Center of Medical Information Science, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi 783-8505, Japan; Integrated Center for Advanced Medical Technologies, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku City, Kochi 783-8505, Japan.
J Neurol Sci. 2013 Dec 15;335(1-2):164-8. doi: 10.1016/j.jns.2013.09.023. Epub 2013 Sep 25.
The effects of smoking on clinical outcomes following acute stroke remain controversial.
We evaluated the influence of smoking on 90-day outcomes after acute atherothrombotic stroke in 292 Japanese men extracted from the database of the Edaravone and Argatroban Stroke Therapy for Acute Ischemic Stroke randomized parallel-group trial that tested the safety and efficacy of edaravone and argatroban therapy in 814 patients in 2004-2008. Smokers were matched with non-smokers of the same age for identical age distribution in the smoker and non-smoker groups. Poor 90-day outcomes (defined as death, Barthel index<60, or modified Rankin score>3) were evaluated using a logistic regression model. Significant variables (P<0.05) in univariate analysis were further evaluated by multivariate logistic regression analysis using a forward-selection method.
Body temperature, age, National Institute of Health Stroke Scale score at admission, systolic blood pressure, and smoking status were selected in the final model. Smokers had significantly increased odds of poor 90-day functional outcomes independent of other statistically significant predictor variables (adjusted odds ratio, 2.28; 95% confidence interval, 1.15-4.55; P=0.019).
In Japanese men, smoking leads to poor functional outcomes at 3 months after acute atherothrombotic stroke.
吸烟对急性脑卒中后临床结局的影响仍存在争议。
我们评估了吸烟对 2004 年至 2008 年间 814 例患者接受依达拉奉和阿加曲班治疗急性缺血性脑卒中试验（Edaravone and Argatroban Stroke Therapy for Acute Ischemic Stroke）数据库中 292 例日本男性急性动脉粥样硬化性脑卒中后 90 天结局的影响。该试验比较了依达拉奉和阿加曲班治疗的安全性和有效性。吸烟者按照年龄匹配年龄分布相同的非吸烟者，以纳入吸烟者和非吸烟者组。采用 logistic 回归模型评估 90 天预后不良（定义为死亡、Barthel 指数<60 或改良 Rankin 评分>3）。对单变量分析中具有统计学意义的变量（P<0.05），进一步采用向前选择法进行多变量 logistic 回归分析。
最终模型中选择了体温、年龄、入院时国立卫生研究院卒中量表评分、收缩压和吸烟状况。与其他具有统计学意义的预测变量独立相比，吸烟者发生 90 天预后不良的可能性显著增加（调整后的优势比，2.28；95%置信区间，1.15-4.55；P=0.019）。
在日本男性中，吸烟导致急性动脉粥样硬化性脑卒中后 3 个月的功能结局不良。
