性后，雌二醇与简要症状量表全球严重程度指数评分呈正相关 （B（SE） = 0.29 （0.12），F（1,102） = 5.60，p = 0.02）。未发现激素与恢复之间存在显着关系。结论： 这些值得进一步研究的结果表明，卵巢激素可能与脑震荡和脑震荡后心理症状的严重程度有关。