Olsen Tom Skyhøj, Andersen Klaus Kaae
Frederiksberg Hospital, Denmark.
Gend Med. 2010 Aug;7(4):284-95. doi: 10.1016/j.genm.2010.08.001.
It is generally believed that differences in age, stroke characteristics, and cardiovascular risk factors account for observed sex-specific differences in stroke survival.
We aimed to study female stroke survival advantage before and after the average age of menopause, and whether female survival advantage applies only to patients for whom stroke is the most likely cause of death.
The Danish National Indicator Project, a registry designed to list all hospitalized stroke patients in Denmark beginning in March 2001, had 40,155 registered patients as of February 2007. All registered patients had undergone evaluation including stroke severity (as measured by the Scandinavian Stroke Scale [SSS], using a total score of 0-58, in which lower scores indicate more severe strokes), computed tomography, and cardiovascular risk factors. Patients were followed from admission until death or censoring. Case fatality (stratified by 1 week, 1 month, 3 months, and 1 year) in men and women was correlated with age and stroke severity. Adjustment for cardiovascular risk factors was performed by means of multivariate regression analysis.
A total of 20,854 (51.9%) men and 19,301 (48.1%) women were registered. Women were significantly older than men at the time of stroke (74.5 vs 69.7 years, respectively; P < 0.001) and had signficantly more severe strokes, as expressed by the mean SSS score (39.6 vs 43.3; P < 0.001). Stratification of 1-week to 1-year case fatality according to age and stroke severity indicated that women survived significantly better than men from the mid-fifties onward, when controlling for age, stroke severity, and cardiovascular risk factor profile. The observed female survival advantage increased with age. The female survival advantage was seen in patients with severe as well as mild strokes, but not in those younger than age 50 years.
Our findings dispute the effects of female sex hormones as the underlying cause of female survival superiority over men. Instead, we propose the hypothesis that the progressive deficiency of male sex hormones (testosterone), beginning in men in middle age, is the underlying cause of the gap in survival rates between men and women. Accordingly, the female survival advantage is rooted in male inferiority rather than innate female superiority.
人们普遍认为，年龄、中风特征和心血管危险因素的差异导致了观察到的中风存活率方面的性别差异。
我们旨在研究绝经平均年龄前后女性中风存活优势，以及女性存活优势是否仅适用于中风最有可能是死亡原因的患者。
丹麦国家指标项目是一个旨在列出2001年3月起丹麦所有住院中风患者的登记系统，截至2007年2月登记了40155名患者。所有登记患者都接受了评估，包括中风严重程度（用斯堪的纳维亚中风量表[SSS]测量，总分0 - 58分，分数越低表明中风越严重）、计算机断层扫描和心血管危险因素。患者从入院开始随访直至死亡或失访。按1周、1个月、3个月和1年分层的男女病死率与年龄和中风严重程度相关。通过多变量回归分析对心血管危险因素进行调整。
共登记了20854名男性（51.9%）和19301名女性（48.1%）。中风时女性比男性年龄显著更大（分别为74.5岁和69.7岁；P < 0.001），并且中风更严重，平均SSS分数表明了这一点（39.6对43.3；P < 0.001）。根据年龄和中风严重程度对1周到1年的病死率进行分层表明，从五十多岁中期起，在控制年龄、中风严重程度和心血管危险因素概况后，女性存活情况显著优于男性。观察到的女性存活优势随年龄增加。女性存活优势在严重中风和轻度中风患者中均可见，但在50岁以下患者中未观察到。
我们的研究结果对女性性激素作为女性存活优于男性的根本原因的观点提出了质疑。相反，我们提出假说，从中年男性开始的男性性激素（睾酮）逐渐缺乏是男女存活率差距的根本原因。因此，女性存活优势源于男性劣势而非女性先天优势。
