斯里兰卡队列中中风的性别差异

Ranawaka Udaya K, Mettananda Chamila D, Nugawela Miyurangi, Pathirana Jithmi, Chandrasiri Jayalath, Jayawardena Champa, Amarasekara Deepa, Hettarachchi Raja, Premawansa Gayani, Pathmeswaran Arunasalam

Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.

Colombo North Teaching Hospital, Ragama, Sri Lanka.

Cerebrovasc Dis. 2024 Dec 10:1-8. doi: 10.1159/000542943.

INTRODUCTION

Stroke characteristics, subtypes, and risk factors in women may differ from men. Data on sex differences in stroke are scarce in developing countries, especially the South Asian region. We aimed to describe the sex differences in patients with stroke admitted to a tertiary care hospital in Sri Lanka.

METHODS

Consecutive patients with stroke enrolled in the Ragama Stroke Registry over 3 years (2020-2023) were studied. Sex differences in demographics, presentation delays, clinical characteristics, stroke subtypes, risk factors, stroke severity, and early functional outcomes were compared using χ2 test, independent sample t test and Wilcoxon rank-sum test. Associations of early functional dependence were studied using multiple logistic regression.

RESULTS

Of 949 patients with stroke, 387 (40.8%) were women, with a median age of 66 (interquartile range [IQR] 57-73) years compared to 63 (IQR 54-70) years in men (p < 0.001). Women had more ischaemic strokes (85.8% vs. 78.6% in men, p = 0.005). Swallowing difficulty (p = 0.039) and bladder involvement (p = 0.001) were more common in women, whereas dysarthria (p = 0.002) and cerebellar signs (p = 0.005) were more common in men. More women had hypertension (74.4% vs. 59.4%, p < 0.001) and diabetes (52.2% vs. 41.6%, p = 0.001), whereas smoking (0.3% vs. 35.1%, p < 0.001), alcohol use (0.3% vs. 55.0%, p < 0.001), and other substance abuse (0.8% vs. 5.2%, p < 0.001) were almost exclusively seen in men. No differences were noted in delays to hospital admission (delay ≥4.5 h: women 45.4% vs. men 41.3%, p = 0.222). There were no sex differences in the rates of CT scanning (women 100% vs. men 99.6%, p = 0.516) or thrombolysis for ischaemic stroke (women 7.8% vs. men 10.2%, p = 0.458), but more men received stroke unit care (women 37.2% vs. men 45.4%, p = 0.012). No differences were noted between sexes in the clinical (Oxfordshire classification, p = 0.671) or aetiological (TOAST criteria, p = 0.364) subtypes of stroke. Stroke severity on admission was similar between sexes (median NIHSS score; women 8.0 vs. men 8.0, p = 0.897). More women had a discharge Barthel index (BI) <60 than men (62.6% vs. 53.5%, p = 0.007), but female sex was not associated with BI <60 on multivariate logistic regression (p = 0.134). There was no difference in in-hospital mortality (women 5.9% vs. men 5.9%, p = 0.963).

CONCLUSIONS

Women with stroke in this Sri Lankan cohort were older, had different risk factor profiles and clinical stroke characteristics, and had more ischaemic strokes. Female sex was not independently associated with functional disability on discharge or in-hospital mortality.

引言

女性的中风特征、亚型和风险因素可能与男性不同。发展中国家，尤其是南亚地区，关于中风性别差异的数据很少。我们旨在描述在斯里兰卡一家三级护理医院住院的中风患者的性别差异。

方法

对连续3年（2020 - 2023年）纳入拉贾马中风登记处的中风患者进行研究。使用卡方检验、独立样本t检验和威尔科克森秩和检验比较人口统计学、就诊延迟、临床特征、中风亚型、风险因素、中风严重程度和早期功能结局方面的性别差异。使用多因素逻辑回归研究早期功能依赖的相关性。

结果

在949例中风患者中，387例（40.8%）为女性，中位年龄为66岁（四分位间距[IQR] 57 - 73岁），而男性为63岁（IQR 54 - 70岁）（p < 0.001）。女性缺血性中风更多见（85.8%对男性的78.6%，p = 0.005）。吞咽困难（p = 0.039）和膀胱受累（p = 0.001）在女性中更常见，而构音障碍（p = 0.002）和小脑体征（p = 0.005）在男性中更常见。更多女性患有高血压（74.4%对59.4%，p < 0.001）和糖尿病（52.2%对41.6%，p = 0.001），而吸烟（0.3%对35.1%，p < 0.001）、饮酒（0.3%对55.0%，p < 0.001）和其他药物滥用（0.8%对5.2%，p < 0.001）几乎仅见于男性。入院延迟方面未发现差异（延迟≥4.5小时：女性45.4%对男性41.3%，p = 0.222）。CT扫描率（女性100%对男性99.6%，p = 0.516）或缺血性中风的溶栓率（女性7.8%对男性10.2%，p = 0.458）无性别差异，但更多男性接受了中风单元护理（女性37.2%对男性45.4%，p = 0.012）。中风的临床（牛津郡分类，p = 0.671）或病因学（TOAST标准，p = 0.364）亚型在性别之间未发现差异。入院时的中风严重程度在性别之间相似（中位NIHSS评分；女性8.0对男性8.0，p = 0.897）。出院时巴氏指数（BI）<60的女性比男性更多（62.6%对53.5%，p = 0.007），但在多因素逻辑回归中，女性性别与BI <60无关（p = 0.134）。住院死亡率无差异（女性5.9%对男性5.9%，p = 0.963）。