Sex Differences in Patients with First-ever Stroke (in terms of stroke types, risk factors, warning signs and stroke complications)

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나병조

¹

, 정재한

²

, 선종주

²

, 홍진우

²

, 박성욱

³

, 정우상

²

, 문상관

²

, 박정미

³

, 고창남

³

, 조기호

²

, 김영석

²

, 배형섭

³

원 저

Sex Differences in Patients with First-ever Stroke

(in terms of stroke types, risk factors, warning signs and stroke complications) Byung-jo Na

¹

, Jae-han Jung

²

, Jong-joo Sun

²

, Jin-woo Hong

²

,

Seong-uk Park

³

, Woo-sang Jung

²

, Sang-kwan Moon

²

, Jung-mi Park

³

, Chang-nam Ko

³

, Ki-ho Cho

²

, Young-suk Kim

²

, Hyung-sup Bae

³

1

Department of Internal Medicine Kang-Nam Kyung-Hee Oriental Medicine Hospital, College of Oriental Medicine, Kyung-Hee University, Seoul, Korea

2

Department of Cardiovascular & Neurologic Disease (Stroke center) College of Oriental Medicine, Kyung-Hee University

3

Stroke & Neurological Disorders Center, East-West Neo Medical Center, Kyung Hee University Objectives : The objective of this study was to assess whether there were sex differences in stroke types, risk factors, warning signs, and stroke complications among patients with first-ever stroke.

Methods : Six-hundred seventy six patients with first-ever stroke were recruited at the Department Cardiovascular and Neurologic Diseases (Stroke center) of KyungHee University Oriental Hospital, DongGuk University International Hospital, and Kyungwon University In-cheon Oriental Medical Hospital from September 2005 to June 2007. Patients were hospitalized within 28 days after the onset of stroke. We investigated their stroke types, ischemic stroke subtypes by TOAST classification, risk factors, warning signs, stroke complications, general characteristics such as age, sex, etc.

Results : Overall, 347 patients were male and 279 female. Compared with males, female patients were significantly older (mean age 67.3±11.1 versus 62.4±11.6 years) (P=0.000).

We did not find significant sex differences in stroke types or ischemic stroke subtypes by TOAST classification.

History of hypertension was significantly more frequent in female than male patients (P=0.000).

Among stroke complications, urinary tract infection was significantly more frequent in female than male patients (P=0.003).

Among warning signs, blepharospasm was significantly more frequent in female than male patients (P=0.006).

Conclusions : Knowledge of sex differences of stroke patients can help us gain better insights on the characteristics of stroke patients. We need further and larger scale research to acquire more concrete conclusions on this theme.

Key Words : First-ever stroke, sex differences

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2005

2005 31297

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연구방법

1.

연구 대상 1)

2005 10 1 2007 6 30

, ,

(Brain-CT) (Brain-MRI)

28 626 .

2)

,

(Transient ischemic attack, TIA)

(SDH) (EDH)

old lesion

.

2.

임상 연구 조사표

2007 8 17 2007 8 19

2007 9 2

: , 2 994-5

(Tel : 02-3457-9006, Fax : 02-3457-9160, E-mail : [email protected])

This work was supported by the Korea Science and

Engineering Foundation (KOSEF) grant funded by the

Korea government(MOST) (M10527010002-07N2701

-00210).

(3)

.

9)

.

3.

조사변수 1)

, ,

. 2)

Design of the Trial of Org 10172 in Acute Stroke Treatment( TOAST) Large Artery Atherosclerosis( LAA), Cardioembolism(

CE), Small Vessel Occlusion( SVO), Stroke of Other determined Etiology( SOE), Stroke of Undetermined Etiology( SUE)

¹⁰⁾

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2 Brain

MR-diffusion Flare

MR-angio , diffusion

angio Flare

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3 review . Cardioembolism

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3 ,

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,

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,

.

24 . 4)

-

.

“

”

3 .

38.5 ,

(Urinary Analysis) WBC 5/HPF , many bacteria U.T.I(Urinary tract infection)

, Chest X ray

pneumonia ,

hoarseness, sputum, cough U.R.I(Upper respiratory infection) . reattack

,

, seizure

partial seizure .

, X-ray

.

stool occult blood .

4.

통계처리

SPSS(Stastical Program

for Social Science) 12.0K for Windows

(4)

, Student T-test,

Chi-square test . P value

0.05 .

연구 결과

1.

연령

626 64.6

±11.6 . 347 , 279

,

62.4±11.6 , 67.3±11.1

(P=0.000)(Table1).

2.

남녀별 뇌졸중 유형 비교

558 (89.1%),

68 (10.9%) , TOAST

LAA 87 (15.6%), CE 12 (2.2%), SVO 442 (79.2%), SOE 6 (1.1%), SUE 11 (2.0%)

SVO .

310 (89.3%), 37 (10.7%)

, TOAST LAA 49

SOE 2 (0.6%), SUE(1.9%) 6

SVO . 248 (88.9%),

31 (11.1%) . TOAST

LAA 38 (15.3%), CE 7 (2.8%), SVO 194 (78.2%), SOE 4 (1.6%), SUE(2.0%) 5

SVO .

TOAST (Table1).

3.

남녀별 과거력 비교

336 (53.7%)

, 177 (28.3%), 32

(5.1%), 31 (5.0%),

26 (4.2%), TIA 19 (3%) . 160 (46.1%), 100 (28.8%),

, 17 (4.9%),

12 (3.5%), TIA 12 (3.5%) . 176 (63.1%), 77 (27.7%), 15 (5.4%),

14 (5.0%), 12 (3.5%), TIA

7 (2.5%) .

Men Women P Total

Total cases, n(%) 347 279 626

Mean age, y 62.4±11.6 67.3±11.1 0.000 64.6±11.6

Hemorrhage, n(%) 37(10.7) 31(11.1) NS 68(10.9)

Infarction, n(%) 310(89.3) 248(88.9) NS 558(89.1)

LAA, n(%) 49(15.8) 38(15.3) NS 87(15.6)

CE, n(%) 5(1.6) 7(2.8) NS 12(2.2)

SVO, n(%) 248(80.0) 194(78.2) NS 442(79.2)

SOE, n(%) 2(0.6) 4(1.6) NS 6(1.1)

SUE, n(%) 6(1.9) 5(2.0) NS 11(2.0)

Abbreviations: LAA: Large Artery Atherosclerosis, CE: Cardioembolism, SVO: Small Vessel Occlusion, SOE: Stroke of other

determined etiology, SUE: Stroke of Undetermined etiology

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160 (46.1%), 176 (63.1%)

(P=0.000).

, , TIA

(Table2).

4.

남녀별 뇌졸중 합병증 비교

33 (5.3%)

19 (3.0%), 5 (0.8%), 3 (0.5%),

2 (0.3%), 1 (0.2%) .

33 10 (2.9%),

23 (8.2%)

(P=0.003).

Men (n=347)

Women

(n=279) P Total

(n=626) Past History

Hypertension, n(%) 160(46.1) 176(63.1) 0.000 336(53.7)

Diabetes mellitus, n(%) 100(28.8) 77(27.7) NS 177(28.3)

Hyperlipidemia, n(%) 17(4.9) 15(5.4) NS 32(5.1)

Ischemic heart disease, n(%) 17(4.9) 14(5.0) NS 31(5.0)

Atrial fibrillation, n(%) 12(3.5) 14(5.0) NS 26(4.2)

TIA, n(%) 12(3.5) 7(2.5) NS 19(3.0)

Complications

Urinary tract infection, n(%) 10(2.9) 23(8.2) 0.003 33(5.3)

Upper respiratory infection, n(%) 9(2.6) 10(3.6) NS 19(3.0)

Pneumonia, n(%) 2(0.6) 3(1.1) NS 5(0.8)

Reattack, n(%) 2(0.6) 3(1.1) NS 5(0.8)

Bed sores, n(%) 0(0) 3(1.1) NS 3(0.5)

Bone fracture, n(%) 0(0) 2(0.7) NS 2(0.3)

GI bleeding, n(%) 2(0.6) 0(0) NS 2(0.3)

Seizure, n(%) 1(0.3) 0(0) NS 1(0.2)

Warning signs, n(%)

Tension at cervical lesion, n(%) 153(44.1) 122(43.7) NS 275(43.9)

Blephalospasm, n(%) 73(21.0) 86(30.8) 0.006 159(25.4)

One side of numbness, tingling sensation,

dead sensation, n(%) 75(21.6) 67(24.0) NS 142(22.7)

One side paralysis or weakness, n(%) 39(11.2) 44(15.8) NS 83(13.3)

Facial spasm, n(%) 32(9.2) 30(10.8) NS 62(9.9)

Paralysis of 1st, 2nd fingers, n(%) 29(8.4) 27(9.7) NS 56(9.0) Sudden difficulty in speaking or dysarthria, n(%) 21(6.1) 16(5.7) NS 37(5.9)

Blurred and double vision, loss of

vision in an eye or both eye, n(%) 18(5.2) 17(6.1) NS 35(5.6)

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10 (3.6%), 2 (0.6%), 3

(1.1%), 2 (0.6%),

3 (1.1%) .

3 (1.1%), 2 (0.7%)

.

2 (0.6%), 1 (0.3%)

(Table 2).

5.

남녀별 중풍전조증의 비교

275 (43.9%)

, 159 (25.4%),

142 (22.7%),

83 (13.3%), 62 (9.9%),

56 (9.0%), 37

(5.9%), 35 (5.6%)

(Table2).

153 (44.1%)

, 75 (21.6%)

73 (21.0%), 39

(11.2%), 32 (9.2%),

29 (8.4%), 21 (6.1%), 18 (5.2%) (Table2).

122 (43.7%)

, 86 (30.8%),

67 (24.0%), 44

(15.8%), 30 (10.82%), 27 (9.7%),

17 (6.1%), 16 (5.7%), (Table2).

73 (21.0%), 86 (30.8%)

(P=0.006) (Table2).

, ,

(Table2).

고 찰

, ,

4 626

. 62.4±11.6 , 67.3±11.1

(P=0.000).

2,4,5,6,7,8,11,12,13)

.

160 (46.1%), 176 (63.1%)

(P=0.000).

2,4,6,7,11)

. Jaume

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12,13)

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TIA (Table2).

2,7,11)

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13)

4,6,12)

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2,6,7,13)

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2,4,6,7)

11,12)

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cardioembolism 12 (2.2%)

12)

.

10 (2.9%), 23 (8.2%)

(P=0.003).

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, , , ,

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3 (1.1%), 2 (0.7%)

2 (0.6%) (Table 2).

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73 (21.0%), 86

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16,17,18,19)

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20)

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21)

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(Table2).

558 (89.1%), 68 (10.9%)

8.2:1 ,

TOAST SVO 442

SVO .

.

4,6,11)

.

TOAST SVO

248 (80.0%), 194 (78.2%) TOAST

(Table 2).

cardioembolic stroke ,

atherothrombotic stroke

4)

. 28

LAA, CE SVO

.

. ,

, , .

.

2007 ( )

(M10527010002- 07N2701-00210).

참고 문헌

1. . http://www.kosis.kr DB.

2. Moira K. Kapral, Jiming Fang, Michael D.

Hill, Frank Silver, Janice Richards, Cheryl Jaigobin, Angela M. Cheung. Sex Differences in Stroke Care and Outcomes: Results From the Registry of the Canadian Stroke Network.

Stroke 2005;36:809-814.

3. American Stroke Association. Available at http://www.strokeassociation.org.

4. Jaume Roquer, Ana Rodriguez Campello and Meritxell Gomis. Sex Differences in First-Ever Acute Stroke. Stroke 2003;34:1581-1585.

5. Melinda A. Smith, Lynda D. Lisabeth, Devin L. Brown and Lewis B. Morgenstern. Gender comparisons of diagnostic evaluation for ischemic stroke patients. Neurology 2005;

65:855-858.

6. Antonio Di Carlo, Maria Lamassa, Marzia Baldereschi, Giovanni Pracucci, Anna Maria Basile, Charles D.A. Wolfe, Maurice Giroud, Anthony Rudd, Augusto Ghetti and Domenico Inzitari. Sex Differences in the Clinical Presentation, Resource Use, and 3-Month Outcome of Acute Stroke in Europe: Data From a Multicenter Multinational Hospital- Based Registry. Stroke 2003;34:1114-1119.

7. Jayna M. Holroyd-Leduc, Moira K. Kapral,

Peter C. Austin and Jack V. Tu. Sex

Differences and Similarities in the Manag-

(9)

ement and Outcome of Stroke Patients. Stroke 2000;31:1833-1837.

8. , , , , .

. 2007:18(1):26-31.

9. , , , , ,

, , , .

CRF SOP . .

2006;27(1):204-19.

10. Adams HP Jr, Woolson RF, Clarke WR, Davis PH, Bendixen BH, Love BB, Wasek PA, Grimsman KJ. Design of the Trial of Org 10172 in Acute Stroke Treatment(TOAST).

Control Clin Trials. 1997 Aug;18(4):359-77.

11. Eva Lotta Glader, Birgitta Stegmayr, Bo Norrving, Per-Olov Wester, Kjell Asplund.

Sex Differences in Management and Outcome After Stroke. Stroke 2003;34:1970-1975.

12. Melinda A. Smith, Lynda D. Lisabeth, Devin L. Brown and Lewis B. Morgenstern. Gender comparisons of diagnostic evaluation for ischemic stroke patients. Neurology 2005;65:

855-858.

13. Julia Warner Gargano, Mathew J. Reeves. Sex Differences in Stroke Recovery and Stroke- Specific Quality of Life. Results From a Statewide Stroke Registry. Stroke 2007;38:

1-7.

14. . .

: . 2006:393-408.

15. Authors P. Sex-related influences on the frequency and age of onset of primary dystonia. Epidemiologic Study of Dystonia in Europe(ESDE) Collaborative Group. Neurology.

1999;53:1871-3.

16. Grandas F, Lopez-Manzanares L, Traba A.

Transient blepharospasm secondary to unilateral striatal infarction. Mov Disord. 2004;19:1100-2.

17. Jankovic J, Patel SC. Blephrospasm associated with brainstem lesions. Neurology. 1983;

33:1237-40.

18. Larumbe R, Vaamonde J, Artieda J, et al.

Reflex blespharospasm associated with bilateral basal ganglia lesion. Mov Disord. 1993;8:198- 200.

19. Lee MS, Marsden CD. Movement disorders following lesions of the thalamus or subth- alamic region. Mov Disord. 1994;9: 493-507.

20. T etgen, M Muhlau,C Gaser, D Sander.

Bilateral grey-matter increase in the putamen in primary blepharospasm. J Neurol Neurosurg Psychiatry. 2006;77:1017-20.

21. , , , , ,

, , , , , .

.

. 2007;28(1):47-67.