吸烟与溶栓的关系取决于缺血性卒中亚型。
Smoking-Thrombolysis Relationship Depends on Ischemic Stroke Subtype.
作者信息
Tong Xu, Wang Chunjuan, Liao Xiaoling, Pan Yuesong, Yan Hongyi, Cao Yibin, Liu Liping, Zheng Huaguang, Zhao Xingquan, Wang Chunxue, Li Hao, Wang David, Wang Yilong, Wang Yongjun
机构信息
From the Department of Neurology (X.T., Chunjuan Wang, X.L., Y.P., H.Y., L.L., H.Z., X.Z., H.L., Yilong Wang, Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke (Chunjuan Wang, Y.P., H.Y., H.L., Yilong Wang, Yongjun Wang), Vascular Neurology (X.L., H.Z., X.Z., Yongjun Wang), Neuro-intensive Care Unit (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, Hebei, China (X.T., Y.C.); China National Clinical Research Center for Neurological Diseases, Beijing, China (X.L., L.L., H.Z., X.Z., Chunxue Wang, H.L., Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China (Chunjuan Wang); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China (Y.P.); and Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
出版信息
Stroke. 2016 Jul;47(7):1811-6. doi: 10.1161/STROKEAHA.116.013124. Epub 2016 May 24.
BACKGROUND AND PURPOSE
The relationship between smoking and the outcome in patients received thrombolysis is undetermined. The outcome could be influenced by different stroke subtypes. This study aimed to explore whether smoking had any impact on the outcome in patients with stroke of different subtypes who received intravenous thrombolysis.
METHODS
All patients who received intravenous thrombolysis within 4.5 hours after symptom onset from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) database were eligible to be entered into this analysis. Smokers were considered if they smoked at least 1 cigarette/d for >6 months before stroke. Ischemic stroke subtype was classified by using the Trial of Org 10172 in Acute Stroke Treatment criteria. Outcome measurements included post-intravenous thrombolysis symptomatic intracranial hemorrhage within 7 days, mortality, and functional independence at 90 days. The relationship between smoking and thrombolysis was analyzed by using univariate and multivariate logistic regression models.
RESULTS
Of 1118 patients enrolled, we identified 454 smokers and 664 nonsmokers. After stratifying for ischemic stroke subtypes, multivariate analysis revealed a significant relationship between smoking and functional independence in patients with noncardioembolism stroke subtypes (large artery atherosclerosis: odds ratio [OR], 1.452; 95% confidence interval [CI], 1.053-2.264; small artery occlusion: OR, 4.275; 95% CI, 1.098-16.649; other: OR, 3.120; 95% CI, 1.162-8.373). Furthermore, smoking was specially related to lower rates of symptomatic intracranial hemorrhage (OR, 0.316; 95% CI, 0.120-0.832) and mortality (OR, 0.272; 95% CI, 0.128-0.577) in patients with large artery atherosclerosis subtype.
CONCLUSIONS
In patients treated with intravenous thrombolysis, smoking could be related to a better chance of functional independence if their subtype of stroke was noncardioembolic, and a lower risk of symptomatic intracranial hemorrhage and mortality in those with large artery atherosclerosis.
背景与目的
吸烟与接受溶栓治疗患者的预后之间的关系尚不确定。预后可能受不同卒中亚型的影响。本研究旨在探讨吸烟对接受静脉溶栓治疗的不同亚型卒中患者的预后是否有任何影响。
方法
从中国急性缺血性卒中溶栓实施与监测（TIMS-中国）数据库中纳入症状发作后4.5小时内接受静脉溶栓治疗的所有患者进行本分析。如果患者在卒中前至少6个月每天吸烟至少1支，则视为吸烟者。采用急性卒中治疗中Org 10172试验标准对缺血性卒中亚型进行分类。结局指标包括静脉溶栓后7天内症状性颅内出血、死亡率以及90天时的功能独立性。采用单因素和多因素逻辑回归模型分析吸烟与溶栓之间的关系。
结果
在纳入的1118例患者中，我们确定了454例吸烟者和664例非吸烟者。在对缺血性卒中亚型进行分层后，多因素分析显示，在非心源性栓塞性卒中亚型患者中，吸烟与功能独立性之间存在显著关系（大动脉粥样硬化：比值比[OR]，1.452；95%置信区间[CI]，1.053 - 2.264；小动脉闭塞：OR，4.275；95% CI，1.098 - 16.649；其他：OR，3.120；95% CI，1.162 - 8.373）。此外，吸烟与大动脉粥样硬化亚型患者较低的症状性颅内出血发生率（OR，0.316；95% CI，0.120 - 0.832）和死亡率（OR，0.272；95% CI，0.128 - 0.577）特别相关。
结论
在接受静脉溶栓治疗的患者中，如果卒中亚型为非心源性栓塞性，吸烟可能与更好的功能独立性机会相关，而在大动脉粥样硬化患者中，吸烟与症状性颅内出血和死亡率的风险较低相关。
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