Stroke：国内脑动脉粥样硬化存在地理分布差异和性别差异

我国脑缺血患者动脉粥样硬化的地理分布差异和性别差异尚未清楚阐述。为此，我国北京天坛医院的王拥军教授和香港中文大学威尔斯王子医院药物与治疗科的Xinying Zou博士等人进行合作，完成了一项研究，研究结果在线发表在2013年6月11日的Stroke杂志上。研究结果显示：我国的症状性脑动脉粥样硬化存在地理分布差异和性别差异。

该研究是一项前瞻性多中心研究。研究人员评估了国内22所医院的2864位连续病例，他们都是症状出现7天内的急性脑缺血患者。所有的入选病例都进行了3维飞行时间MRA和多普勒彩超或增强MRA以寻找颅内或颅外动脉的狭窄。颅内大动脉狭窄定义为MRA中直径减少≥50%。

研究结果显示：脑动脉粥样硬化患者中，北方人所占的比例显著高于南方人(50.22%比41.88%; P<0.0001)。北方人饮酒更多、抽烟也更多，有糖尿病、卒中史、脑梗死史、心脏病的比例更高，体块指数更大。大于63岁的患者中，女性出现脑动脉粥样硬化的比例显著高于男性 (51.51% 比45.40%; P=0.028)。在老年患者中，女性患糖尿病、高血压、高脂血症和心脏病的比例高于男性。

该研究发现：我国的症状性脑动脉粥样硬化存在地理分布差异和性别差异。公共卫生机构应加强改善关系民众健康的社会决定因素，预防/控制高危人群的危险因素以降低卒中风险。

Geographic and Sex Difference in the Distribution of Intracranial Atherosclerosis in China.
BACKGROUND AND PURPOSE
Geographic variation and sex difference in the distribution of intracranial atherosclerosis (ICAS) have not been fully discussed before in Chinese patients with cerebral ischemia. We performed this study with the aim to investigate geographic and sex difference in the distribution of ICAS in China.
METHODS
In this prospective multicenter study, we evaluated 2864 consecutive patients who experienced an acute cerebral ischemia within 7 days of symptom onset in 22 hospitals in China. All the inclusive patients underwent 3-dimensional time-of-flight MR angiography and duplex color Doppler ultrasound or contrast-enhanced MR angiography to document the presence of intracranial or extracranial stenosis. Intracranial large-artery atherosclerosis was defined as ≥50% diameter reduction on MR angiography.
RESULTS
The proportion of patients with ICAS was significantly higher in north China than in south China (50.22% versus 41.88%; P<0.0001). Patients in the north were likely to consume more alcohol and smoke more cigarettes and had significantly higher proportion of diabetes mellitus, family history of stroke, history of cerebral ischemia, heart disease, and higher body mass index. In patients aged >63 years, the percentage of ICAS in women was notably higher than in men (51.51% versus 45.40%; P=0.028). In elderly patients, women had higher proportion of diabetes mellitus, hypertension, hyperlipidemia, and heart disease than men.
CONCLUSIONS
There exists geographic and sex difference in the distribution of symptomatic ICAS in China. Public health measures should strengthen improving social determinants of health and risk factor prevention/control in high-risk populations for decreasing stroke risk.