吸烟与冠心病关系的研究

Relations between cigarette smoking and coronary artery disease

目的探讨吸烟与冠心病的发病及预后之间的关系。方法将DESIRE-plus(Drug-E-luting Stent Impact on Revascularization plus)研究中符合本研究的3186例患者分为三组,无吸烟组1714例,已戒烟组462例,在吸烟组1010例。通过分析三组间一般临床情况、冠状动脉造影和血运重建情况以及主要不良心脑血管事件发生率等方面的异同,探讨吸烟与冠心病的发病及预后之间的关系。结果无吸烟组、已戒烟组、在吸烟组三组间年龄、诊断差异有统计学意义,年龄分别为62.5±9.8岁、60.5±9.9岁和55.3±10.3岁(P<0.001);在吸烟组ST段抬高心肌梗死及非ST段抬高心肌梗死的发生率分别为23.0%、5.7%,明显高于无吸烟组(13.1%、4.9%)、已戒烟组(12.3%、3.0%),P<0.001。冠状动脉造影情况也有明显差别,已戒烟组中三支病变及左主干病变分别占45.4%、10.6%,明显高于无吸烟组(39.2%、8.5%)和在吸烟组(35.2%、6.5%),P值分别为0.006和0.024。已戒烟组CABG率(33.8%)明显高于无吸烟组(29.0%)和在吸烟组(24.5%),P=0.001。三组间随访死亡率及总死亡率有明显差别,无吸烟组、已戒烟组、在吸烟组随访死亡率分别为1.6%、3.9%、1.3%(P=0.001),总死亡率分别为1.6%、3.9%、1.3%(P=0.001)。结论吸烟能使冠心病患者发病年龄提前,能促发血脂异常、炎性反应,从而引发冠心病,并有增加主要不良心脑血管事件发生率、随访死亡率、总死亡率的趋势。

Objective To investigate the relations between cigarette smoking and the morbidity and prognosis of coronary artery disease （ CAD）. Methods A total of 3 186 patients were divided into 3 groups： non-smoking group （n = 1 714）, stop-smoking group （n =462） and the smoking （n = 1 010）. All the patients came from the registry study of DESIRE-plus （ Drug-Eluting Stent Impact on Revascularization plus）. We intended to investigate the relations between cigarette smoking and CAD by analyzing the information of genernal clinical data, coronary angiography （ CAG）, Revascularization and major adverse cardiac cerebral vessels events（MACCE）. Results The mean age of patients in the non-smoking group, the stop-smoking group and the smoking group was 62. 5 ± 9. 8, 60. 5 ± 9. 9 and 55.3± 10. 3 years old, respectively （ P 〈 0. 001 ）. The morbidity of STEMI and NSTEMI of the smoking group was higher than that of the other groups （STEMI： 23.0% vs 13.1%, 12. 3%, P 〈0. 001 ; NSTEMI： 5.7% vs 4. 9%, 3.0% , P 〈0. 001）. The incidences of 3-vessel disease and left main disease was higher in the stop-smoking group compared with the non-smoking and the smoking group （3-vessel disease： 45.4% vs 39. 2%, 35.2% ,P = 0. 006; left main disease： 10.6% vs 8.5% , 6. 5%, P =0. 024）. The CABG rates and mortality across the non-smoking group, the non-smoking and the smoking group were 33.8% vs 29. 0% vs 24.5% and l. 6% vs 3.9% vs 1.3%, respectively, both P = 0. 001. Conclusion Cigarette smoking can accelerate the process of CAD, induce inflammatory reaction and tend to increase the rate of MACCE and mortality.