Rotimi Oluyemi R, Ajani Iretioluwa F, Penwell Alexandria, Lari Shyyon, Walker Brittany, Nathaniel Thomas I
College of Public health, East Tennessee State University, Johnson City, TN, USA.
School of Medicine Greenville, University of South Carolina, SC, USA.
Womens Health (Lond). 2020 Jan-Dec;16:1745506520922760. doi: 10.1177/1745506520922760.
Clinical factors associated with exclusion from recombinant tissue plasminogen activator in both men and women are not completely understood. The aim of this study is to determine whether there is a gender difference in clinical risk factors that excluded ischemic stroke patients with a history of smoking from recombinant tissue plasminogen activator.
Retrospective data from a stroke registry were analyzed, and multivariable linear regression models were used to determine gender differences. Logistic regression models determined exclusion clinical risk factors for thrombolysis in male and female acute ischemic stroke patients with a history of smoking, while sequentially adjusting for sociodemographic, clinical, and stroke-related variables. The Kaplan-Meier survival analysis was used to determine the exclusion probabilities of men and women with a history of smoking within the stroke population.
Of the 1,446 acute ischemic stroke patients eligible for recombinant tissue plasminogen activator, 379 patients with a history of smoking were examined, of which 181 received recombinant tissue plasminogen activator while 198 were excluded from receiving recombinant tissue plasminogen activator. Of the 198 patients, 75 females and 123 males were excluded from receiving recombinant tissue plasminogen activator. After multivariable adjustment for age, National Institutes of Health scores, and stroke-related factors, females who present with weakness/paresis on initial examination (OR = 0.117, 95% CI, 0.025-0.548) and men who present with a history of previous transient ischemic attack (OR = 0.169, 95% CI, 0.044-0.655), antiplatelet medication use (OR = 0.456, 95% CI, 0.230-0.906), and weakness/paresis on initial examination (OR = 0.171, 95% CI, 0.056-0.521) were less likely to be excluded from recombinant tissue plasminogen activator (thrombolysis therapy).
In an ischemic stroke population with a history of smoking, female smokers are more likely to be excluded from thrombolysis therapy in comparison to men, even after adjustment for confounding variables.
关于男性和女性被排除在重组组织型纤溶酶原激活剂治疗之外的临床相关因素尚未完全明确。本研究旨在确定有吸烟史的缺血性中风患者在被排除接受重组组织型纤溶酶原激活剂治疗的临床风险因素方面是否存在性别差异。
对中风登记处的回顾性数据进行分析，并使用多变量线性回归模型来确定性别差异。逻辑回归模型确定有吸烟史的男性和女性急性缺血性中风患者溶栓治疗的排除临床风险因素，同时依次对社会人口统计学、临床和中风相关变量进行调整。采用Kaplan-Meier生存分析来确定中风人群中有吸烟史的男性和女性的排除概率。
在1446例符合重组组织型纤溶酶原激活剂治疗条件的急性缺血性中风患者中，对379例有吸烟史的患者进行了检查，其中181例接受了重组组织型纤溶酶原激活剂治疗，198例被排除接受重组组织型纤溶酶原激活剂治疗。在这198例患者中，75例女性和123例男性被排除接受重组组织型纤溶酶原激活剂治疗。在对年龄、美国国立卫生研究院卒中量表评分和中风相关因素进行多变量调整后，初次检查时有无力/轻瘫表现的女性（比值比=0.117，95%置信区间，0.025-0.548）以及有既往短暂性脑缺血发作史的男性（比值比=0.169，95%置信区间，0.044-0.655）、使用抗血小板药物（比值比=0.456，95%置信区间，0.230-0.906）和初次检查时有无力/轻瘫表现的男性（比值比=0.171，95%置信区间，0.056-0.521）被排除接受重组组织型纤溶酶原激活剂（溶栓治疗）的可能性较小。
在有吸烟史的缺血性中风人群中，即使在对混杂变量进行调整后，女性吸烟者相比男性更有可能被排除在溶栓治疗之外。
