背景:在急性主动脉夹层(AAD)中,性别异质性报告并非详尽无遗,部分甚至相互矛盾。
目的:探讨临床特征的性别差异,A型AAD患者的治疗和预后。
方法:对报告A型AAD性别差异的研究(2004-2022年)进行了文献的系统评价和荟萃分析。在检索到的1938年研究中,16(16069名患者,7142名女性和8927名男性)符合所有资格标准。数据汇总使用随机效应模型作为合并风险比和平均差。
结果:由于经过审议的手稿报告的信息,仅在手术治疗的A型AAD患者中进行分析。在医院就诊时,A型AAD女性比男性年龄大,但BMI较低,BSA和肌酐血浆水平。主动吸烟,二叶主动脉瓣和以前的心脏手术在女性中不太常见,而糖尿病更常见。此外,女性比男性更频繁地出现心包积液/心包填塞。有趣的是,住院手术死亡率在不同性别之间没有差异(RR,1.02;95%CI,0.53-1.99;p=0.95),而男性中5(RR0.94;95%CI:0.92-0.97;p<0.001)和10年生存率(RR0.82;95%CI:0.74-0.92;p=0.004)较高.对接受药物治疗的A型AAD患者的住院结局进行的描述性分析证实,男女死亡率都高得令人望而却步(男性58.6%vs女性53.8%,p=0.59)。
结论:女性性别表型在A型AAD中似乎很明显,这意味着需要个性化的患者管理方法以及量身定制的预防策略。PROSPERO注册表ID:CRD42022359072。
关于急性主动脉夹层(AAD)性别异质性的报道并非详尽无遗,部分甚至相互矛盾。临床特征的性别差异,通过系统评价和文献荟萃分析,对A型AAD患者的治疗和结局进行调查.在A型AAD中,女性性别表型似乎很明显,这意味着需要个性化的管理患者方法以及量身定制的预防策略。有趣的是,虽然住院手术死亡率在性别之间没有差异,男性的5年和10年生存率较高。在不久的将来,预计将从国际临床注册和试验中获得明确的性别特异性数据。
In acute aortic dissection (AAD) sex heterogeneity reports are not exhaustive and in part even conflicting.
To explore sex differences in clinical features, management, and outcomes among patients with type A AAD.
A systematic
review and meta-analysis of the literature were conducted for studies (2004-2022) reporting type A AAD sex differences. Among the 1938 studies retrieved, 16 (16 069 patients, 7142 women, and 8927 men) fulfilled all eligibility criteria. Data were aggregated used the random-effects model as pooled risk ratio and mean difference. Due to information reported by considered manuscripts, analysis were performed only among surgically treated type A AAD patients. At the time of hospital presentation type A AAD women were older than men but had lower body mass index (BMI), body surface area (BSA), and creatinine plasma levels. Active smoking, bicuspid aortic valve, and previous cardiac surgery were less common in women while diabetes mellitus was more frequent. Furthermore, women experienced more frequently pericardial effusion/cardiac tamponade than men. Interestingly, in-hospital surgical mortality did not differ between sexes [risk ratio (RR), 1.02; 95% confidence interval (CI), 0.53-1.99; P = 0.95], whereas 5 (RR 0.94; 95% CI: 0.92-0.97; P < 0.001) and 10-year survival (RR 0.82; 95% CI: 0.74-0.92; P = 0.004) was higher among men. A descriptive analysis of in-hospital outcomes among medically treated type A AAD patients confirmed prohibitive high mortality for both sexes (men 58.6% vs. women 53.8%, P = 0.59).
A female sex phenotype appears to be evident in type A AAD implying the need for a personalized management patient approach along with tailored preventive strategies.
CRD42022359072.
Reports regarding sex heterogenicity in acute aortic dissection (AAD) are not exhaustive and in part even conflicting. Sex differences in clinical features, management, and outcomes were investigated among patients with type A AAD through a systematic
review and meta-analysis of literature. A female sex phenotype appears to be evident in type A AAD implying the need for a personalized management patient approach along with tailored preventive strategies. Interestingly, while in-hospital surgical mortality did not differ between sexes, 5- and 10-year survival was higher among men. In the near future, definitive sex-specific data from international clinical registries and trials are expected.