吸烟与脑卒中高危人群颈动脉粥样硬化发生的相关性分析

摘要

目的：探讨吸烟与脑卒中高危人群颈动脉硬化发生的相关性。方法选取2012年5月—2013年2月在北京市丰台区王佐卫生服务中心、蒲黄榆社区卫生服务中心、花乡社区卫生服务中心、方庄社区卫生服务中心筛查的脑卒中高危人群7284例,将患者分为从未吸烟组和吸烟组进行颈动脉超声检查,观察两组患者颈动脉内膜中层厚度及斑块形成情况；根据吸烟指数将吸烟组患者分为轻度吸烟、中度吸烟及重度吸烟3个亚组,观察吸烟时间、吸烟量等因素下不同亚组间颈动脉内膜中层厚度及斑块形成情况。结果与未吸烟组相比,吸烟组颈动脉内膜增厚及斑块形成发生率明显增高(P<0.01),颈动脉内膜增厚及斑块形成的发生率与吸烟呈正相关(Spearman相关系数分别为0.134、0.125,P<0.05)；在吸烟组各亚组间,颈动脉内膜增厚及斑块形成的发生率依次增高(P<0.01),颈动脉内膜增厚及斑块形成发生率与吸烟指数呈正相关(Spearman相关系数分别为0.122、0.099,P<0.05)。多因素Logistic回归分析显示,性别、年龄、高血压病史、糖尿病病史、吸烟指数、体育锻炼很少或轻体力劳动、明显超重等与颈动脉硬化相关。与不吸烟组相比,轻度吸烟组OR=1.549(P<0.01),中度吸烟组OR=1.767(P<0.01),重度吸烟组OR=2.147(P<0.01)。结论在脑卒中高危人群中,吸烟是颈动脉硬化及斑块形成的独立危险因素,与颈动脉硬化及斑块形成的发生呈正相关,吸烟时间、吸烟量等因素与颈动脉硬化发生亦呈正相关,吸烟对颈动脉粥样硬化进程的影响是累积的。%Objective To investigate the correlativity between smoking and carotid atherosclerosis for high risk group of stroke.Meth-ods 7 284 cases of high risk group of stroke selected from Beijing Fengtai District Wangzuo Community Health Service Center,Pu-huangyu Community Health Service Center,Huaxiang Community Health Service Center,Fangzhuang Community Health Service Center were divided into smoking group and non smoking group.Carotid artery ultrasound was applied to observe the intima media thickness (IMT)and atherosclerotic plaque.Further,the group with smoking was divided into 3 subgroups,mild smoking group,medi-um smoking group and Heavy smoking group,according to Smoking Index(SI).Results Compared with the non smoking group, the occurrence rates of IMT and atherosclerotic plaque in the smoking group were significantly higher( P<0.01).The occurrence rates were positively correlated with smoking(Spearman correlation coefficient were 0.134,0.125,P<0.05).For the subgroups of smoking, the occurrence rates were increased in turn ( P<0.01),and the occurrence rates were also positively correlated with SI(Spearman correlation coefficient were 0.122,0.099,P<0.05).Logistic multi factor regression analysis showed that gender,age,history of hy-pertension,diabetes,smoking index physical exercise little or light manual labor,apparently overweight were associated with carotid atherosclerosis.And compared with the non smoking group,mild smoking group OR= 1.549(P<0.01),medium smoking group OR= 1.767 ( P<0.01),heavy smoking group OR= 2.147 ( P<0.01).Conclusion In the high risk group of stroke,smoking is inde-pendent risk factor for carotid atherosclerosis and plaque formation and positively correlated With the occurrence of carotid athero-sclerosis and plaque formation.Factors such as smoking time,smoking also presents positive correlation with carotid atherosclerosis. The influence of smoking on carotid atherosclerotic process is cumulative.