关键词: 女性卒中; 静脉溶栓; 性别差异; 危险因素

Abstract:

Objective To explore the gender differences of recombinant tissue plasminogen activator (rt-PA) thrombolytic treatment in patients with acute ischemic stroke and its potential influential factors. Methods A retrospective case study was conducted based on the data of hospitalized patients within 6 hours after onset of acute ischemic stroke and received rt-PA intravenous treatment of Neurology Departments of six tertiary hospitals in Nanjing, Xuzhou and Yangzhou of Jiangsu clinical stroke centers from 2012 to 2013 year. Baseline risk factors, the incidence of intracranialhemorrhage and stroke complications, difference of neurological function and prognosis after thrombolysis, and the factors associated with neurologic functions after 10~14 d thrombolysis s between different gender were analyzed retrospectively. Results A total of 289 patients were enrolled in the study including 111 in the women group and 178 in the men group. The average age of onset and rate of age ≥75 years old, the rate of atrial fibrillation history and hypertension history, the coagulation levels of serum platelet count, serum globulin, serum high-density lipoprotein cholesterol and serum D-dimer, the average systolic blood pressure before thrombolysis, and the rate of cardiogenic embolic stroke were all higher in women group than in men group, however, the rate of smoke history and drink history, the incidence of large artery atherosclerotic stroke, the incidence of mild intravascular stenosis by intracranial and extracranial magnetic resonance angiography (MRA) or computed tomography angiography (CTA) were all lower in women group than in men group. There were no significant differences in terms of cerebrovascular events history, history of diabetes, the intravascular non-stenosis rate, and moderate and severe intravascular stenosis rate, etc. The National Institutes of Health Stroke Scale (NIHSS) scores and Glasgow Coma Scale (GCS) scores, degree of consciousness involvement, the incidence of intracranial hemorrhage and stroke-related morbidity (especially the incidence of cardiovascularrelated events) at admission, within 24 h and 10~14 d after thrombolysis of women were all higher than men, while neurological function decrease within 24 h and 10~14 d after thrombolysis of women were lower than men. There were no significant differences between the incidence of symptomatic intracerebral hemorrhage (SICH) and death within 24 h or 10~14 d after thrombolysis. The linear correlation analysis demonstrated that admission NIHSS scores, Early Neurological Improvement (ENI) (NIHSS scores decline within 24 h ≥8 scores or NIHSS of 24 h was 0 or 1), SICH within 10~14 d after thrombolysis, atrial fibrillation history, baseline high-density lipoprotein cholesterol levels were all related to 10~14 d NIHSS scores after thrombolysis of women group. Meanwhile, the admission NIHSS scores, the degrees of 24 h NIHSS improvement, the 10~14 d SICH after thrombolysis, the incidence of onset to thrombolysis time ≤180 min were all related to 10~14 d NIHSS scores after thrombolysis of men group. Conclusion This study concludes that women stroke patients benefit less in neurologic functions after thrombolysis than men, which are possibly related to admission high-density cholesterol level, admission NIHSS scores, degree of neurological function improvement after thrombolysis within 24h, SICH after thrombolysis and atrial fibrillation history.

Key words: Women stroke; Intravenous thrombolysis; Gender difference; Risk factor