Ospel Johanna, Singh Nishita, Ganesh Aravind, Goyal Mayank
Department of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.
Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.
J Stroke. 2023 Jan;25(1):16-25. doi: 10.5853/jos.2022.04077. Epub 2023 Jan 31.
There are several controversies regarding the role of sex and gender in the pathophysiology and management of acute stroke. Assessing the role of sex, i.e., biological/pathophysiological factors, and gender, i.e., sociocultural factors, in isolation is often not possible since they are closely intertwined with each other. To complicate matters even more, the functional baseline status of women and men at the time of their first stroke is substantially different, whereby women have, on average, a poorer reported/ascertained baseline function compared to men. These differences in baseline variables account for a large part of the differences in post-stroke outcomes between women and men. Adjusting for these baseline differences is difficult, and in many cases, residual confounding cannot be excluded. Despite these obstacles, a better understanding of how patient sex and gender differences influence acute stroke and stroke care pathways is crucial to avoid biases and allow us to provide the best possible care for all acute stroke patients. Disregarding patient sex and gender on one hand and ignoring potential confounding factors in sex- and gender-stratified analyses on the other hand, may cause researchers to come to erroneous conclusions and physicians to provide suboptimal care. This review outlines sex- and gender-related factors in key aspects of acute stroke, including acute stroke epidemiology, diagnosis, access to care, treatment outcomes, and post-acute care. We also attempt to outline knowledge gaps, which deserve to be studied in further detail, and practical implications for physicians treating acute stroke patients in their daily practice.
关于性别在急性中风的病理生理学和治疗中的作用，存在若干争议。由于生物/病理生理因素（即性别）和社会文化因素（即社会性别）相互紧密交织，常常无法孤立地评估它们各自的作用。更复杂的是，男性和女性首次中风时的功能基线状态存在显著差异，平均而言，女性报告/确定的基线功能比男性更差。这些基线变量的差异在很大程度上解释了男女中风后结局的差异。调整这些基线差异很困难，而且在许多情况下，无法排除残留混杂因素。尽管存在这些障碍，但更好地了解患者的性别差异如何影响急性中风及中风护理途径，对于避免偏见并使我们能够为所有急性中风患者提供尽可能最佳的护理至关重要。一方面忽视患者的性别，另一方面在按性别分层分析中忽略潜在的混杂因素，可能会导致研究人员得出错误结论，医生提供的护理也不够理想。本综述概述了急性中风关键方面中与性别相关的因素，包括急性中风流行病学、诊断、获得治疗的机会、治疗结果以及急性后期护理。我们还试图概述值得进一步详细研究的知识空白，以及对在日常实践中治疗急性中风患者的医生的实际影响。
