目的探讨急性缺血性卒中患者重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)静脉溶栓治疗性别反应性差异及其可能影响因素。方法搜集2012至2013年江苏省临床卒中中心包括南京、徐州和扬州地区,6家三级医院神经内科住院的急性缺血性卒中发病6 h内,行rt-PA静脉溶栓病例,回顾性分析其不同性别之间的基线危险因素,溶栓后颅内出血、卒中并发症发生率、神经功能及预后的差异,并分析不同性别患者溶栓后10~14 d对神经功能产生重要影响的可能相关因素。结果本研究共入组289例患者,其中女性111例,男性178例。女性组平均发病年龄,女性组年龄≥75岁比率,既往有心房颤动、高血压病史,血小板计数、球蛋白、高密度胆固醇、D-二聚体方面等凝血水平,溶栓前平均收缩压水平,心源性栓塞性卒中发生率等高于男性组;在既往吸烟、饮酒史,大动脉粥样硬化性卒中发生率,颅内外磁共振血管造影或计算机断层扫描血管造影术提示的血管内轻度狭窄率低于男性组;而两组在既往脑血管事件、糖尿病病史,血管内无狭窄率、中度及重度狭窄率等方面未见明显性别差异。女性在入院时、溶栓后24 h内及10~14 d时神经功能缺损评分、格拉斯哥昏迷评分、意识受累程度、颅内出血发生率、卒中相关并发症发生率(尤其心血管相关事件发生率)均高于男性组,24 h内及溶栓后10~14 d神经功能缺损评分下降程度低于男性。而24 h内、溶栓后10~14 d症状性脑出血及死亡发生率未见显著性别差异。分别对女性组及男性组发病10~14 d神经功能缺损评分进行线性相关分析,发现入院神经功能缺损评分、早期神经功能改善(24 h内神经功能缺损评分下降≥8分或24 h神经功能缺损评分为0或1分)、溶栓后10~14 d症状性脑出血发生、既往心房颤动病史、基线高密度胆固醇水平与女性患者溶栓后10~14 d神经功能相关。同时,入院神经功能缺损评分、24 h较入院神经功能缺损评分的改善程度,溶栓后10~14 d症状性脑出血发生,发病距离溶栓时间≤180 min发生率与男性患者溶栓后10~14 d神经功能相关。结论在本研究中,女性卒中患者溶栓后神经功能获益不如男性,与入院高密度胆固醇水平、入院神经功能缺损评分、溶栓后24 h内神经功能改善程度、溶栓后症状性脑出血发生、既往有心房颤动病史等因素相关。 Objective To investigate the differences in gender responsiveness and its possible influencing factors in patients with acute ischemic stroke treated by recombinant tissue plasminogen activator (rt-PA). Methods A retrospective analysis was performed on the intravenous thrombolytic therapy of rt-PA within 6 h after onset of acute ischemic stroke hospitalized in Jiangsu Stroke Center, Nanjing, Xuzhou and Yangzhou from 2012 to 2013. The retrospective analysis The baseline risk factors of different genders, intracranial hemorrhage after thrombolysis, the incidence of stroke complications, neurological function and prognosis were analyzed, and the possible correlation between the neurological function and the severity of neurological dysfunction factor. Results A total of 289 patients were enrolled in this study, including 111 females and 178 males. The average age of onset in women, the age group of women ≥75 years old, previous history of atrial fibrillation, history of hypertension, platelet count, globulin, high density cholesterol, D-dimer and other coagulation levels, mean systolic blood pressure before thrombolysis , The incidence of cardioembolic stroke was higher than the male group; in the past, smoking, drinking history, the incidence of major atherosclerotic stroke, intracranial magnetic resonance angiography or computed tomography angiography prompted mild intravascular The stenosis rate was lower than that of the male group. However, there was no significant gender difference between the two groups in the past cerebrovascular events, the history of diabetes mellitus, the intravascular stenosis rate, moderate and severe stenosis rate. Neurological deficit score, Glasgow coma score, degree of consciousness involvement, incidence of intracranial hemorrhage, incidence of stroke-associated complications (especially incidence of cardiovascular-related events) in women at admission, within 24 h after thrombolysis and at 10 to 14 d, Were higher than the male group, within 24 h and 10-14 d after thrombolysis decreased neurological deficit scores lower than men. Within 24 hours, there was no significant gender difference in the incidence of symptomatic intracerebral hemorrhage and death from 10 to 14 days after thrombolysis. Linear correlation analysis of neurological deficit score of 10-14 days in female group and male group respectively showed that admission neurological deficit score and early neurological function improvement (neurologic deficit score decreased ≥8 points or 24-h neurological deficit within 24 hours Score 0 or 1), symptomatic intracerebral hemorrhage 10 to 14 days after thrombolysis, previous history of atrial fibrillation, and baseline high-density cholesterol levels were associated with neurological function 10 to 14 days after thrombolysis in female patients. At the same time, admission neurological deficit score, 24 h after admission neurological deficit score improvement, 10-14 d after thrombolytic symptoms of cerebral hemorrhage, the incidence of thrombolysis time ≤ 180 min incidence of male patients with thrombolysis after 10 ~ 14 d neurological function. Conclusions In this study, the neurological benefit of thrombolytic patients in female stroke patients did not benefit as much as that of males, which was related to the high-density of admission cholesterol, admission neurological deficit score, neurological function improvement within 24 hours after thrombolysis, symptomatic intracerebral hemorrhage after thrombolysis Occurrence, previous history of atrial fibrillation and other factors.