Kvistad C E, Oeygarden H, Logallo N, Thomassen L, Waje-Andreassen U, Naess H
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Acta Neurol Scand. 2014 Nov;130(5):299-304. doi: 10.1111/ane.12225. Epub 2014 Feb 15.
Smoking has been associated with improved outcome in thrombolysed patients with myocardial infarction and higher recanalization rates in stroke patients treated with tissue plasminogen activator (tPA). We hypothesized a positive association between smoking and favourable outcome in stroke patients treated with tPA and no such association in acute stroke patients not treated with tPA, suggesting a beneficial effect of smoking on thrombolysis with tPA.
Stroke patients treated with tPA and stroke patients not treated with tPA, but presenting within 6 h after stroke onset, were included in two separate groups. Three groups were defined according to smoking habits: current smoking, previous smoking and no smoking. Functional outcome by modified Rankin Scale (mRS) was assessed after 1 week or at discharge, if discharged earlier. Favourable outcome was defined as mRS 0 or 1.
A total of 399 patients were treated with tPA (94 current smokers, 148 previous smokers and 157 non-smokers), whereas 424 patients were not treated with tPA (90 current smokers, 164 previous smokers and 170 non-smokers). Current smoking was independently associated with favourable outcome in patients treated with tPA when adjusted for confounders (OR 2.08, 95% CI 1.09-3.95, P = 0.025). There was no such association in acute stroke patients not treated with tPA (OR 1.26, 95% CI 0.67-2.36, P = 0.472).
Our study showed an association between current smoking and favourable short-term outcome in stroke patients treated with tPA, but not in acute stroke patients not treated with tPA. This may indicate a more effective thrombolysis with tPA in smokers.
吸烟与心肌梗死溶栓患者预后改善以及组织型纤溶酶原激活剂（tPA）治疗的中风患者再通率升高有关。我们假设吸烟与tPA治疗的中风患者良好预后之间存在正相关，而在未接受tPA治疗的急性中风患者中不存在这种相关性，这表明吸烟对tPA溶栓有有益作用。
接受tPA治疗的中风患者和未接受tPA治疗但在中风发作后6小时内就诊的中风患者被纳入两个独立的组。根据吸烟习惯定义了三组：当前吸烟者、既往吸烟者和不吸烟者。在1周后或更早出院时，采用改良Rankin量表（mRS）评估功能结局。良好结局定义为mRS 0或1。
共有399例患者接受了tPA治疗（94例当前吸烟者，148例既往吸烟者和157例不吸烟者），而424例患者未接受tPA治疗（90例当前吸烟者，164例既往吸烟者和170例不吸烟者）。在调整混杂因素后，当前吸烟与接受tPA治疗的患者的良好结局独立相关（OR 2.08，95%CI 1.09 - 3.95，P = 0.025）。在未接受tPA治疗的急性中风患者中不存在这种相关性（OR 1.26，95%CI 0.67 - 2.36，P = 0.472）。
我们的研究表明，当前吸烟与接受tPA治疗的中风患者的良好短期结局之间存在关联，但在未接受tPA治疗的急性中风患者中不存在这种关联。这可能表明吸烟者使用tPA溶栓更有效。
