Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China.
Rheumatology (Oxford). 2024 Jul 1;63(7):1917-1922. doi: 10.1093/rheumatology/kead498.
Cigarette smoking is an established risk factor for autoimmune diseases. However, whether smoking plays a clear role in thrombotic APS (TAPS) has not been determined. We aimed to investigate the effects of smoking on the clinical characteristics and prognosis of TAPS.
This was a prospective cohort study from 2013 to 2022. During the study period, 297 patients were diagnosed with TAPS, including 82 smokers and 215 non-smokers. After propensity score matching, 57 smokers and 57 non-smokers matched by age and sex were analysed.
Overall, smokers with TAPS had more cardiovascular risk factors than non-smokers, including hypertension (36.59% vs 14.42%, P < 0.001), obesity (15.85% vs 7.44%, P = 0.029), dyslipidaemia (64.63% vs 48.37%, P = 0.012) and hyperhomocysteinaemia (62.20% vs 36.28%, P < 0.001). Arterial thrombotic events were more common in smokers at diagnosis (62.20% vs 46.05%, P = 0.013), especially myocardial infarction, visceral thrombosis and peripheral vascular thrombosis. After matching, smokers showed balanced cardiovascular risk factors with non-smokers at baseline, but retained a higher prevalence of arterial thrombosis (59.65% vs 33.33%, P = 0.005), mainly distributed in cerebral vascular, cardiovascula and retinal vascular territories. During follow-up, smokers presented a tendency for more recurrent arterial thrombosis and less recurrent venous thrombosis. Smokers had significantly poorer outcomes for organ damage with higher Damage Index for APS score (median 2.00 vs 1.00, P = 0.008), especially in the cardiovascular (26.32% vs 3.51%, P = 0.001), gastrointestinal (15.79% vs 1.75%, P = 0.016) and ophthalmologic (10.53% vs 00.00%, P = 0.027) systems.
Smoking is related to increased arterial events and poor prognosis in TAPS patients. Patients with TAPS should be fully encouraged to avoid smoking.
吸烟是自身免疫性疾病的既定危险因素。然而，吸烟是否对血栓性 APS（TAPS）有明确的作用尚未确定。我们旨在研究吸烟对 TAPS 临床特征和预后的影响。
这是一项 2013 年至 2022 年的前瞻性队列研究。在研究期间，共诊断 297 例 TAPS 患者，其中 82 例为吸烟者，215 例为非吸烟者。经过倾向评分匹配，分析了 57 例年龄和性别匹配的吸烟者和 57 例非吸烟者。
总体而言，TAPS 吸烟者比非吸烟者有更多的心血管危险因素，包括高血压（36.59% vs 14.42%，P<0.001）、肥胖（15.85% vs 7.44%，P=0.029）、血脂异常（64.63% vs 48.37%，P=0.012）和高同型半胱氨酸血症（62.20% vs 36.28%，P<0.001）。吸烟者在诊断时更常见动脉血栓事件（62.20% vs 46.05%，P=0.013），尤其是心肌梗死、内脏血栓和外周血管血栓。匹配后，吸烟者与非吸烟者在基线时的心血管危险因素平衡，但动脉血栓的发生率仍较高（59.65% vs 33.33%，P=0.005），主要分布在脑血管、心血管和视网膜血管区域。在随访期间，吸烟者有更多的复发性动脉血栓形成和较少的复发性静脉血栓形成的趋势。吸烟者的器官损害程度较高，APS 损害指数评分更高（中位数 2.00 vs 1.00，P=0.008），尤其是心血管系统（26.32% vs 3.51%，P=0.001）、胃肠道（15.79% vs 1.75%，P=0.016）和眼科（10.53% vs 0.00%，P=0.027）系统。
吸烟与 TAPS 患者的动脉事件增加和预后不良有关。TAPS 患者应充分鼓励其避免吸烟。
