Circulation:200万人超大型队列研究数据提示:早产或会增加妇女中风的长期风险!

2021-05-13 MedSci原创 MedSci原创

早产应被视为女性一生中中风的一个危险因素。

中风是世界上第三大死亡原因。有研究显示,我国成年人中风的发生率约为25%,即,每4个人中就有一人在一生中会遭遇中风。其中,女性,尤其是绝经后的女性疾病负担更重。大多数发生在女性的中风比男性更严重,更容易导致严重的残疾甚至是更高的病死率。

目前已知的中风主要危险因素包括高血压、吸烟、糖尿病、高脂血症、缺血性心脏病(IHD)和外周动脉疾病。然而,大多数危险因素在女性中不如在男性中普遍。其他性别特异性因素,包括不良妊娠结局,也可能在长期中风风险中起重要作用。因此,需要更好地了解与妊娠相关的危险因素,以改善女性的长期脑血管病风险并进行有针对性的预防措施。

数据显示,全世界近11%的分娩为早产,每年影响1500万例分娩。据报道,早产的妇女将来患高血压、糖尿病和高脂血症的风险增加,而后者均为中风的既定风险因素。几项研究也报告了早产后较高的中风风险,相对风险在1.3至1.9范围内。

不良的妊娠结局已被确定为晚年中风的重要危险因素。然而,目前尚不清楚这种关联是否可归因于早产和中风的共同家庭(遗传或环境)决定因素的混淆。为此,来自美国西奈山伊坎医学院的专家开展了相关的研究,结果发表在最新的《循环》Circulation杂志上。

研究人员对对1973-2015年间瑞典所有2188043名单胎分娩的妇女进行了一项全国性队列研究,这些妇女在2015年前接受了全国范围内中风诊断的随访。使用Cox回归用于计算与妊娠持续时间相关的中风的调整后危险比(aHRs),并联合分析评估由共有的家族(遗传或环境)因素引起的混杂。

1973-2015年瑞典按妊娠持续时间和分娩后时间调整的中风危险比

在4800万人·年的随访中,36372名(1.7%)妇女被诊断为中风。在分娩后的10年中,与正常妊娠妇女相比,早产(胎龄< 37周)相关的中风风险升高61%(aHR=1.61,95%CI:1.45–1.79)。进一步分层显示,极早早产(22–27周)妇女中风风险升高181%(95%CI: 2.02–3.91),早期早产(28–33周)风险升高107%,而中度(34-36周)与轻度早产的中风风险分别升高38%与15%。

同时,这些风险在分娩后10-19年仍存在:与足月妇女相比,早产妇女风险升高61%,然后轻度下降,但在分娩后20-29年风险仍较足月妇女高35%,且在30-43年仍保持此水平。

与足月妊娠的比较,按孕期调整的风险比和未调整的中风风险差异

此外,在整个随访期间(长达43年),早产与出血性(aHR=1.31,95%CI:1.25–1.38)和缺血性(aHR=1.54,95%CI:1.47–1.61])卒中都密切相关。而这些发现不能用家庭中早产和中风的共同决定因素来解释。自发早产或医学指征早产后中风风险更高,且复发性早产与风险进一步增加相关。

由此可见,早产与出血性和缺血性卒中的未来风险较高相关。这些关联在至少40年后仍然显著升高,并且在很大程度上独立于协变量和共有的家庭因素。早产应被视为女性一生中中风的一个危险因素。

 

参考文献:

Preterm Delivery and Long-Term Risk of Stroke in Women: A National Cohort and Cosibling Study. doi.org/10.1161/CIRCULATIONAHA.120.052268

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    2021-07-12 www.gongxuelei1987

    学习了

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    2021-05-13 ms2000001051330459

    学习了,涨知识了!

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    2021-05-14 guging

    中风是俗称,应该称为缺血性卒中吧

    0

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