Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Gyeonggi, South Korea.
Department of Neurology, Kyung Hee University, College of Medicine, Seoul, South Korea.
Transl Stroke Res. 2018 Jun;9(3):267-273. doi: 10.1007/s12975-017-0579-6. Epub 2017 Oct 24.
Several studies, but not all, have shown that women benefit more from intravenous thrombolysis than men; few have accounted for pre-stroke mobility. Our aim was to determine whether there was an interaction between gender and thrombolysis treatment in 3-month modified Rankin Scale (mRS) score, after adjusting for pre-stroke mobility. We retrospectively reviewed medical records of 1390 consecutive ischemic stroke patients admitted between October 2012 and July 2015. The 3-month mRS was obtained from clinic visits. Thrombolysis-by-gender interaction was evaluated in univariate and multivariate analyses using ordinal logistic ("shift") regression with the full mRS range from 0 to 6 as the dependent variable. We included 926 (456 women and 470 men) patients with follow-up. Women were older (mean age 68.1 vs 65.8 years, P = 0.013), less likely to be treated with thrombolysis (15.6 vs 24.0%, P = 0.002), less often discharged to home (49.1 vs 59.6%, P = 0.001), and more likely to use ambulation aids pre-stroke (13.6 vs 8.5%, P = 0.014).Women had worse outcomes than men in those not treated with thrombolysis (mRS ≥ 3: 55.1 vs 40.1%, P < 0.001). In those who received thrombolysis, there were no gender differences (47.9 vs 50.4%, P = 0.736). In multivariable modeling, there was a significant gender-treatment interaction (P < 0.001), after adjustment for gender, pre-stroke ambulation aid use, age, age-by-gender interaction, initial stroke severity, diabetes, heart failure, and prior stroke. Our results show that women benefit from thrombolysis more than men, and the thrombolysis-by-gender interaction persists after adjustment for pre-stroke mobility impairment.
一些研究表明，女性从静脉溶栓治疗中获益多于男性；但很少有研究考虑到卒中前的活动能力。我们的目的是确定在调整卒中前活动能力后，性别和溶栓治疗之间是否存在 3 个月改良 Rankin 量表（mRS）评分的交互作用。我们回顾性分析了 2012 年 10 月至 2015 年 7 月期间连续收治的 1390 例缺血性卒中患者的病历。通过临床就诊获得 3 个月 mRS。使用 ordinal logistic（“移位”）回归，将 0 至 6 分的全 mRS 范围作为因变量，在单变量和多变量分析中评估溶栓治疗的性别交互作用。我们纳入了 926 例（女性 456 例，男性 470 例）有随访的患者。女性年龄更大（平均年龄 68.1 岁 vs. 65.8 岁，P=0.013），接受溶栓治疗的可能性更小（15.6% vs. 24.0%，P=0.002），出院回家的可能性更小（49.1% vs. 59.6%，P=0.001），卒中前使用助行器的可能性更大（13.6% vs. 8.5%，P=0.014）。在未接受溶栓治疗的患者中，女性的结局比男性差（mRS≥3：55.1% vs. 40.1%，P<0.001）。在接受溶栓治疗的患者中，性别间无差异（47.9% vs. 50.4%，P=0.736）。在多变量模型中，调整性别、卒中前使用助行器、年龄、年龄与性别交互作用、初始卒中严重程度、糖尿病、心力衰竭和既往卒中后，存在显著的性别-治疗交互作用（P<0.001）。我们的结果表明，女性从溶栓治疗中获益多于男性，且在调整卒中前活动能力障碍后，溶栓治疗的性别交互作用仍然存在。
