Ovbiagele Bruce, Weir Christopher J, Saver Jeffrey L, Muir Keith W, Lees Kennedy R
Stroke Center and Department of Neurology, UCLA School of Medicine, Los Angeles, CA 90095, USA.
Cerebrovasc Dis. 2006;21(4):260-5. doi: 10.1159/000091224. Epub 2006 Jan 27.
The status of smoking as a risk factor for the occurrence of stroke is well established. However, there is a paucity of data on the relationship between smoking status and acute stroke outcomes. We evaluated the role of recent smoking as a prognostic factor following acute ischemic stroke.
We analyzed data from patients enrolled in the Intravenous Magnesium Efficacy in Stroke (IMAGES) trial. Outcome measures studied included change in IMAGES stroke score, poor functional outcomes at day 30 and 90 (defined as Rankin Scale >1 and Barthel Index <95), and survival over the first 3 months after stroke. The independent effect of smoking status (subjects who had smoked in the past year) on outcome was evaluated by logistic regression analysis and Cox's proportional hazards model, adjusting for variables known to predict outcome after ischemic stroke.
There were 2,386 subjects in the IMAGES efficacy dataset, including 615 recent or current smokers and 1,771 nonsmokers, among whom smokers were younger (p < 0.0001). After adjusting for covariates, smokers had increased odds of poor 90-day functional outcome independently of other statistically significant predictor variables, as assessed by Rankin Scale (odds ratio 1.38; 95% confidence interval 1.09-1.75) and Barthel Index (odds ratio 1.42; 95% confidence interval 1.13-1.79) at day 90. Smoking status did not affect survival at day 90.
Current or recent smokers experience poorer functional outcomes than nonsmokers 3 months after acute ischemic stroke.
吸烟作为中风发生的危险因素，其地位已得到充分确立。然而，关于吸烟状况与急性中风预后之间关系的数据却很匮乏。我们评估了近期吸烟作为急性缺血性中风后预后因素的作用。
我们分析了参与中风静脉注射镁疗效（IMAGES）试验的患者数据。研究的结局指标包括IMAGES中风评分的变化、第30天和第90天的不良功能结局（定义为Rankin量表>1且Barthel指数<95）以及中风后前3个月的生存率。通过逻辑回归分析和Cox比例风险模型评估吸烟状况（过去一年吸烟的受试者）对结局的独立影响，并对已知可预测缺血性中风后结局的变量进行调整。
IMAGES疗效数据集中有2386名受试者，包括615名近期或当前吸烟者和1771名非吸烟者，其中吸烟者更年轻（p<0.0001）。在调整协变量后，吸烟者90天功能结局不良的几率增加，独立于其他具有统计学意义的预测变量，第90天时根据Rankin量表评估（优势比1.38；95%置信区间1.09 - 1.75）和Barthel指数评估（优势比1.42；95%置信区间1.13 - 1.79）。吸烟状况不影响第90天的生存率。
急性缺血性中风后3个月，当前或近期吸烟者的功能结局比非吸烟者更差。
