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    根據(jù)發(fā)表在《神經(jīng)外科》（Neurosurgery）雜志上的一個(gè)近期關(guān)于煙霧病最大規(guī)模的研究表明，女性在手術(shù)治療煙霧病后出現(xiàn)不利結(jié)果的風(fēng)險(xiǎn)增加。

    煙霧病是一種罕見的疾病，因腦動(dòng)脈狹窄造成。moyamoya來源于日語，意為冒煙，因患者的病變血管在X線下會(huì)出現(xiàn)象是冒煙的表現(xiàn)而得名。盡管該病因不明，研究者相信基因在本病的發(fā)展過程中起一定作用。這種病癥通常見于少年和兒童，最常見于女性。

    斯坦福大學(xué)的Dr Gray K Steinberg和他的團(tuán)隊(duì)開展的這項(xiàng)試驗(yàn)發(fā)現(xiàn)，煙霧病患者明顯受益于手術(shù)。然而他們也發(fā)現(xiàn)，術(shù)后風(fēng)險(xiǎn)在男性和女性中都普遍存在。

    為了明確婦女和女孩在煙霧病手術(shù)后有更高的風(fēng)險(xiǎn)，專家們研究了1991-2010年期間，他們做的430例血管重建術(shù)的結(jié)果。所有的手術(shù)都是由Steinberg博士開展完成。研究過程中發(fā)現(xiàn)，他們所分析的患者，70%以上是女性，平均年齡31歲，1/3為兒童。鑒于多數(shù)患者為雙側(cè)腦動(dòng)脈受阻，Dr steinberg共做了717例次血管重建手術(shù)。這種雙側(cè)受累的情況，女性比男性多見。

    專家們還發(fā)現(xiàn)，手術(shù)前女性患者發(fā)生短暫性腦缺血發(fā)作（TIA）是男性患者的兩倍；對(duì)于更嚴(yán)重的卒中而言，沒有性別差異。

    手術(shù)重建血管后，所有患者有類似的結(jié)果，但是在術(shù)后隨訪5年中，女性可能更容易遇到一些問題，如卒中，甚至死亡。11.4%的女性患者出現(xiàn)負(fù)面影響，相比之下男性患者僅有5.3%。

    作者評(píng)論，這些數(shù)據(jù)提示性別對(duì)煙霧病患者的自然進(jìn)程和術(shù)后病程的影響被低估了。專家指出，他們的研究結(jié)論是煙霧病對(duì)女性的侵害更大，盡管女性出現(xiàn)不良結(jié)局的幾率較高，但是總體發(fā)生率還是比較低的。

    英文原文：

    Sex Differences in Clinical Presentation and Treatment Outcomes in Moyamoya Disease

    Khan, Nadia MD; Achrol, Achal S. MD; Guzman, Raphael MD; Burns, Terry C. MD, PhD; Dodd, Robert MD, PhD; Bell-Stephens, Teresa RN; Steinberg, Gary K. MD, PhD

    BACKGROUND: Moyamoya （MM） disease is an idiopathic steno-occlusive angiopathy occurring more frequently in females.

    OBJECTIVE: To evaluate sex differences in preoperative symptoms and treatment outcomes after revascularization surgery.

    METHODS: We analyzed 430 MM disease patients undergoing 717 revascularization procedures spanning 19 years （1991-2010） and compared gender differences in preoperative symptoms and long-term outcomes after surgical revascularization.

    RESULTS: A total of 307 female and 123 male patients （ratio, 2.5:1） with a mean age of 31.0 ± 16.7 years and adults-to-children ratio of 2.5:1 underwent 717 revascularization procedures. Female patients were more likely to experience preoperative transient ischemic attacks （odds ratio: 2.1, P = .001） and less likely to receive a diagnosis of unilateral MM disease （odds ratio: 0.6, P = .04）。 No association was observed between sex and risk of preoperative ischemic or hemorrhagic stroke. There was no difference in neurological outcome because both male and female patients experienced significant improvement in the modified Rankin Scale score after surgery （P < .0001）。 On Kaplan-Meier survival analysis, 5-year cumulative risk of adverse postoperative events despite successful revascularization was 11.4% in female vs 5.3% in male patients （P = .05）。 In multivariate Cox proportional hazards analysis, female sex trended toward an association with adverse postoperative events （hazard ratio: 1.9, P = .14）。

    CONCLUSION: Female patients are more susceptible to the development of preoperative transient ischemic attack and may be at higher risk of adverse postoperative events despite successful revascularization. There is, however, no sex difference in neurological outcome because patients of both sexes experience significant improvement in neurological status with low risk of the development of future ischemic events after surgical revascularization.

    ABBREVIATIONS: ΔmRS score, change in modified Rankin Scale score