根据发表在《神经外科》（Neurosurgery）杂志上的一个近期关于烟雾病最大规模的研究表明，女性在手术治疗烟雾病后出现不利结果的风险增加。

    烟雾病是一种罕见的疾病，因脑动脉狭窄造成。moyamoya来源于日语，意为冒烟，因患者的病变血管在X线下会出现象是冒烟的表现而得名。尽管该病因不明，研究者相信基因在本病的发展过程中起一定作用。这种病症通常见于少年和儿童，最常见于女性。

    斯坦福大学的Dr Gray K Steinberg和他的团队开展的这项试验发现，烟雾病患者明显受益于手术。然而他们也发现，术后风险在男性和女性中都普遍存在。

    为了明确妇女和女孩在烟雾病手术后有更高的风险，专家们研究了1991-2010年期间，他们做的430例血管重建术的结果。所有的手术都是由Steinberg博士开展完成。研究过程中发现，他们所分析的患者，70%以上是女性，平均年龄31岁，1/3为儿童。鉴于多数患者为双侧脑动脉受阻，Dr steinberg共做了717例次血管重建手术。这种双侧受累的情况，女性比男性多见。

    专家们还发现，手术前女性患者发生短暂性脑缺血发作（TIA）是男性患者的两倍；对于更严重的卒中而言，没有性别差异。

    手术重建血管后，所有患者有类似的结果，但是在术后随访5年中，女性可能更容易遇到一些问题，如卒中，甚至死亡。11.4%的女性患者出现负面影响，相比之下男性患者仅有5.3%。

    作者评论，这些数据提示性别对烟雾病患者的自然进程和术后病程的影响被低估了。专家指出，他们的研究结论是烟雾病对女性的侵害更大，尽管女性出现不良结局的几率较高，但是总体发生率还是比较低的。

    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