Song Yunsun, Lee Dongwhane, Suh Dae Chul, Kim Joong-Goo, Kim Jae Kyun, Han Minkyu, Liu Hairi, Zhao Lingbo, Kim Eun Hye, Jung Sung Chul, Lee Dong-Geun, Koo Hyun Jung, Kim Min-Ju, Baek Seunghee, Hwang Seon Moon, Kim Bum Joon, Kim Yeon-Jung, Cho Hong-Jun, Kim Sang Joon, Jeon Sang-Beom, Kim Jong S
Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Neurointervention. 2019 Mar;14(1):43-52. doi: 10.5469/neuroint.2018.01123. Epub 2019 Feb 28.
Cigarette smoking (CS) is one of the major risk factors of cerebral atherosclerotic disease, however, its level of contribution to extracranial and intracranial atherosclerotic stenosis (ECAS and ICAS) was not fully revealed yet. The purpose of our study was to assess the association of CS to cerebral atherosclerosis along with other risk factors.
All consecutive patients who were angiographically confirmed with severe symptomatic cerebral atherosclerotic disease between January 2002 and December 2012 were included in this study. Multivariate logistic regression analyses were performed to identify risk factors for ECAS and ICAS. Thereafter, CS group were compared to non-CS group in the entire study population and in a propensity-score matched population with two different age-subgroups.
Of 1709 enrolled patients, 794 (46.5%) had extracranial (EC) lesions and the other 915 (53.5%) had intracranial (IC) lesions. CS group had more EC lesions (55.8% vs. 35.3%, P<0.001) whereas young age group (<50 years) had more IC lesion (84.5% vs. 47.6%, P<0.001). In multivariate analysis, seven variables including CS, male, old age, coronary heart disease, higher erythrocyte sedimentation rate, multiple lesions, and anterior lesion were independently associated with ECAS. In the propensity-score matched CS group had significant more EC lesion compared to non-CS group (65.7% vs. 47.9%) only in the old age subgroup.
In contrast to a significant association between CS and severe symptomatic ECAS shown in old population, young patients did not show this association and showed relatively higher preference of ICAS.
吸烟是脑动脉粥样硬化疾病的主要危险因素之一，然而，其对颅外和颅内动脉粥样硬化狭窄（ECAS和ICAS）的影响程度尚未完全明确。本研究的目的是评估吸烟与脑动脉粥样硬化以及其他危险因素之间的关联。
本研究纳入了2002年1月至2012年12月期间经血管造影证实患有严重症状性脑动脉粥样硬化疾病的所有连续患者。进行多因素逻辑回归分析以确定ECAS和ICAS的危险因素。此后，在整个研究人群以及倾向评分匹配人群中的两个不同年龄亚组中，将吸烟组与非吸烟组进行比较。
在1709名纳入患者中，794名（46.5%）有颅外（EC）病变，另外915名（53.5%）有颅内（IC）病变。吸烟组有更多的EC病变（55.8%对35.3%，P<0.001），而年轻年龄组（<50岁）有更多的IC病变（84.5%对47.6%，P<0.001）。在多因素分析中，包括吸烟、男性、老年、冠心病、较高的红细胞沉降率、多发病变和前部病变在内的七个变量与ECAS独立相关。在倾向评分匹配中，仅在老年亚组中，吸烟组的EC病变明显多于非吸烟组（65.7%对47.9%）。
与老年人群中吸烟与严重症状性ECAS之间的显著关联相反，年轻患者未表现出这种关联，且表现出相对较高的ICAS偏好。
