Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (M.A., M.C.V.).
Department of Neurology (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.), Leiden University Medical Center, the Netherlands.
Stroke. 2022 Feb;53(2):345-354. doi: 10.1161/STROKEAHA.120.034040. Epub 2021 Dec 14.
BACKGROUND AND PURPOSE: Women have worse outcomes than men after stroke. Differences in presentation may lead to misdiagnosis and, in part, explain these disparities. We investigated whether there are sex differences in clinical presentation of acute stroke or transient ischemic attack. METHODS: We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Inclusion criteria were (1) cohort, cross-sectional, case-control, or randomized controlled trial design; (2) admission for (suspicion of) ischemic or hemorrhagic stroke or transient ischemic attack; and (3) comparisons possible between sexes in ≥1 nonfocal or focal acute stroke symptom(s). A random-effects model was used for our analyses. We performed sensitivity and subanalyses to help explain heterogeneity and used the Newcastle-Ottawa Scale to assess bias. RESULTS: We included 60 studies (n=582 844; 50% women). In women, headache (pooled odds ratio [OR], 1.24 [95% CI, 1.11-1.39]; I=75.2%; 30 studies) occurred more frequently than in men with any type of stroke, as well as changes in consciousness/mental status (OR, 1.38 [95% CI, 1.19-1.61]; I=95.0%; 17 studies) and coma/stupor (OR, 1.39 [95% CI, 1.25-1.55]; I=27.0%; 13 studies). Aspecific or other neurological symptoms (nonrotatory dizziness and non-neurological symptoms) occurred less frequently in women (OR, 0.96 [95% CI, 0.94-0.97]; I=0.1%; 5 studies). Overall, the presence of focal symptoms was not associated with sex (pooled OR, 1.03) although dysarthria (OR, 1.14 [95% CI, 1.04-1.24]; I=48.6%; 11 studies) and vertigo (OR, 1.23 [95% CI, 1.13-1.34]; I=44.0%; 8 studies) occurred more frequently, whereas symptoms of paresis/hemiparesis (OR, 0.73 [95% CI, 0.54-0.97]; I=72.6%; 7 studies) and focal visual disturbances (OR, 0.83 [95% CI, 0.70-0.99]; I=62.8%; 16 studies) occurred less frequently in women compared with men with any type of stroke. Most studies contained possible sources of bias. CONCLUSIONS: There may be substantive differences in nonfocal and focal stroke symptoms between men and women presenting with acute stroke or transient ischemic attack, but sufficiently high-quality studies are lacking. More studies are needed to address this because sex differences in presentation may lead to misdiagnosis and undertreatment.
背景与目的：女性在中风后比男性的预后更差。表现上的差异可能导致误诊，部分解释了这些差异。我们研究了急性中风或短暂性脑缺血发作患者的临床表现是否存在性别差异。
方法：我们根据系统评价和荟萃分析的首选报告项目进行了系统评价和荟萃分析。纳入标准为：(1)队列、横断面、病例对照或随机对照试验设计；(2)因(疑似)缺血性或出血性中风或短暂性脑缺血发作而入院；(3)在≥1 项非局灶性或局灶性急性中风症状中可能存在性别比较。我们使用随机效应模型进行分析。我们进行了敏感性和亚分析以帮助解释异质性，并使用纽卡斯尔-渥太华量表评估偏倚。
结果：我们纳入了 60 项研究(582844 名患者；50%为女性)。在女性中，头痛(汇总优势比[OR]，1.24 [95%置信区间，1.11-1.39]；I=75.2%；30 项研究)比任何类型中风的男性更常见，意识/精神状态改变(OR，1.38 [95%置信区间，1.19-1.61]；I=95.0%；17 项研究)和昏迷/昏迷(OR，1.39 [95%置信区间，1.25-1.55]；I=27.0%；13 项研究)也更常见。非旋转性头晕和非神经症状等非特异性或其他神经症状在女性中发生频率较低(OR，0.96 [95%置信区间，0.94-0.97]；I=0.1%；5 项研究)。总体而言，局灶性症状的出现与性别无关(汇总 OR，1.03)，但构音障碍(OR，1.14 [95%置信区间，1.04-1.24]；I=48.6%；11 项研究)和眩晕(OR，1.23 [95%置信区间，1.13-1.34]；I=44.0%；8 项研究)更常见，而偏瘫/偏瘫症状(OR，0.73 [95%置信区间，0.54-0.97]；I=72.6%；7 项研究)和局灶性视觉障碍(OR，0.83 [95%置信区间，0.70-0.99]；I=62.8%；16 项研究)在女性中发生频率较低。大多数研究都存在可能的偏倚来源。
结论：在急性中风或短暂性脑缺血发作患者中，男性和女性的非局灶性和局灶性中风症状可能存在实质性差异，但高质量的研究仍然不足。需要更多的研究来解决这个问题，因为表现上的性别差异可能导致误诊和治疗不足。
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