Christensen Hanne, Bushnell Cheryl
Continuum (Minneap Minn). 2020 Apr;26(2):363-385. doi: 10.1212/CON.0000000000000836.
This article reviews sex differences in stroke risk and presentation, with a particular emphasis on the unique risk factors women experience throughout the lifespan.
Although prior studies suggested women have worse outcomes after stroke, it is now clear that age, prestroke functional status, and comorbidities explain many of the differences between men and women in stroke severity, functional outcomes, and mortality. Several meta-analyses and large cohort studies have evaluated the risk factors for women related to reproductive factors and found that fewer years between menarche and menopause, pregnancy complications (preeclampsia/eclampsia, preterm delivery, and stillbirth), oophorectomy, hormone replacement therapy use, and younger age at menopause all increase the risk of stroke. Although the nonreproductive risks of stroke overlap between men and women, those with greater impact on women include age, hypertension, atrial fibrillation, socioeconomic status, and depression.
Significant sex differences are observed in risk factors of stroke and stroke outcome. Including this information in the clinical assessment of the individual patient may support development of more effective prevention plans.
本文回顾了中风风险和临床表现方面的性别差异，特别强调了女性在整个生命周期中所经历的独特风险因素。
尽管先前的研究表明女性中风后的预后较差，但现在很清楚，年龄、中风前功能状态和合并症解释了男性和女性在中风严重程度、功能结局和死亡率方面的许多差异。几项荟萃分析和大型队列研究评估了与生殖因素相关的女性风险因素，发现初潮和绝经之间的年限较短、妊娠并发症（先兆子痫/子痫、早产和死产）、卵巢切除术、激素替代疗法的使用以及绝经年龄较小都会增加中风风险。尽管中风的非生殖风险在男性和女性之间存在重叠，但对女性影响更大的因素包括年龄、高血压、心房颤动（房颤）、社会经济地位和抑郁症。
在中风风险因素和中风结局方面观察到显著的性别差异。将这些信息纳入个体患者的临床评估中，可能有助于制定更有效的预防计划。
