吸烟对急性缺血性脑卒中静脉溶栓治疗预后的影响  

The Relation between Smoking and Prognosis of Intravenous Thrombolysis in Acute Ischemic Stroke Patients

作　　者：李九如[1] 张万里[1] 王贞[1] 王志敏 黄雪融[3] 邱伟文[4] 梁海燕[5] 金笑平[6] 陆霞[1] 邵蓓[1] 

机构地区：[1]温州医科大学附属第一医院神经内一科,325000 [2]台州市人民医院,318020 [3]温州医科大学附属第三医院,325200 [4]丽水市中心医院,323000 [5]台州市立医院,318000 [6]台州医院,317000

出　　处：《中国临床神经科学》2015年第2期161-167,共7页Chinese Journal of Clinical Neurosciences

基　　金：浙江省科技厅公益技术研究社会发展项目(编号:2011C33017)

摘　　要：目的：探讨吸烟与大动脉粥样硬化性急性缺血性脑卒中（AIS）患者静脉溶栓治疗预后的相关性。方法收集浙江地区就诊于6家大型综合性医院的129例大动脉粥样硬化性AIS患者的临床资料进行分析。其中37例未接受静脉溶栓患者（未溶栓组，均为非吸烟者）；92例在4.5 h内接受重组组织型纤溶酶原激活物（rt-PA）静脉溶栓治疗（溶栓组），再依据是否有吸烟史分为溶栓吸烟组35例和溶栓非吸烟组57例。采用美国国立卫生研究院卒中量表（NIHSS）评价基线情况，改良Rankin评分（mRS）评价3个月后预后，mRS〈2分定义为临床预后良好。比较各组基线特点和3个月预后情况，采用Logistic回归分析探讨吸烟与静脉溶栓预后的相关性。结果未溶栓组90 d预后良好率为8.1%（3/37例）低于溶栓吸烟组[54.3%（19/35例）]和溶栓非吸烟组[24.6%（14/57例）]（χ2=19.631，P=0.000）]。溶栓吸烟组溶栓前接受阿司匹林抗血小板治疗的比例低于溶栓非吸烟组[2.8%（1/35例） vs 17.5%（10/57例）]（χ2=4.443， P=0.047）。溶栓吸烟组年龄低于溶栓非吸烟组[（57.89＆#177;13.32）岁 vs （67.04＆#177;10.12）岁]（t=-3.492，P=0.001）。溶栓吸烟组90 d预后良好率较溶栓非吸烟组高[54.3%（19/35例） vs 24.6%（14/57例）]（χ2=8.329，P=0.004）。二元Logistic回归分析示基线NIHSS（OR=0.767，95%CI：0.669-0.879，P=0.000）、入院血糖（OR=0.822，95%CI：0.695-0.972， P=0.022）、性别（OR=0.251，95%CI：0.071-0.888，P=0.032）、吸烟（OR=12.633，95%CI：3.291-48.487，P=0.000）是AIS静脉溶栓预后良好的独立影响因素。结论在大动脉粥样硬化性AIS患者静脉溶栓后，吸烟患者较非吸烟患者拥有更好的临床结局。Aim To investigate the relation between smoking and prognosis of intravenous thrombolysis in acute atherothrombotic stroke patients. Methods One hundred and twenty-nine acute atherothrombotic stroke patients who came from 6 large general hospitals in Zhejiang were enrolled in this study, including stroke patients treated with rt-PA （92 cases） and stroke patients not treated with rt-PA （37 cases）. The stroke patients treated with rt-PA were divided into two groups：a smoking group （35 cases） and a non-smoking （n=57）. Stroke patients not treated with rt-PA were all non-smoking （37 cases）. Baseline characteristics and prognosis were compared between the groups, and the correlation between smoking and functional outcome after intravenous thrombolysis was analyzed by Logistic regression analysis. Results Compared with rt-PA-smoking group [54.3%（19/35）] （χ2=18.075, P=0.000） and rt-PA-non-smoking group [24.6%（14/57）] （χ2=4.100, P=0.043）, the rate of favorable outcome in non-rt-PA-non-smoking group [8.1%（3/37）] was lower. In the group treated with rt-PA, the rate of having received antiplatelet therapy before treated with rt-PA in smoking group was lower than that in non-smoking group, patients in smoking group were younger than that in non-smoking group. At day 90, patients in smoking group accounted for more favorable outcome （Modiifed Rankin Scale score〈2） than that in non-smoking group [54.3%（19/35）, 24.6%（14/57）] （χ2=8.329, P=0.004）. Logistic regression analysis revealed that the baseline National Institute of Health Stroke Scale （NIHSS） （OR=0.767, 95%CI：0.669-0.879, P=0.000）, blood glucose （OR=0.822, 95%CI：0.695-0.972, P=0.022）, gender （OR=0.251, 95%CI：0.071-0.888, P=0.032）, smoking （OR=12.633, 95%CI：3.291-48.487, P=0.000） were the risk factors for the favorable outcome. Conclusion There was an association between smoking and favorable outcome in acute atherothrombotic stroke patients treated with rt-PA.

关 键 词：吸烟 脑缺血 大动脉粥样硬化 脑卒中 血栓溶解疗法 组织型纤溶酶原激活物 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]