Stroke:短暂性脑缺血发作后,临床特征和预后,男女有别

2021-02-04 Freeman MedSci原创

短暂性脑缺血发作后,临床特征和预后,男女有别

 

性别之间在缺血性卒中的发病率、表现和结果方面的差异已经被深入研究。与男性相比,女性的中风发病率较低,但中风的重要血管风险因素如心房颤动的发生率较高。女性发生脑卒中时年龄更大,脑卒中更严重,结果更差。

即便如此,关于短暂性脑缺血发作(TIA)后其临床表现、病因、影像学特征和预后等方面的性别差异,目前只有有限的数据。最近,一些研究人员在一个前瞻性的小卒中患者队列中观察到性别之间后续血管事件的风险相似。TIA后的早期卒中风险很高,需要紧急处理;但很少有研究关注TIA后卒中的长期风险。

藉此,西班牙莱里达大学医院的Francisco Purroy等人TIA患者的基线特征、表现、病因、神经影像学特征以及长期预后预测因素等方面的性别差异。

他们对2006年1月至2010年6月的连续的TIA患者进行了前瞻性队列研究非确定性TIA事件的定义是存在孤立的非典型症状。中位随访时间为6.5(四分位数范围,5.0-9.6)年后,按性别分层统计卒中复发(SR)和主要血管事件的复合风险。

结果显示:在研究的723名患者中,有302名患者发生了重大血管事件。


在研究的723名患者中,302名(41.8%)为女性,79名(10.9%)发生了非明确的TIA事件。供血区弥散加权成像模式(OR 1.61)和非确定性TIA事件(OR 2.66)与女性相关,而主动吸烟(OR 0.3)和大动脉粥样硬化(OR 0.5)与男性相关。

男女的SR风险相似(女性12.6%,男性14.3%)。相比之下,女性发生重大血管事件的风险显著低于男性(17.5% vs 23.8% )。在男女中,调整年龄后,大动脉粥样硬化与SR相关(HR 3.22 vs HR 2.00 )。

在Kaplan-Meier分析中,弥散加权影像学阳性(P=0.014)和明确的TIA(对数秩检验P=0.022)的女性,SR的风险显著升高。

这个研究的重要意义在于,尽管SR的风险相似,但在基线特征、表现症状、急性缺血病变模式、病因和结果方面存在性别相关的差异。因此有必要考虑到这些差异,从而确定最佳的预防策略。

原文出处:

Purroy, F., Vicente-Pascual, M., Arque, G., Baraldes-Rovira, M., Begue, R., Gallego, Y., ... & Vazquez-Justes, D. (2021). Sex-Related Differences in Clinical Features, Neuroimaging, and Long-Term Prognosis After Transient Ischemic Attack. _Stroke_, _52_(2), 424-433.

 

 
 
 
 

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