静脉溶栓治疗患者中卒中模拟的性别特异性差异的中介因素：一项全国性分析，共纳入 174995 例患者。

Mediators of sex-specific differences in rates of stroke mimics among patients treated with intravenous thrombolysis: A nationwide analysis of 174,995 patients.

机构信息

National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA; Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA.

Warren Alpert Medical School, Brown University, Providence, RI, USA; Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.

出版信息

J Stroke Cerebrovasc Dis. 2024 Dec;33(12):108021. doi: 10.1016/j.jstrokecerebrovasdis.2024.108021. Epub 2024 Sep 18.

DOI:10.1016/j.jstrokecerebrovasdis.2024.108021

PMID:39303869

Abstract

INTRODUCTION

Women are at higher risk of stroke mimics; however, the underlying reasons are unclear.

METHODS

In this retrospective cohort study of the 2016-2020 National Inpatient Sample database, we identified patients treated with intravenous thrombolysis (IVT). Demographic information, vascular risk factors, comorbidities, and presence of known risk factors for stroke mimics (seizures, migraines, demyelinating diseases, psychiatric illnesses, and functional neurological disorders [FND]) were identified using ICD-10 codes. Rates of no cerebral infarction (NCI) were compared between men and women. Mediation analyses were conducted to identify significant drivers of sex-specific differences in the rate of NCI.

RESULTS

174,995 IVT-treated patients were identified; 41,605 (23.8 %) had NCI. Female patients had significantly higher rates of NCI compared to men (26.2 % vs. 20.9 %, p < 0.001). Women had significantly higher rates of stroke mimic risk factors (seizures, migraines, demyelinating disease, anxiety, depression, FND, and electrolyte derangements; all p < 0.001). Mediation analyses revealed that 39.8 %, 19.1 % of female sex's association with higher rates of NCI were mediated by higher rates of migraines and FND among women, respectively (both p < 0.001).

CONCLUSIONS

IVT-treated women were more likely to have NCI than men. This relationship was largely mediated by higher rates of migraine and FND among women.

摘要

简介

女性发生卒中样发作的风险更高；然而，其潜在原因尚不清楚。

方法

在这项回顾性队列研究中，我们对 2016 年至 2020 年国家住院患者样本数据库中的静脉溶栓治疗患者进行了研究。使用 ICD-10 编码确定了接受静脉溶栓治疗的患者的人口统计学信息、血管危险因素、合并症以及已知的卒中样发作的危险因素（癫痫发作、偏头痛、脱髓鞘疾病、精神疾病和功能性神经障碍[FND]）。比较了男性和女性患者的无脑梗死（NCI）发生率。进行中介分析以确定性别差异导致 NCI 发生率的显著驱动因素。

结果

共纳入 174995 例接受 IVT 治疗的患者，其中 41605 例（23.8%）发生了 NCI。与男性相比，女性患者的 NCI 发生率明显更高（26.2%比 20.9%，p<0.001）。女性具有更高的卒中样发作危险因素发生率（癫痫发作、偏头痛、脱髓鞘疾病、焦虑、抑郁、FND 和电解质紊乱；均p<0.001）。中介分析显示，女性较高的 NCI 发生率与女性较高的偏头痛和 FND 发生率分别相关（均p<0.001），这两者分别介导了女性性别与较高的 NCI 发生率相关的 39.8%和 19.1%。