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对于CLTI的内血管再血管化的速度和结果的性别差异

Katerina Dangas¹, Joseph M Kim², Siling Li²

¹Richard and Susan Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA.

Journal of vascular surgery

|February 26, 2026

概括

患有慢性四肢威胁性缺血症 (CLTI) 的女性比男性更少接受内血管再血管化,但存活率更高. 然而,女性在手术后的行走能力下降更大.

科学领域:

血管外科血管外科
医疗保健服务研究医疗服务研究
医学中的性别差异.

背景情况:

慢性四肢威胁性缺血 (CLTI) 是外周动脉疾病 (PAD) 的一种严重形式,需要立即重新血管.
关于CLTI内血管再血管化率和患者结果的基于性别的差异,目前的数据有限.
了解这些差异对于优化所有患者的血管护理至关重要.

研究的目的:

为了研究与CLTI相关的内血管再血管化率的性别差异.
为了比较结果,包括死亡率,截肢和功能状态,在男性和女性患者之间进行CLTI的重血管化.
根据性别识别血管护理提供和结果的潜在差异.

主要方法:

从2016年到2023年使用医疗保险服务费索赔的回顾性队列研究.
包括所有为CLTI接受下肢内血管再血管化的患者.
用Kaplan-Meier和Cox回归模型对按性别分层的人口率,基线特征和结果 (死亡率,大/小截肢,重复血管化,门诊状态) 的分析.

主要成果:

总共有333,173名患者接受了再血管化;44.0%是女性,年龄较大,更有可能来自社会经济困境的社区.
与男性相比,女性患者的死亡或重大截肢风险 (HR 0.91),重大截肢风险 (HR 0.82) 和死亡率 (HR 0.93) 的调整风险明显较低.
尽管存活率更高,但女性在重血管化后的循环功能下降的调整风险更高 (HR 1.06).

结论:

女人对CLTI的再血管化率低于男性,并经历了更好的生存结果,但 ambulatory功能下降更大.
这些发现突出了在CLTI管理和结果中基于性别的显著差异.
对推动这些性别差异的可修改因素的进一步研究对于提高PAD男性和女性的血管护理质量至关重要.

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