Hamdan Alhafidz, Barnes Jonathan, Mitchell Patrick
Faculty of Medical Sciences, Newcastle University;
J Neurosurg. 2014 Dec;121(6):1367-73. doi: 10.3171/2014.7.JNS132318. Epub 2014 Sep 12.
The pathophysiology of aneurysmal subarachnoid hemorrhage (aSAH) is unclear. Sex may play a role in the outcome of patients with aSAH.
The authors retrospectively identified 617 patients with aSAH (April 2005 to February 2010) and analyzed sex differences in risk factors (age, hypertension, smoking, alcohol consumption, and family history), admission-related factors (World Federation of Neurosurgical Societies grade and admission delay), aneurysm characteristics (site, side, location, and multiplicity), and outcomes (treatment modalities [coiling/clipping/both/conservative], complications [vasospasm and hydrocephalus], length of stay, and modified Rankin Scale score at 3 months).
The female patients with aSAH were older than the male patients (mean age 56.6 vs 51.9 years, respectively, p < 0.001), and more women than men were ≥ 55 years old (56.2% vs 40.4%, respectively, p < 0.001). Women exhibited higher rates of bilateral (6.8% vs 2.6%, respectively, p < 0.05), multiple (11.5% vs 5.2%, respectively, p < 0.05), and internal carotid artery (ICA) (36.9% vs 17.5%, respectively, p < 0.001) aneurysms and a lower rate of anterior cerebral artery aneurysms (26.3% vs 44.8%, respectively, p < 0.001) than the men, but no side differences were noted. There were no sex differences in risk factors, admission-related factors, or outcome measures. For both sexes, outcomes varied according to aneurysm location, with odds ratios for a poor outcome of 1.62 (95% CI 0.91-2.86, p = 0.1) for middle cerebral artery, 2.41 (95% CI 1.29-4.51, p = 0.01) for ICA, and 2.41 (95% CI 1.29-4.51, p = 0.006) for posterior circulation aneurysms compared with those for anterior cerebral artery aneurysms. The odds ratio for poor outcome (modified Rankin Scale score of 4-6) in women compared with men after adjusting for significant prognostic factors was 0.71 (95% CI 0.45-1.11, p > 0.05).
The overall outcomes after aSAH between women and men are similar.
动脉瘤性蛛网膜下腔出血（aSAH）的病理生理学尚不清楚。性别可能在aSAH患者的预后中起作用。
作者回顾性确定了617例aSAH患者（2005年4月至2010年2月），并分析了危险因素（年龄、高血压、吸烟、饮酒和家族史）、入院相关因素（世界神经外科协会分级和入院延迟）、动脉瘤特征（部位、侧别、位置和多发性）以及预后（治疗方式[栓塞/夹闭/两者/保守治疗]、并发症[血管痉挛和脑积水]、住院时间和3个月时的改良Rankin量表评分）方面的性别差异。
aSAH女性患者比男性患者年龄大（平均年龄分别为56.6岁和51.9岁，p<0.001），≥55岁的女性比男性多（分别为56.2%和40.4%，p<0.001）。女性双侧动脉瘤（分别为6.8%和2.6%，p<0.05）、多发动脉瘤（分别为11.5%和5.2%，p<0.05）和颈内动脉（ICA）动脉瘤（分别为36.9%和17.5%，p<0.001）的发生率高于男性，而大脑前动脉动脉瘤的发生率低于男性（分别为26.3%和44.8%，p<0.001），但未发现侧别差异。在危险因素、入院相关因素或预后指标方面没有性别差异。对于男女两性，预后因动脉瘤位置而异，大脑中动脉动脉瘤预后不良的比值比为1.62（95%CI 0.91 - 2.86，p = 0.1），ICA动脉瘤为2.41（95%CI 1.29 - 4.51，p = 0.01），后循环动脉瘤为2.41（95%CI 1.29 - 4.51，p = 0.006），与大脑前动脉动脉瘤相比。在调整显著预后因素后，女性与男性相比预后不良（改良Rankin量表评分为4 - 6）的比值比为0.71（95%CI 0.45 - 1.11，p>0.05）。
aSAH后男女总体预后相似。
