Fredwall Megan, Sternberg Shannon, Blackhurst Dawn, Lee Andrew, Leacock Rodney, Nathaniel Thomas I
University of South Carolina School of Medicine, Greenville, South Carolina.
Greenville Health System, Greenville, South Carolina.
J Stroke Cerebrovasc Dis. 2016 Nov;25(11):2569-2574. doi: 10.1016/j.jstrokecerebrovasdis.2016.06.012. Epub 2016 Sep 8.
Gender differences in the use of recombinant tissue-type plasminogen activator (r-tPA) in stroke are complicated. In this study, we investigated gender differences using r-tPA exclusion criterion in a stroke population.
We analyzed the data from ischemic stroke patients aged 18 years or older from the Greenville Health System stroke registry on r-tPA administration between January 2010 and December 2013. We identified exclusion criterion and used specific clinical factors to determine gender differences in stroke patients receiving r-tPA.
Of the 633 patients who were eligible to receive r-tPA, less than half received r-tPA (n = 241) whereas 422 were not able to receive r-tPA. Of the 241 patients who received r-tPA, 49.4% were female and 50.6% were male. Of the 422 patients who did not receive r-tPA, more women (235) were excluded from r-tPA than men (187) (P < .05). There were no gender differences in warning signs and contraindications in female versus male stroke patients (P > .005). There were however gender differences in age group as more women (38%; n = 235) were more likely to be excluded if they are more than 80 years old than men (19%, n = 187).
Within a large stroke population, exclusion criteria for r-tPA in women and men were similar with regard to race, initial National Institutes of Health Stroke Scale score, warning signs, and contraindications, but were different in the age group population exclusion criterion for intravenous r-tPA. We observed that intracerebral hemorrhage and match on computed tomography perfusion/magnetic resonance imaging or visible infarct greater than one third of the middle cerebral artery distribution were absolute criteria for exclusion.
重组组织型纤溶酶原激活剂（r - tPA）在中风治疗中的性别差异情况较为复杂。在本研究中，我们在中风人群中使用r - tPA排除标准来调查性别差异。
我们分析了格林维尔健康系统中风登记处2010年1月至2013年12月期间18岁及以上缺血性中风患者接受r - tPA治疗的数据。我们确定了排除标准，并使用特定临床因素来确定接受r - tPA治疗的中风患者的性别差异。
在633名有资格接受r - tPA治疗的患者中，不到一半的患者接受了r - tPA（n = 241），而422名患者无法接受r - tPA。在接受r - tPA治疗的241名患者中，女性占49.4%，男性占50.6%。在未接受r - tPA治疗的422名患者中，被排除在r - tPA治疗之外的女性（235名）多于男性（187名）（P < 0.05）。女性与男性中风患者在警示标志和禁忌证方面没有性别差异（P > 0.005）。然而，在年龄组方面存在性别差异，80岁以上的女性（38%；n = 235）比男性（19%，n = 187）更有可能被排除。
在一大群中风患者中，r - tPA在男女中的排除标准在种族、初始美国国立卫生研究院卒中量表评分、警示标志和禁忌证方面相似，但在静脉注射r - tPA的年龄组人群排除标准方面有所不同。我们观察到脑出血以及计算机断层扫描灌注/磁共振成像匹配或可见梗死大于大脑中动脉分布的三分之一是绝对排除标准。
