Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK.
Neurology. 2012 Sep 18;79(12):1215-22. doi: 10.1212/WNL.0b013e31826b951e. Epub 2012 Sep 5.
To determine any sex differences in age-specific prevalence or severity of leukoaraiosis, a marker of white matter ischemia, in population-based and clinic cohorts of TIA/stroke and in a systematic review of the literature.
Age-specific sex differences were calculated for both CT and MRI in the Oxford Vascular Study (OXVASC) and in an MRI-based clinic cohort. We pooled odds ratios (ORs) for leukoaraiosis in women vs men from published studies by fixed-effect meta-analysis, stratified by patient characteristics (stroke vs nonstroke) and CT vs MRI.
Among 10 stroke studies (all CT-based), leukoaraiosis was most frequent in women (OR = 1.42, 95% confidence interval [CI] 1.27-1.57, p < 0.0001), with little heterogeneity between studies (p = 0.28). However, no such excess was seen in 10 reports of nonstroke cohorts (0.91, 0.67-1.24, p = 0.56). Moreover, excess leukoaraiosis in women on CT-imaging in OXVASC (1.38, 1.15-1.67, p = 0.001) was explained by their older age (age-adjusted OR = 1.01, 0.82-1.25, p = 0.90). Leukoaraiosis was more severe in older (≥ 75) women (CT-1.50, 1.14-1.97, p = 0.004 in OXVASC; MRI-1.70, 1.17-2.48, p = 0.006 in OXVASC and clinic cohort). However, leukoaraiosis was independently associated with early mortality (hazard ratio = 1.46, 1.23-1.73, p < 0.0001), suggesting that comparisons in older age groups will be biased by prior premature death of men with leukoaraiosis. Sex differences in severity of leukoaraiosis were not addressed in previous studies.
Previously reported excess leukoaraiosis in women with TIA/stroke is likely to be confounded by age and apparently greater severity in older women is likely to be biased by premature death in men with leukoaraiosis.
在 TIA/中风的人群队列和文献系统回顾中，确定基于人群和临床队列的 TIA/中风中白质缺血标志物——脑白质疏松症的年龄特异性患病率或严重程度是否存在性别差异。
我们在牛津血管研究（OXVASC）中计算了 CT 和 MRI 中年龄特异性的性别差异，并在基于 MRI 的临床队列中计算了这种差异。我们通过固定效应荟萃分析，针对发表的研究，按患者特征（中风与非中风）和 CT 与 MRI 进行分层，汇总女性与男性脑白质疏松症的比值比（OR）。
在 10 项基于 CT 的中风研究中，脑白质疏松症在女性中最为常见（OR=1.42，95%置信区间[CI]1.27-1.57，p<0.0001），且研究间的异质性较小（p=0.28）。然而，在 10 项非中风队列的报告中并未发现这种过度现象（0.91，0.67-1.24，p=0.56）。此外，在 OXVASC 中，女性 CT 成像的脑白质疏松症过多（1.38，1.15-1.67，p=0.001），这可由其年龄较大来解释（年龄调整 OR=1.01，0.82-1.25，p=0.90）。在 OXVASC 和临床队列中，年龄较大（≥75 岁）的女性脑白质疏松症更严重（CT-1.50，1.14-1.97，p=0.004；MRI-1.70，1.17-2.48，p=0.006）。然而，脑白质疏松症与早期死亡率独立相关（风险比=1.46，1.23-1.73，p<0.0001），这表明在年龄较大的组别中进行比较时，脑白质疏松症患者中男性的过早死亡会产生偏倚。先前的研究并未探讨脑白质疏松症严重程度的性别差异。
此前报道的 TIA/中风女性中脑白质疏松症过多可能受到年龄的影响，而年龄较大的女性脑白质疏松症的严重程度似乎更大，这可能是由于脑白质疏松症男性的过早死亡导致的偏倚。
