Fukuoka Takuya, Nakazato Yoshihiko, Kawasaki Hitoshi, Ikeda Kei, Furuya Tomotsugu, Miyake Akifumi, Mitsufuji Takashi, Ito Yasuo, Takahashi Kazushi, Araki Nobuo, Tahahashi Norio, Yamamoto Toshimasa
Department of Neurology, Saitama Medical University, Japan.
Intern Med. 2018 Jun 15;57(12):1703-1706. doi: 10.2169/internalmedicine.9655-17. Epub 2018 Feb 9.
Objective The purpose of this study was to clarify the clinical features of ischemic patients for whom cigarette smoking was the sole risk factor for ischemic stroke. Methods Among the 1,329 patients (male, n=833; female, n=496) with acute ischemic stroke who were admitted to our hospital between April 2005 and September 2016, 346 (26%) were smokers [male, n=308 (36.9%); female, 38 (7.6%)]. In 42 (3.1%; male, n=41; female, n=1) cases, cigarette smoking was considered to be the sole risk factor for ischemic stroke. Data regarding gender, age, the clinical type of ischemic stroke, the National Institutes of Health Stroke Scale (NIHSS) score at the admission, the modified Rankin scale (mRS) scores before the onset and at discharge, the progression of symptoms, and the recurrence of infarction were investigated. Results The mean age of the 42 patients was 63.2±12.4 years (range, 26-86 years). The clinical types of ischemic stroke included atherothrombosis (n=19), lacunar (n=17), other type (n=2) and undetermined type (n=4). The median NIHSS score at the time of admission for ischemic stroke was 2 (interquartile range: IQR 1-4.25). The median mRS scores before the onset and at the discharge were 0 (IQR 0-0) and 1 (IQR 0-2), respectively. One patient had symptoms of progression; no patients had recurrence of infarction. Conclusion Our findings suggest that cigarette smoking alone may induce ischemic stroke; moreover, patients for whom smoking was the sole risk factor for ischemic stroke showed milder symptoms in comparison to patients with other risk factors; however, ischemic stroke was induced from youth. Since cigarette smoking has detrimental effects on the central nervous system, we suggest that people be encouraged to quit smoking in order to maintain good health.
目的 本研究旨在阐明吸烟是缺血性卒中唯一危险因素的缺血性患者的临床特征。方法 在2005年4月至2016年9月期间我院收治的1329例急性缺血性卒中患者（男性833例，女性496例）中，346例（26%）为吸烟者[男性308例（36.9%），女性38例（7.6%）]。在42例（3.1%；男性41例，女性1例）病例中，吸烟被认为是缺血性卒中的唯一危险因素。调查了患者的性别、年龄、缺血性卒中的临床类型、入院时的美国国立卫生研究院卒中量表（NIHSS）评分、发病前和出院时的改良Rankin量表（mRS）评分、症状进展情况以及梗死复发情况。结果 42例患者的平均年龄为63.2±12.4岁（范围26 - 86岁）。缺血性卒中的临床类型包括动脉粥样硬化血栓形成（19例）、腔隙性（17例）、其他类型（2例）和未定型（4例）。缺血性卒中入院时NIHSS评分的中位数为2（四分位间距：IQR 1 - 4.25）。发病前和出院时mRS评分的中位数分别为0（IQR 0 - 0）和1（IQR 0 - 2）。1例患者有症状进展；无患者发生梗死复发。结论 我们的研究结果表明，仅吸烟可能诱发缺血性卒中；此外，吸烟是缺血性卒中唯一危险因素的患者与有其他危险因素的患者相比症状较轻；然而，缺血性卒中可在年轻时诱发。由于吸烟对中枢神经系统有有害影响，我们建议鼓励人们戒烟以保持健康。
