The Second Hospital of Tianjin Medical University, Tianjin, China; Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China.
Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China.
Am J Med Sci. 2021 Nov;362(5):462-471. doi: 10.1016/j.amjms.2021.05.007. Epub 2021 May 14.
Low total cholesterol (TC) levels were shown to be an independent predictor of intracerebral hemorrhagic stroke in previous studies. However, the role of sex in risk and outcome of patients with ICH and low TC levels is unclear. Therefore, the objective of our study was to assess the sex differences in the risk factors and outcomes after spontaneous intracerebral hemorrhage (ICH) in patients with low TC levels in China.
This study recruited consecutive patients diagnosed with ICH who were admitted to the Stroke Registry System in Tianjin between May 2005 and May 2018. Patients with low TC levels (defined as TC<200 mg/dl) were analyzed in this study. Sex differences in clinical features, risk factors, and outcomes at hospital discharge, 3 months, and 12 months after ICH were evaluated.
Of the 824 patients with low TC levels, 610 men (74%) and 214 women (26%). The mean age at ICH onset was younger in men than in women (60.93±12.54 vs. 64.5±12.28, P<0.001), and men were more likely to have higher educational levels than women. There were higher prevalence rates of hypertension, current smoking status, and alcohol consumption in men. Urinary tract infections were more prevalent in women, and hepatic/renal dysfunctions were more prevalent in men. Women had significantly higher neurological function deficits. With lower Barthel indices (BIs) and higher modified Rankin scale (mRS) scores at admission; but there was no significant difference between men and women in National Institutes of Health Stroke Scale (NIHSS) scores. The study showed that there was no significant difference in mortality and dependency rates at hospital discharge, 3 months, and 12 months after ICH.
Our study showed that there were no sex differences in clinical outcomes of patients with ICH and low TC levels, which suggests that the effect of low cholesterol as a risk factor for cerebral hemorrhage is the same on patients of different sexs. The possible mechanisms need larger, prospective, multicenter studies to further research.
先前的研究表明，总胆固醇（TC）水平较低是颅内出血性卒中的独立预测因子。然而，TC 水平较低的脑出血患者的性别与风险和结局的关系尚不清楚。因此，本研究旨在评估中国 TC 水平较低的脑出血患者的危险因素和结局的性别差异。
本研究纳入了 2005 年 5 月至 2018 年 5 月期间在中国天津市卒中登记系统就诊并诊断为脑出血的连续患者。本研究分析了 TC 水平较低（定义为 TC<200mg/dl）的患者。评估了脑出血后住院、3 个月和 12 个月时性别在临床特征、危险因素和结局方面的差异。
在 824 名 TC 水平较低的患者中，男性 610 例（74%），女性 214 例（26%）。男性脑出血发病时的平均年龄小于女性（60.93±12.54 岁 vs. 64.5±12.28 岁，P<0.001），且男性的受教育程度高于女性。男性高血压、当前吸烟状态和饮酒的患病率较高，而女性尿路感染的患病率较高，男性肝/肾功能异常的患病率较高。女性的神经功能缺损明显更为严重。入院时，女性的 Barthel 指数（BI）较低，改良 Rankin 量表（mRS）评分较高，但 NIHSS 评分在男性和女性之间无显著差异。研究表明，脑出血后住院、3 个月和 12 个月时的死亡率和依赖率无显著差异。
本研究表明，TC 水平较低的脑出血患者的临床结局无性别差异，这表明低胆固醇作为脑出血的危险因素对不同性别的患者的影响是相同的。可能的机制需要更大的、前瞻性的、多中心研究进一步研究。
