Irie Fumi, Kamouchi Masahiro, Hata Jun, Matsuo Ryu, Wakisaka Yoshinobu, Kuroda Junya, Ago Tetsuro, Kitazono Takanari
From the Department of Medicine and Clinical Science (F.I., J.H., R.M., Y.W., J.K., T.A., T.K.), Department of Health Care Administration and Management (M.K., R.M.), and Center for Cohort Studies (M.K., J.H., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Department of Nephrology, Hypertension, and Strokology, Kyushu University Hospital, Fukuoka, Japan (Y.W., J.K., T.A., T.K.).
Stroke. 2015 Feb;46(2):471-6. doi: 10.1161/STROKEAHA.114.006739. Epub 2014 Dec 30.
Variable sex differences in clinical outcomes after stroke have been reported worldwide. This study aimed to elucidate whether sex is an independent risk factor of poor functional outcome after acute ischemic stroke.
Using the database of patients with acute stroke registered in the Fukuoka Stroke Registry in Japan from 1999 to 2013, 6236 previously independent patients with first-ever ischemic stroke who were admitted within 24 hours of onset were included in this study. Baseline characteristics were assessed on admission. Study outcomes included neurological improvement, neurological deterioration, and poor functional outcome (modified Rankin Scale score, 3-6 at discharge). Logistic regression analyses were performed to evaluate the association between sex and clinical outcomes.
Overall, 2398 patients (38.5%) were women. Severe stroke (National Institutes of Health Stroke Scale score, ≥8) on admission was more prevalent in women than in men. The frequency of neurological improvement or deterioration during hospitalization was not different between the sexes. After adjusting for possible confounders, including age, stroke subtype and severity, risk factors, and poststroke treatments, it was found that female sex was independently associated with poor functional outcome at discharge (odds ratio, 1.30; 95% confidence interval, 1.08-1.57). There was heterogeneity of the association between sex and poor outcome according to age: women had higher risk of poor outcome than men among patients aged ≥70 years, but no clear sex difference was found in patients aged <70 years.
Female sex was associated with the risk of poor functional outcome at discharge after acute ischemic stroke.
全球范围内均有报道称中风后临床结局存在不同的性别差异。本研究旨在阐明性别是否为急性缺血性中风后功能结局不良的独立危险因素。
利用日本福冈中风登记处1999年至2013年登记的急性中风患者数据库，本研究纳入了6236例首次发生缺血性中风且在发病24小时内入院的既往独立患者。入院时评估基线特征。研究结局包括神经功能改善、神经功能恶化以及功能结局不良（改良Rankin量表评分，出院时为3 - 6分）。进行逻辑回归分析以评估性别与临床结局之间的关联。
总体而言，2398例患者（38.5%）为女性。入院时重度中风（美国国立卫生研究院中风量表评分≥8分）在女性中比在男性中更常见。住院期间神经功能改善或恶化的频率在两性之间无差异。在调整了可能的混杂因素，包括年龄、中风亚型和严重程度、危险因素以及中风后治疗后，发现女性性别与出院时功能结局不良独立相关（比值比，1.30；95%置信区间，1.08 - 1.57）。根据年龄，性别与不良结局之间的关联存在异质性：在70岁及以上的患者中，女性比男性有更高的不良结局风险，但在70岁以下的患者中未发现明显的性别差异。
女性性别与急性缺血性中风后出院时功能结局不良的风险相关。
