脑出血扩大及死亡率中的性别差异。
Sex differences in intracerebral hemorrhage expansion and mortality.
作者信息
Marini Sandro, Morotti Andrea, Ayres Alison M, Crawford Katherine, Kourkoulis Christina E, Lena Umme K, Gurol Edip M, Viswanathan Anand, Goldstein Joshua N, Greenberg Steven M, Biffi Alessandro, Rosand Jonathan, Anderson Christopher D
机构信息
Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA.
出版信息
J Neurol Sci. 2017 Aug 15;379:112-116. doi: 10.1016/j.jns.2017.05.057. Epub 2017 May 31.
BACKGROUND AND OBJECTIVE
Due to conflicting results in multiple studies, uncertainty remains regarding sex differences in severity and mortality after intracerebral hemorrhage (ICH). We investigated the impact of sex on ICH severity, expansion, and mortality.
METHODS
We analyzed prospectively collected ICH patients and assessed clinical variables and mortality rate. Mediation analyses were used to examine associations between sex and mortality and sex and hematoma expansion.
RESULTS
2212 patients were investigated, 53.5% male. Men with ICH were younger (72 vs. 77years), had greater smoking and alcohol use, and were more likely to have hypertension, diabetes, hypercholesterolemia and coronary artery disease (all p<0.05). Lobar hemorrhages were more frequent in women (47.6% vs 38.4%, p<0.001). Male sex was a risk factor for hematoma expansion (Odd Ratio (OR) 1.7, 95% confidence interval (CI) 1.15-2.50, p=0.007). Multivariable analysis found that male sex was independently associated with 90-day mortality (OR 2.15 (95% CI 1.46-3.19), p<0.001), and one-year mortality (Hazard Ratio 1.28 (95% CI: 1.09-1.50), p=0.003). Early hematoma expansion mediated a portion of the association between sex and mortality (mediation p=0.02).
CONCLUSIONS
Men with ICH experience a higher risk of both expansion and early and late mortality, even after controlling for known risk factors. Further research is needed to explore the biological mechanisms underlying these observed differences.
背景与目的
由于多项研究结果相互矛盾，脑出血（ICH）后严重程度和死亡率的性别差异仍存在不确定性。我们研究了性别对脑出血严重程度、血肿扩大及死亡率的影响。
方法
我们对前瞻性收集的脑出血患者进行分析，并评估临床变量和死亡率。采用中介分析来检验性别与死亡率以及性别与血肿扩大之间的关联。
结果
共调查了2212例患者，其中男性占53.5%。脑出血男性患者较年轻（72岁对77岁），吸烟和饮酒更多，且更易患高血压、糖尿病、高胆固醇血症和冠状动脉疾病（均p<0.05）。女性叶状出血更常见（47.6%对38.4%，p<0.001）。男性是血肿扩大的危险因素（比值比（OR）1.7，95%置信区间（CI）1.15 - 2.50，p = 0.007）。多变量分析发现，男性与90天死亡率独立相关（OR 2.15（95% CI 1.46 - 3.19），p<0.001），与1年死亡率也独立相关（风险比1.28（95% CI：1.09 - 1.50），p = 0.003）。早期血肿扩大介导了性别与死亡率之间的部分关联（中介p = 0.02）。
结论
即使在控制已知危险因素后，脑出血男性患者仍有更高的血肿扩大风险以及早期和晚期死亡风险。需要进一步研究以探索这些观察到的差异背后的生物学机制。
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