心肌梗死合并贫血患者输血策略的性别差异比较：MINT试验预设二次分析
本研究为MINT试验的预设二次分析，纳入3504例急性心肌梗死合并贫血患者，其中女性1593例（45.4%），比较限制性与宽松性红细胞输注策略在不同性别中的临床效果。结果显示主要结局（30天死亡或心肌梗死）在女性和男性中发生率均为15.7%，性别与输血策略间无显著交互作用（交互P=0.60）。研究支持在心肌梗死合并贫血患者中采用性别中立的输血阈值。
要点
- 女性占MINT试验人群近半数，女性和男性主要结局发生率相同（均为15.7%）
- 限制性输注组男性30天心源性死亡风险显著高于宽松组（RR 2.34，95%CI 1.48-3.70）
- 性别与输血策略对主要结局无显著交互作用，支持性别中立输血阈值
核心结论
- 在急性心肌梗死合并贫血患者中，限制性与宽松性输血策略在女性和男性中的主要结局相当，支持性别中立的输血阈值
研究设计与样本
- 基于MINT试验的预设二次分析，纳入3504例急性心肌梗死合并贫血患者，其中女性1593例（45.4%）
- 按性别分层分析限制性与宽松性红细胞输注策略的临床效果
主要发现
- 主要结局（30天死亡或心肌梗死）在女性和男性中均为15.7%，限制组女性16.5%、男性17.1%，宽松组女性14.9%、男性14.2%
- 女性30至180天死亡率低于男性（11.0% vs 13.5%，P=0.04），性别与输血策略对主要结局无显著交互（交互P=0.60）
- 限制性输注组男性30天心源性死亡RR为2.34（95%CI 1.48-3.70，交互P=0.05）
关键数值与推荐
- 主要结局为30天复合终点死亡或心肌梗死，次要结局包括心力衰竭、卒中、心源性死亡和180天死亡率
- 限制性输注组男性30天心源性死亡RR 2.34，95%CI 1.48-3.70，交互P=0.05
临床怎么用
- 在急性心肌梗死合并贫血患者中，临床医生可对女性和男性采用一致的输血阈值策略
- 需关注限制性输血策略下男性心源性死亡风险升高的可能，但整体证据尚不支持按性别差异化输血
局限性
- 本研究为二次分析，预设的性别亚组分析效能可能不足以检测所有交互效应
- 按性别分层后某些次要结局的事件数较少，影响统计推断的稳健性
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: The optimal transfusion strategy in patients with acute myocardial infarction (AMI) and anemia may be influenced by sex differences in pathophysiology and cardiovascular outcomes. The Myocardial Ischemia and Transfusion trial (MINT) randomized patients with AMI and anemia to restrictive or liberal transfusion thresholds, but sex-stratified outcomes remain undefined. The objective was to evaluate whether the clinical effect of restrictive versus liberal red blood cell transfusion strategies differs by sex in patients hospitalized with AMI and anemia. METHODS: In this prespecified secondary analysis of the MINT trial, we examined outcomes by sex and transfusion strategy. The primary outcome was 30-day composite death or MI. Secondary outcomes included heart failure, stroke, cardiac death, and 180-day mortality. Adjusted relative risks (RRs) and hazard ratios (HRs) were estimated accounting for sex differences at baseline. Interactions between sex and transfusion effects were assessed. RESULTS: There were 3504 study participants, of whom 1593 (45.4%) were women. Women received fewer transfusions on average. Primary outcome occurred in 15.7% of women and 15.7% of men and occurred in 16.5% of women and 17.1% of men in the restrictive arm, versus 14.9% and 14.2% in the liberal arm, respectively. Women had a lower mortality between 30 and 180 days (11.0% versus 13.5%; P=0.04). There were no statistically significant interactions between sex and transfusion strategy for the primary outcome (interaction P=0.60). For 30-day cardiac death, a higher RR in men was observed in the restrictive transfusion arm (RR, 2.34; 95% CI, 1.48-3.70; interaction P=0.05). CONCLUSIONS: For MINT patients with anemia and AMI, women comprised nearly half of the study population, and randomization to a restrictive or liberal transfusion strategy resulted in comparable outcomes in women and men. These findings support sex-neutral transfusion thresholds. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02981407.
引用
- Abbott, Benatar, Ballantyne, et al. Comparative Efficacy of Transfusion Strategies in Women and Men With Myocardial Infarction and Anemia: Prespecified Secondary Findings From the MINT Trial. Circulation. 2026. PMID: 42145087. doi:10.1161/CIRCULATIONAHA.125.078320
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。