不同性别脑梗死患者危险因素的比较

Comparison of the risk factors between male and female patients with cerebral infarction

目的探讨不同性别脑梗死患者危险因素的差异。方法回顾性分析2006年全国33家三级甲等医院急性脑梗死住院患者1633例，年龄为18～94岁；男993例，女640例。设计统一调查病例表，内容包括：人口统计学资料（性别、年龄、居住地、文化程度及工作状态等）、既往史及危险因素等。结果①男女脑梗死住院患者的比例为1．55：1。女性发病年龄为（66±12）岁，高于男性的（65±12）岁，两者比较，P=0．049。②青年期（18～45岁）男性脑梗死的发生率显著高于女性，分别为74．39％和25．61％（P〈0．05），其他年龄段亦均高于女性，但差异无统计学意义（P〉0．05）。③两组患者居住地均以市区居高，差异无统计学意义；在男性患者中，中学文化程度以上卒中的发生率居高，女性文化程度低的卒中发生率居高，差异有统计学意义（χ^2=137．8，P=0．000）。女性患者无业人员高于男性，男性国家企业及退休人员患者高于女性，差异有统计学意义（χ^2=124．2，P=0．000）。④男性患者的危险因素分别为：高血压（60．8％）、高龄（41．7％）、吸烟（21．1％）、糖尿病（20．1％）；女性患者的危险因素分别为：高血压（63．9％）、高龄（44．4％）、糖尿病（24．4％）、心脏病（24．2％）。女性脑梗死患者糖尿病、心脏病的发生率高于男性，男性脑梗死患者动脉粥样硬化、吸烟、饮酒的发生率高于女性，差异有统计学意义（P〈0．05）。⑤多元Logistic回归分析，吸烟和饮酒均可以增加肥胖的危险（分别为OR=3．059，95％CI：1．978～4．731；OR=2．330，95％CI：1．221～4．445）。结论①各年龄段男性脑梗死患者所占比例均高于女性。②高血压是所有脑梗死患者的首要危险因素。③吸烟、饮酒或多种危险因素共存，可能是男性脑梗死患者比例高的主要原因，尤其在青年男性中更加显著。④文化程度低及无业女性脑梗死发生率较高。

Objective To investigate the difference of the risk factors between male and female patients with cerebral infarction. Methods A total of 1633 inpatients with acute cerebral infarction （female 640, male 993） aged 18 -94 years old from 33 grade A class Ⅲ hospitals in China in 2006 were analyzed retrospectively. A standardized questionnaire was designed, including demographic data （ gender, age, residence, education and working state）, past history and risk factors, etc. Results ①The proportion of inpatients with cerebral infarction in females and males was 1 ： 1.55 ; the age of female patients was older than that of the males （66 ± 12 vs. 65 ± 12）. ②The incidence of cerebral infarction of male young adults（aged 18 to 45 years） was significantly higher than that in females, and they were 74.39% and 25.61% , respectively. In the other age periods the incidence of cerebral infarction in males was also higher than the females, but there were no significant differences （ P 〉 0. 05 ）.③Most patients in both groups lived in urban areas. The educational level of most male patients with stroke was higher than that of most female patients, and there was significant difference （χ^2 = 137.8, P = 0. 000 ）. The prevalence rate of cerebral infarction in unemployed females were higher than males, but in the male retirees were higher than females, there was significant difference （χ^2 = 124.2, P = 0. 000）. ④The risk factors for males were hypertension （60.8%）, advanced age （41.7%）, smoking （21.1%）, and diabetes mellitus （20.1%）,respectively; the risk factors for females were hypertension （63.9%） , advanced age （44.4%） , diabetes mellitus （24.4%）, and heart disease （24.2%）, respectively. The incidences of diabetes mellitus and heart disease in females were higher than those in males, while the incidences of atherosclerosis, smoking and alcohol consumption in males were higher than those in females, and there were significant differences （P 〈 0.05）. ⑤Multiple logistic regression analysis showed that smoking and alcohol consumption inereased the risk of obesity （OR=3.059, 95% CI 1.978 -4.731 and OR=2.330, 95% CI 1.221 - 4. 445, respectively）. Conclusions The prevalence rate of cerebral infarction in all age groups in males were higher than that in females. Hypertension was the primary risk factor of cerebral infarction in all patients. Smoking, alcohol consumption or coexistence of multiple risk factors may be the main cause of the high incidence of cerebral intaretion in males, especially in young males. Females with lower educated level and professionless has higher incidence of cerebral infarction.