高血压和吸烟对缺血性卒中风险的协同作用：一项加性和乘法相互作用分析的病例对照研究
Synergistic Effect of Hypertension and Smoking on Ischemic Stroke Risk: A Case-Control Study With Additive and Multiplicative Interaction Analysis.
摘要(中文译文)
缺血性卒中仍是全球范围内死亡和残疾的主要原因。本单中心回顾性病例对照研究评估了吸烟、饮酒及传统心血管危险因素对首次缺血性卒中的独立及交互作用。2018年1月至2025年6月期间，经影像学确诊的首次缺血性卒中病例与对照按年龄（±3岁）和性别以1：2比例匹配。评估了吸烟状态、包年、酒精摄入量、高血压、糖尿病及血脂变量。采用预先设定协变量的条件logistic回归，并在乘法尺度和加法尺度上评估交互作用。使用Firth惩罚法处理稀疏数据，采用链式方程多重插补处理缺失数据。共纳入312例病例和624例对照。目前吸烟（比值比[OR] 2.34，95%置信区间[CI] 1.82-3.01）、大量饮酒（>100 g/周；OR 1.89，95% CI 1.34-2.67）、高血压（OR 3.21，95% CI 2.54-4.06）和糖尿病（OR 2.12，95% CI 1.56-2.88）与缺血性卒中独立相关。高血压与目前吸烟在乘法尺度（交互作用OR 1.58，95% CI 1.12-2.24；P = 0.009）和加法尺度（交互作用相对超额风险2.87，95% CI 1.21-4.53；归因比例0.32，95% CI 0.15-0.49；协同指数2.18，95% CI 1.35-3.52）上均显示显著交互作用。模型区分度良好（曲线下面积0.82，95% CI 0.79-0.85）。这些发现支持对高血压与吸烟暴露共存个体采取综合预防策略。
Abstract
Ischemic stroke remains a leading cause of death and disability worldwide. This single-center retrospective case-control study evaluated the independent and interactive effects of smoking, alcohol consumption, and traditional cardiovascular risk factors on first-ever ischemic stroke. Cases with radiologically confirmed first-ever ischemic stroke and controls were matched in a 1:2 ratio by age (±3 years) and sex between January 2018 and June 2025. Smoking status, pack-years, alcohol intake, hypertension, diabetes mellitus, and lipid variables were assessed. Conditional logistic regression with pre-specified covariates was applied, with interaction evaluated on both multiplicative and additive scales. Firth's penalization was used to address sparse data, and multiple imputation by chained equations was used to handle missing data. A total of 312 cases and 624 controls were included. Current smoking (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.82-3.01), heavy alcohol consumption (>100 g/wk; OR 1.89, 95% CI 1.34-2.67), hypertension (OR 3.21, 95% CI 2.54-4.06), and diabetes mellitus (OR 2.12, 95% CI 1.56-2.88) were independently associated with ischemic stroke. Hypertension and current smoking demonstrated significant interaction on both multiplicative (interaction OR 1.58, 95% CI 1.12-2.24; P = 0.009) and additive scales (relative excess risk due to interaction 2.87, 95% CI 1.21-4.53; attributable proportion 0.32, 95% CI 0.15-0.49; synergy index 2.18, 95% CI 1.35-3.52). Model discrimination was good (area under the curve 0.82, 95% CI 0.79-0.85). These findings support integrated prevention strategies for individuals with coexisting hypertension and smoking exposure.
如何引用
AMA
Jiaqi Wu, Yaru Li, Haoran Chen, Hebo Wang. Synergistic Effect of Hypertension and Smoking on Ischemic Stroke Risk: A Case-Control Study With Additive and Multiplicative Interaction Analysis.. Journal of visualized experiments : JoVE. 2026; doi:10.3791/70381.
APA
Jiaqi Wu, Yaru Li, Haoran Chen, Hebo Wang (2026). Synergistic Effect of Hypertension and Smoking on Ischemic Stroke Risk: A Case-Control Study With Additive and Multiplicative Interaction Analysis.. Journal of visualized experiments : JoVE. https://doi.org/10.3791/70381
GB/T 7714
Jiaqi Wu, Yaru Li, Haoran Chen, Hebo Wang. Synergistic Effect of Hypertension and Smoking on Ischemic Stroke Risk: A Case-Control Study With Additive and Multiplicative Interaction Analysis.[J]. Journal of visualized experiments : JoVE, 2026 doi:10.3791/70381.
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