James Michael L, Cox Margueritte, Xian Ying, Smith Eric E, Bhatt Deepak L, Schulte Phillip J, Hernandez Adrian, Fonarow Gregg C, Schwamm Lee H
1 Departments of Anesthesiology and Neurology, Duke University Medical Center , Durham, North Carolina.
2 Duke Clinical Research Institute , Durham, North Carolina.
J Womens Health (Larchmt). 2017 Apr;26(4):380-388. doi: 10.1089/jwh.2016.5849. Epub 2016 Oct 18.
Compared to ischemic stroke, sex differences in response to intracerebral hemorrhage (ICH) are largely unexplored, and their potential interactions with patient age have not been examined. This study hypothesized that risk for poor outcome is greater in women with increasing age.
The Get With The Guidelines-Stroke database was used to assess differences between men and women with ICH. Data from 192,826 ICH patients admitted from January 1, 2009 through March 31, 2014 to 1,728 fully participating sites were analyzed using logistic regression to test interactions between age/sex and outcome.
In the total study population, 48.9% were women (median age 75; male median age 67). On admission, women over 65 years were less likely to have atrial fibrillation or dyslipidemia, or use antiplatelet therapy or cholesterol reducers, but more likely to suffer worse neurological deficit than men over 65. As age increased, odds of in-hospital mortality increased in both men and women, although the relationship was stronger in men. Odds of combined mortality and discharge to hospice were similar in men and women with increasing age, but odds for discharge to home and independent ambulation at discharge decreased more in women with increasing age.
After adjusting for covariates, modest sex differences in early outcomes after ICH were linked to age. While statistically significant, detected interactions should be considered in context. Future study may examine whether sex-based interactions represent biologic or treatment differences, unmeasured covariates, or some combination thereof.
与缺血性中风相比，脑出血（ICH）反应中的性别差异在很大程度上尚未得到探索，并且它们与患者年龄的潜在相互作用也未得到研究。本研究假设，随着年龄增长，女性预后不良的风险更大。
使用“遵循指南-中风”数据库评估脑出血男性和女性之间的差异。分析了2009年1月1日至2014年3月31日期间入住1728个完全参与研究地点的192826例脑出血患者的数据，采用逻辑回归分析来检验年龄/性别与预后之间的相互作用。
在整个研究人群中，48.9%为女性（中位年龄75岁；男性中位年龄67岁）。入院时，65岁以上的女性患房颤或血脂异常的可能性较小，使用抗血小板治疗或降胆固醇药物的可能性也较小，但比65岁以上的男性更容易出现更严重的神经功能缺损。随着年龄的增加，男性和女性的院内死亡率均增加，尽管男性的这种关系更强。随着年龄的增加，男性和女性联合死亡率及出院至临终关怀机构的几率相似，但随着年龄的增加，女性出院回家及出院时独立行走的几率下降得更多。
在调整协变量后，脑出血后早期预后的适度性别差异与年龄有关。虽然具有统计学意义，但所检测到的相互作用应结合具体情况考虑。未来的研究可探讨基于性别的相互作用是代表生物学或治疗差异、未测量的协变量，还是它们的某种组合。
