吸烟对脑梗死患者脑血管反应性的影响

Effects of Smoking on Cerebrovascular Reactivity in Patients with Cerebral Infarction

目的探讨吸烟对脑梗死患者脑血管反应性的影响。方法前瞻性连续纳入2018年1月-2019年1月于深圳市人民医院神经内科住院治疗的发病1周内的急性脑梗死患者,应用经颅多普勒超声以屏气指数(breath-holding index,BHI)评价脑血管对高碳酸血症的反应性。根据脑血管反应性(cerebrovascular reactivity,CVR)是否正常,分为BHI正常组与BHI受损组。将两组临床资料进行单因素分析,将有统计学意义的变量(P<0.05)进行多因素Logistic回归分析。计算ROC曲线下面积,从而判断吸烟对脑梗死患者CVR结局的早期预测价值。结果共纳入112例患者,BHI受损组(76例)的吸烟、高血压病、颅内动脉狭窄的比例明显高于BHI正常组(36例)(56.6%vs 30.6%,P=0.01;85.5%vs 66.7%,P=0.021;47.4%vs 25%,P=0.024)。高尿酸血症的患病率低于BHI正常组(10.5%vs 25%,P=0.046)。多因素Logistic回归分析结果显示吸烟(OR 3.438,95%CI 1.397~8.463,P=0.007)、高血压病(OR 3.075,95%CI 1.110~8.518,P=0.031)、颅内动脉狭窄(OR 2.571,95%CI 1.016~6.506,P=0.046)是脑梗死患者CVR受损的独立危险因素。绘制吸烟的ROC曲线下面积为0.630(95%CI 0.521~0.740,P=0.027),吸烟预测脑梗死患者CVR受损的敏感度为56.6%,特异度为69.4%。结论吸烟、高血压病、颅内动脉狭窄是脑梗死患者CVR受损的独立危险因素,吸烟对脑梗死患者CVR受损具有一定的预测价值。

Objective To investigate the effect of smoking on cerebralvascular reactivity in patients with cerebral infarction.Methods Consecutive patients with acute cerebral infarction within one week of onset who were admitted to Department of Neurology of Shenzhen People’s Hospital from January 2018 to January 2019 were prospectively enrolled in this study. The breath-holding index(BHI) was used to evaluate the reactivity of cerebral vessels to hypercapnia. According to whether cerebrovascular reactivity(CVR) was normal, the patients were divided into BHI normal group and BHI impaired group. Significant variables(P<0.05) in univariate analysis were enrolled in multivariate logistic regression and analyzed, and the area under the receiver operating characteristic(ROC) curve was plotted to determine the early predictive value of smoking for CVR outcome in patients with cerebral infarction.Results A total of 112 patients were included, and the proportion of smoking, hypertension and intracranial arterial stenosis in BHI impaired group(76 cases) were significantly higher than that in BHI normal group(36 cases)(56.6% vs 30.6%, P=0.01;85.5% vs 66.7%, P=0.021;47.4% vs 25%, P=0.024), while the percentage of hyperuricemia was lower than that in BHI normal group(10.5% vs 25%, P=0.046). Multivariate logistic regression analysis showed that smoking(OR 3.438, 95%CI 1.397-8.463, P =0.007), hypertension(OR 3.075, 95%CI 1.110-8.518, P =0.031) and intracranial arterial stenosis(OR 2.571, 95%CI 1.016-6.506, P=0.046) were independent risk factors for CVR impairment in patients with cerebral infarction. The area under the ROC curve for smoking was 0.630(95%CI 0.521-0.740, P=0.027), the sensitivity of predicting CVR impairment for smoking was 56.6% and the specificity was 69.4%.Conclusions Smoking, hypertension and intracranial arterial stenosis were independent risk factors for CVR impairment in patients with cerebral infarction. Smoking has certain predictive value for CVR impairment in patients with cerebral infarction.