Влияет ли пол на клинические характеристики ишемического инсульта у пациентов в возрасте 45–74 лет?

Marina Yu. Maksimova1, Aleksandra S. Airapetova1
1ФГБНУ «Научный центр неврологии», Москва, Россия

Аннотация


Введение. Современные исследования направлены на поиск возрастных и гендерных особенностей заболеваемости и смертности, факторов риска, причин развития, тяжести течения, характера восстановления утраченных функций мозга при ишемическом инсульте (ИИ).

Цель исследования — изучить влияние пола на основные клинические характеристики ИИ в бассейне артерий каротидной системы у пациентов в возрасте 45–74 лет, которым не проводились тромболизис и механическая тромбэктомия.

Материалы и методы. Обследованы 124 пациента: 77 (62,1%) мужчин и 47 (37,9%) женщин среднего и пожилого возраста с ИИ в бассейне артерий каротидной системы, поступившие в ФГБНУ НЦН в течение первых 48 ч с момента развития неврологической симптоматики. Устанавливали подтип и тяжесть ИИ, степень функциональной зависимости пациентов, уровень повседневной и двигательной активности.

Результаты. Женщины были старше мужчин в среднем на 4 года (p = 0,018). Медиана возраста женщин составила 67 лет (58–71 год), медиана возраста мужчин — 63 года (58–66 лет). У женщин чаще диагностировали кардиогенный эмболический ИИ, у мужчин — атеротромботический. У мужчин чаще по сравнению с женщинами выявлялся стеноз внутренней сонной артерии более 50% на стороне инфарктов мозга и гипертрофия левого желудочка, среди женщин — дилатация левого предсердия. Существенных различий в клинической картине, тяжести течения острого периода ИИ и характере восстановления утраченных функций мозга между пациентами разного пола не выявлено.

Выводы. У пациентов среднего и пожилого возраста пол не оказывает влияния на тяжесть течения ИИ и темпы восстановления утраченных функций мозга к концу острого периода инсульта.

Для цитирования: Максимова М.Ю., Айрапетова А.С. Влияет ли пол на клинические характеристики ишемического инсульта у пациентов в возрасте 45–74 лет? Анналы клинической и экспериментальной неврологии. 2021. 15(1): 32–42. https://doi.org/10.25692/ACEN.2021.1.4

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Ключевые слова

ишемический инсульт; возраст; факторы риска

Полный текст:

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Литература

Suslina Z.A., Gulevskaya T.S., Maksimova M.Yu., Morgunov V.A. [Cerebral circulation disorders: diagnosis, treatment, prevention]. Moscow, 2016. 536 p. (In Russ.)

Piradov M.A., Tanashyan M.M., Maksimova M.Yu. (eds.) [Stroke: modern diagnostic and treatment technologies]. Moscow, 2018. 360 p. DOI: 10.24421/MP.2018.18.15909. (In Russ.)

Piradov M.A., Maksimova M.Yu., Tanashyan M.M. [Stroke: step by step instructions. A guide for doctors]. Moscow, 2020. 288 p. DOI: 10.33029/9704-5782-5-STR2-2020-1-288. (In Russ.)

West L.A., Cole S., Goodkind D., He W. 65+ in the United States: 2010. Washington, 2010: 23–212.

Asplund K., Karvanen J., Giampaoli S. et al. Relative risks for stroke by age, sex, and population based on follow-up of 18 European populations in the MORGAM Project. Stroke. 2009; 40(7): 2319–2326. DOI: 10.1161/STROKEAHA.109.547869. PMID: 19520994.

Murphy S.J., McCullough L.D., Smith J.M. Stroke in the female: role of biological sex and estrogen. ILAR J. 2004; 45(2): 147–159. DOI: 10.1093/ilar.45.2.147. PMID: 15111734.

Appelros P., Stegmayr B., Terént A. Sex differences in stroke epidemiology: a systematic review. Stroke. 2009; 40(4): 1082–1090. DOI: 10.1161/STROKEAHA.108.540781. PMID: 19211488.

Norris J.W., Zhu C.Z., Bornstein N.M., Chambers B.R. Vascular risks of asymptomatic carotid stenosis. Stroke. 1991; 22(12): 1485–1490. DOI: 10.1161/01.str.22.12.1485. PMID: 1962321.

Mozaffarian D., Benjamin E.J., Go A.S. et al. Heart disease and stroke statistics — 2015 update: a report from the American Heart Association. Circulation. 2015; 131(4): e29–e322. DOI: 10.1161/CIR.0000000000000152. PMID: 25520374.

Lei C., Wu B., Liu M., Chen Y. Risk factors and clinical outcomes associated with intracranial and extracranial atherosclerotic stenosis acute ischemic stroke. J Stroke Cerebrovasc Dis. 2014; 23(5): 1112–1117. DOI: 10.1016/j.jstrokecerebrovasdis.2013.09.024. PMID: 24189455.

de Weerd M., Greving J.P., de Jong A.W.F. et al. Prevalence of asymptomatic carotid artery stenosis according to age and sex systematic review and metaregression analysis. Stroke. 2009; 40(4): 1105–1113. DOI: 10.1161/STROKEAHA.108.532218. PMID: 19246704.

Rossouw J.E. Hormones, genetic factors, and gender differences in cardiovascular disease. Cardiovasc Res. 2002; 53(3): 550–¬7. DOI: 10.1016/s0008-6363(01)00478-3. PMID: 11861025.

Bots M.L., Breslau P.J., Briët E. et al. Cardiovascular determinants of carotid artery disease. The Rotterdam Elderly Study. Hypertension. 1992; 19(6 Pt 2): 717–720. DOI: 10.1161/01.hyp.19.6.717. PMID: 1592472.

Demarin V., Lisak M., Morović S., Čengić T. Low high-density lipoprotein cholesterol as the possible risk factor for stroke. Acta Clin Croat. 2010; 49(4): 429–439. PMID: 21830454.

Wolf P.A., D’Agostino R.B., Kannel W.B. et al. Cigarette smoking as a risk factor for stroke: the Framingham Study. JAMA. 1988; 259(7): 1025–1029. PMID: 3339799.

MacMahon S., Peto R., Collins R. et al. Blood pressure, stroke, and coronary heart disease: part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990; 335(8692): 765–774. DOI: 10.1016/0140-6736(90)90878-9. PMID: 1969518.

Bejot Y., Catteau A., Caillier M. et al. Trends in incidence, risk factors, and survival in symptomatic lacunar stroke in Dijon, France, from 1989 to 2006: a population-based study. Stroke. 2008; 39(7): 1945–1951. DOI: 10.1161/STROKEAHA.107.510933. PMID: 18436869.

Vermeer S.E., Koudstaal P.J., Oudkerk M. et al. Prevalence and risk factors of silent brain infarcts in the population- based Rotterdam Scan Study. Stroke. 2002; 33(1): 21–25. DOI: 10.1161/hs0102.101629. PMID: 11779883.

Arboix A., García-Eroles L., Massons J. et al. Lacunar infarcts in patients aged 85 years and older. Acta Neurol Scand. 2000; 101(1): 25–29. DOI: 10.1034/j.1600-0404.2000.00005.x. PMID: 10660148.

Arboix A., Blanco-Rojas L., Oliveres M. et al. Clinical characteristics of acute lacunar stroke in women: emphasis on gender differences. Acta Neurol Belg. 2014; 114(2): 107–12. DOI: 10.1007/s13760-013-0257-8. PMID: 24194419.

Lim H.S., Willoughby S.R., Schultz C. et al. Effect of atrial fibrillation on atrial thrombogenesis in humans: impact of rate and rhythm. J Am Coll Cardiol. 2013; 61(8): 852–860. DOI: 10.1016/j.jacc.2012.11.046. PMID: 23333141.

Fang M.C., Singer D.E., Chang Y. et al. Gender differences in the risk of ischemic stroke and peripheral embolism in atrial fibrillation the AnTicoagulation and Risk factors in Atrial fibrillation (ATRIA) study. Circulation. 2005; 112(12): 1687–1691. DOI: 10.1161/CIRCULATIONAHA.105.553438. PMID: 16157766.

Kelly-Hayes M., Beiser A., Kase C.S. et al. The influence of gender and age on disability following ischemic stroke: the Framingham study. J Stroke Cerebrovasc Dis. 2003; 12(3): 119–126. DOI 10.1016/S1052-3057(03)00042-9.

Petrea R.E., Beiser A.S., Seshadri S. et al. Gender differences in stroke incidence and poststroke disability in the Framingham heart study. Stroke. 2009; 40(4): 1032–1037. DOI: 10.1161/STROKEAHA.108.542894. PMID: 17903915.

Adams H.P., Bendixen B.H., Kappelle L.J. et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993; 24: 35–41. PMID: 7678184.

Fussner J., Velasco C. Stroke Coordinator Boot Camp. Assessing Stroke — Scores and Scales — American Heart Association. URL: https://www.heart.org

Wang T.J., Massaro J.M., Levy D. et al. A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: The Framingham Heart Study. JAMA. 2003; 290: 1049–1056. DOI: 10.1001/jama.290.8.1049. PMID: 12941677.

Roger V.L., Go A.S., Lloyd-Jones D.M. et al. Executive summary: Heart disease and stroke statistics--2012 update: A report from the American Heart Association. Circulation. 2012; 125: 188–197. DOI: 10.1161/CIR.0b013e3182456d46. PMID: 22215894.

Reeves M.J., Fonarow G.C., Zhao X. et al. Quality of care in women with ischemic stroke in the GWTG program. Stroke. 2009; 40: 1127–1133. DOI: 10.1161/STROKEAHA.108.543157. PMID: 19211482.

Cordonnier C., Sprigg N., Sandset E.C. et al. Stroke in women — from evidence to inequalities. Nat Rev Neurol. 2017; 13(9): 521–532. DOI: 10.1038/nrneurol.2017.95. PMID: 28731036.

Roy-O'Reilly M., McCullough L.D. Age and sex are critical factors in ischemic stroke pathology. Endocrinology. 2018; 159(8): 3120–3131. DOI: 10.1210/en.2018-00465. PMID: 30010821.

Maksimova M.Yu., Chechetkin А.O., Moskvicheva A.S., Shabalina A.A. [Atherothrombotic stroke in women: blood thrombogenicity and the vascular wall]. Annals of clinical and experimental neurology. 2020; 14(1): 25–32. DOI: 10.25692/ACEN.2020.1.3. (In Russ.)

McDermott M., Lisabeth L.D., Baek J. et al. Sex disparity in stroke quality of care in a community-based study. J Stroke Cerebrovasc Dis. 2017; 26(8): 1781–1786. DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.006. PMID: 28479182.

Chalos V., de Ridder I.R., Lingsma H.F. et al. Does sex modify the effect of endovascular treatment for ischemic stroke? Stroke. 2019; 50(9): 2413–2419. DOI: 10.1161/STROKEAHA.118.023743. PMID: 31412753.

Sheth S.A., Lee S., Warach S.J. et al. Sex differences in outcome after endovascular stroke therapy for acute ischemic stroke. Stroke. 2019; 50(9): 2420–2427. DOI: 10.1161/STROKEAHA.118.023867. PMID: 31412752

Ullberg T., Zia E., Petersson J., Norrving B. Changes in functional outcome over the first year after stroke: an observational study from the Swedish stroke register. Stroke. 2015; 46(2): 389–394. DOI: 10.1161/STROKEAHA.114.006538. PMID: 25538204.

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DOI: http://dx.doi.org/10.25692/ACEN.2021.1.4