Zhang Peng, Guo Zhen-Ni, Yan Xiu-Li, Zhang Fu-Liang, Yang Yi
Department of Neurology, The First Hospital of Jilin University, Chang Chun, China.
Curr Neurovasc Res. 2022;19(2):203-209. doi: 10.2174/1567202619666220530092614.
To our knowledge, no previous studies have investigated the impact of stroke severity on the smoking paradox after intravenous thrombolysis (IVT). We aimed to explore the contribution of stroke severity to the association between smoking and stroke prognosis after IVT.
We enrolled consecutive patients who received IVT within 4.5 hours from stroke onset. A logistic regression model was used to estimate the unadjusted and adjusted odds ratios (ORs) with their 95% confidence intervals (CIs) for poor functional outcome and mortality at 3 months.
Among patients with moderate stroke, smokers experienced a lower risk of 3-month poor outcomes than non-smokers (33.0% vs. 44.4%, unadjusted OR: 0.616; 95% CI: 0.402-0.945). However, among those with severe stroke, smokers had a higher risk of 3-month poor outcomes than non-smokers (81.6% vs. 55.9%, unadjusted OR: 3.496; 95% CI: 1.207-10.127). After adjustment, the negative correlation between smoking and 3-month poor outcome following IVT lost statistical significance in patients with moderate stroke (OR: 0.677 [95% CI: 0.418-1.097]). However, smoking remained a risk factor for 3-month poor outcomes in patients with severe stroke (OR: 4.216 [95% CI: 1.236-14.385]). We also observed a significant interaction between smoking and stroke severity with regard to the risk of poor functional outcomes (p=0.023). However, no such interaction influenced mortality (p=0.901).
Stroke severity affects the association between smoking and 3-month clinical functional outcomes following IVT.
据我们所知，此前尚无研究调查过静脉溶栓（IVT）后卒中严重程度对吸烟悖论的影响。我们旨在探究卒中严重程度在IVT后吸烟与卒中预后之间关联中的作用。
我们纳入了卒中发作后4.5小时内接受IVT的连续患者。采用逻辑回归模型估计未调整和调整后的比值比（OR）及其95%置信区间（CI），以评估3个月时功能预后不良和死亡率。
在中度卒中患者中，吸烟者3个月预后不良的风险低于非吸烟者（33.0%对44.4%，未调整OR：0.616；95%CI：0.402 - 0.945）。然而，在重度卒中患者中，吸烟者3个月预后不良的风险高于非吸烟者（81.6%对55.9%，未调整OR：3.496；95%CI：1.207 - 10.127）。调整后，IVT后吸烟与3个月预后不良之间的负相关在中度卒中患者中失去统计学意义（OR：0.677[95%CI：0.418 - 1.097]）。然而，吸烟仍是重度卒中患者3个月预后不良的危险因素（OR：4.216[95%CI：1.236 - 14.385]）。我们还观察到吸烟与卒中严重程度在功能预后不良风险方面存在显著交互作用（p = 0.023）。然而，这种交互作用对死亡率无影响（p = 0.901）。
卒中严重程度影响IVT后吸烟与3个月临床功能预后之间的关联。
