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AHA 2017:吸烟者死亡率竟然更低?这项中国研究告诉你真相

2017-11-19 宋晨曦 中国医学论坛报今日循环

美国当地时间11月11日~11月15日,2017年美国心脏协会(AHA)科学年会在美国加州阿纳海姆举行。中国研究“吸烟者死亡率竟然更低?——基于CAMI注册研究发现的吸烟悖论现象”研究在AHA的国际舞台闪亮登场。

美国当地时间11月11日~11月15日,2017年美国心脏协会(AHA)科学年会在美国加州阿纳海姆举行。中国研究“吸烟者死亡率竟然更低?——基于CAMI注册研究发现的吸烟悖论现象”研究在AHA的国际舞台闪亮登场。

研究背景

吸烟是众所周知的心血管系统疾病危险因素,能够增加一般人群冠状动脉疾病发生风险,不利于患者长期预后。然而,吸烟与急性心梗患者住院期间死亡率关系仍存在争议。1968年,Weinblatt E 等人首次报道急性心梗患者吸烟者住院期间死亡率低于非吸烟者,即“吸烟悖论”现象,在此后的溶栓治疗和经皮冠脉介入治疗时代,陆续有研究报道该现象存在。一些研究认为“吸烟悖论”由混杂因素导致:与非吸烟者相比,吸烟者年龄更低,并存疾病更少。然而一些研究报道即使控制这些混杂因素后,吸烟者院内死亡率仍然低于非吸烟者。因此本团队开展本项研究探索当代心梗患者中吸烟悖论是否成立,以更好地利用吸烟状态预测患者不良事件风险。

方法

本研究利用2013-2016年中国急性心肌梗死(China Acute Myocardial Infarction, CAMI)注册研究数据库,纳入40640名急性心梗患者(图1)。所有患者根据吸烟状态分为两组:吸烟者定义为目前吸烟或曾经吸烟,目前戒烟的患者;非吸烟者定义为从未吸烟者。提取这些患者基线变量,就诊特点,治疗模式及院内生存状态。并且利用倾向性匹配评分,多因素logistic回归方法系统控制混杂因素。

结果

吸烟者(N=22639)与非吸烟者(N=18001)几乎所有基线变量均存在差异:相比于非吸烟者,吸烟者更年轻,并存疾病更少。吸烟者院内死亡率低于非吸烟者(4.4% vs. 8.8%, p<0.001)。利用倾向性评分匹配,本研究构建一个基线资料均衡可比的队列,包括吸烟者与非吸烟者各9540人,匹配队列中吸烟者与非吸烟者死亡率差异减小,但仍然有统计学差异(5.7% vs.6.6%, p=0.046)。多因素logistic回归分析结果提示,在调整可能的混杂因素后,吸烟仍然是院内死亡的保护因素(OR 0.82, 95% CI 0.73–0.91, P<0.001)。

结论

本研究利用目前亚洲最大的急性心梗数据库,发现吸烟者院内死亡率低于非吸烟者,且该现象不能完全靠混杂因素解释。未来应进一步开展研究探索可能的生物学机制。应当注意研究结果的正确解读:我们仍然强烈建议患者戒烟,该结果的临床价值在于揭示吸烟状态与住院死亡风险的关系,有助于医生更准确地利用吸烟状态及其他有预后意义的因素进行风险评估,以选择更加合理的诊疗策略。

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    2017-11-21 zhaohui6731
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    2017-11-20 雅文博武

    学习了很多先进的医疗技术

    0

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    2017-11-19 lovetcm

    老烟民都死了.留下都是相对健康的

    0

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    2017-11-19 1e0f8808m18(暂无匿称)

    学习了.谢谢分享.

    0

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    2017-11-19 1ddf0692m34(暂无匿称)

    学习了.涨知识

    0

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