Rehman Sabah, Sahle Berhe W, Chandra Ronil V, Dwyer Mitchell, Thrift Amanda G, Callisaya Michele, Breslin Monique, Phan Hoang T, Otahal Petr, Gall Seana
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
J Neurol Sci. 2019 Nov 15;406:116446. doi: 10.1016/j.jns.2019.116446. Epub 2019 Aug 31.
Aneurysmal subarachnoid haemorrhage (aSAH) disproportionally affects women. We conducted a systematic review and meta-analysis to explore sex differences in aSAH risk factors.
Case-control/cohort studies were searched to November 2017 with sex-specific risk factors for aSAH. Meta-analysis was performed when a risk factor was reported in ≥2 studies.
Of 31 studies, 22 were eligible for meta-analysis. Female sex was associated with greater odds of aSAH (HR 1.90 [1.47-2.46]. There was no detectable difference between the sexes for hypertension (OR: men 3.13 [2.26-4.34]; women 3.65 [2.87-4.63], p = .18), smoking (OR: men 2.96 [1.68-5.21]; women 3.11 [1.21-7.97], p = .95), aSAH family history, systolic blood pressure, age and some genetic variations. Alcohol (OR: men 1.50 [1.04-2.17]; women 0.83 [0.48-1.45], p = .003), high alanine aminotransferase levels, and some gene variants increased the risk of aSAH in men. Reproductive factors, divorce and some genetic variations increased the risk in women. High aspartate aminotransferase levels in men and, diabetes (OR: men 0.57 [0.32-1.01]; women 0.24 [0.13-0.43], p = .01) and parity in women reduced aSAH risk.
We recommend sex-specific re-analysis of existing studies of aSAH risk factors. Known aSAH risk factors (hypertension, smoking and alcohol consumption) should be targeted to prevent aSAH in men and women. Registration PROSPERO (ID: CRD42018091521).
动脉瘤性蛛网膜下腔出血（aSAH）对女性的影响尤为严重。我们进行了一项系统综述和荟萃分析，以探究aSAH危险因素中的性别差异。
检索截至2017年11月的病例对照/队列研究，寻找aSAH的性别特异性危险因素。当一项危险因素在≥2项研究中被报道时，进行荟萃分析。
在31项研究中，22项符合荟萃分析的条件。女性发生aSAH的几率更高（HR 1.90 [1.47 - 2.46]）。高血压（OR：男性3.13 [2.26 - 4.34]；女性3.65 [2.87 - 4.63]，p = 0.18）、吸烟（OR：男性2.96 [1.68 - 5.21]；女性3.11 [1.21 - 7.97]，p = 0.95）、aSAH家族史、收缩压、年龄以及一些基因变异在两性之间未发现可检测到的差异。酒精（OR：男性1.50 [1.04 - 2.17]；女性0.83 [0.48 - 1.45]，p = 0.003）、高丙氨酸转氨酶水平以及一些基因变异增加了男性发生aSAH的风险。生殖因素、离婚以及一些基因变异增加了女性的风险。男性高天冬氨酸转氨酶水平以及糖尿病（OR：男性0.57 [0.32 - 1.01]；女性0.24 [0.13 - 0.43]，p = 0.01）和女性生育次数减少了aSAH风险。
我们建议对现有的aSAH危险因素研究进行性别特异性重新分析。已知的aSAH危险因素（高血压、吸烟和饮酒）应作为预防男性和女性aSAH的目标。登记号：PROSPERO（ID：CRD42018091521）
