吸烟与青年脑大动脉粥样硬化性狭窄的相关性分析

The Relationship between Smoking and Cerebral Large-artery Atherosclerotic Stenosis in Young Adults with Ischemic Stroke

目的探讨吸烟与青年缺血性卒中患者脑大动脉粥样硬化性狭窄的相关性。方法2002～2004年于我院神经内科行血管造影检查的青年(18～49岁)脑卒中(包括短暂性脑缺血发作及脑梗死)患者93例,其中73例患者可能存在颅内或颅外大动脉粥样硬化性狭窄作为狭窄组,20例患者无大动脉狭窄作为无狭窄组,对两组患者的吸烟及其他危险因子进行调查。研究变量包括:人口学因子(如年龄、性别)、既往病史(包括高血压、糖尿病、长期吸烟及饮酒史)、实验室检测因子(血浆三酰甘油、高密度脂蛋白、低密度脂蛋白、同型半胱氨酸及血纤维蛋白原)。结果单变量分析发现,两组患者的长期吸烟率、高密度脂蛋白降低率、同型半胱氨酸及三酰甘油的升高率、高密度脂蛋白、纤维蛋白原水平间差别均无显著性意义(P＞0．05)。多变量Logistic回归分析发现,长期吸烟(OR=4．367, 95% CI 1．028-18．554,P=0．046)及血三酰甘油水平升高(OR=3．274,95% CI 1．083-9．900,P=0．036)与青年卒中患者脑大动脉粥样硬化性狭窄的发生有关。结论长期吸烟及血三酰甘油水平升高可能是青年卒中患者脑大动脉粥样硬化性狭窄的独立危险因子,应进行大样本的队列研究加以证实。

Objective To investigate the relationship between smoking and cerebral large-artery atherosclerotic ste- nosis in young adults with ischemic stroke.Methods The study was conducted at Tiantan Hospital during 2002～2004.Ninety -three young adults with ischemic stroke (including cerebral infarction and TIAs) who underwent angiography,aged between 18 and 49 years constituted the study subjects.Among 93 patients,73 were found to have the evidence of intracranial or ex- tracranial cerebral large-artery potential atherosclerotic stenosis (defined as stenotic group),and 20 patients had no stenosis (defined as non-stenotic group).Smoking and other risk factors of cerebrovascular disease were comparatively investigated be- tween the 2 groups.The study variables included the demographic characteristics,such as age and sex;previous medical histo- ry,such as hypertension,diabetes,long-term smoking and long-term alcohol drinking;and laboratory parameters,such as plasma level of triglyceride,high-density lipoprotein,low-density lipoprotein,homocysteine and fibrinogen.Results Uni- variate analysis showed that there were differences between the 2 groups in long-term smoking,homocysteine,triglyceride, high-density lipoprotein and fibrinogen parameters,bat the differences didn't reach statistical significance.Multivariahle logis- tic stepwise regression analysis found that long-term smoking (OR=4.367,95% CI 1.028-18.554,P=0.046) and the high level of plasma triglyceride (OR=3.274,95% CI 1.083-9.900,P=0.036) were 2 independent risk factors of cerebral large-artery potential atherosclerotic stenosis in young adults with ischemic stroke.Conclusion This study suggests that long- term smoking and high level of plasma triglyceride may be 2 independent risk factors of cerebral large artery potential atherosclerot- ic stenosis in young adults with ischemic stroke,and large sample cohort study needs to be conducted to confirm the hypothesis.