Department of Neurology and Stroke Unit, Specialist Hospital, Rydygiera 1, 64-920 Pila, Poland.
Stanisław Staszic University of Applied Sciences in Pila, Poland.
Neurol Neurochir Pol. 2020;54(3):272-276. doi: 10.5603/PJNNS.a2020.0040. Epub 2020 May 29.
We investigated sex differences i n i schaemic s troke p atients t reated w ith i ntravenous a lteplase.
We suggest that it is necessary to improve care for women with atrial fibrillation. Our data suggests that closer evaluation of treatment for ischaemic stroke in men and women is needed, preferably in the form of a prospective study.
This was a multicentre analysis of 1,830 ischaemic stroke patients treated with alteplase from 2004 to 2012. Data was prospectively collected in the Safe Implementation of Treatments in Stroke (SITS) registry. The main outcome measures were symptomatic intracerebral haemorrhage (sICH) within 36 hours of treatment, three months of functional independence, and mortality.
Women were significantly older (mean age 71.3 vs 66.2 years; p < 0.01), more often suffered from hypertension (78.3% vs 70.1%; p < 0.01) and cardio-embolic strokes (34.7% vs 27.1%; p < 0.01), and presented heavier baseline deficits. There were no differences in sICH, but after three months fewer women were functionally independent (46.5% vs 53.3%; p < 0.01) and women had higher mortality (26.0% vs 19.7%; p < 0.01).
Of the ischaemic stroke patients treated with intravenous thrombolysis, women had worse long-term outcomes than men. This discrepancy may be explained by the older age and higher proportion of cardio-embolic strokes with more severe baseline deficits. However, multiple logistic analysis did not show that sex itself had an impact on the greater mortality in women after a stroke, or on the poorer prognosis.
本研究旨在探讨接受阿替普酶静脉溶栓治疗的缺血性脑卒中患者的性别差异。
我们认为有必要改善对伴房颤的女性患者的治疗。我们的数据表明，需要更密切地评估男性和女性缺血性脑卒中患者的治疗效果，最好采用前瞻性研究。
这是一项对 2004 年至 2012 年间接受阿替普酶治疗的 1830 例缺血性脑卒中患者的多中心分析。数据在安全实施溶栓治疗卒中（SITS）登记处进行前瞻性收集。主要结局测量指标为治疗后 36 小时内的症状性颅内出血（sICH）、三个月的功能独立性和死亡率。
女性患者年龄明显较大（平均年龄 71.3 岁比 66.2 岁；p < 0.01），更常患有高血压（78.3%比 70.1%；p < 0.01）和心源性脑栓塞（34.7%比 27.1%；p < 0.01），且基线缺损更严重。两组 sICH 无差异，但三个月后女性功能独立性较差（46.5%比 53.3%；p < 0.01），死亡率较高（26.0%比 19.7%；p < 0.01）。
在接受静脉溶栓治疗的缺血性脑卒中患者中，女性的长期预后比男性差。这种差异可能是由于年龄较大、心源性脑栓塞比例较高以及基线缺损更严重导致的。然而，多元逻辑分析并未表明性别本身对女性脑卒中后死亡率增加或预后较差有影响。
