Berlin Ivan
Université Paris 6, Hôpital Pitié-Salpêtrière, Inserm U 894, Service de Pharmacologie, Paris, France.
Curr Med Res Opin. 2009 Feb;25(2):527-34.
Cardiovascular, pulmonary, and oncological hazards of tobacco smoking have been well studied. Smoking may also have multiple effects on endocrine and metabolic systems affecting pituitary, thyroid, and adrenal glands; testicular and ovarian function; as well as energy balance; lipid, and glucose metabolism; and insulin resistance. Less is known about hormonal and metabolic effects that patients may experience while quitting smoking.
The objective of this article is to review systematically data on the endocrine and metabolic effects of smoking cessation. Articles based upon clinical trials, randomised controlled trials, and meta-analyses were obtained via a MEDLINE search (articles published between 1 August 1998 and 31 July 2008, inclusive; English language; human subjects; including abstracts) using key search terms relating to smoking cessation and endocrine or metabolic parameters. Additional studies were identified from the bibliographies of reviewed literature. Studies related to the search criteria were reviewed, 199 papers were identified, and 57 pertinent to this review were included.
Limited data are available on the short- and long-term effects of smoking cessation on hypothalamic- and thyroid-pituitary-adrenal axes, sex hormones, energy homeostasis, and lipid and glucose metabolism. Initial data indicate that smoking cessation is associated with decreased cortisol levels and in the short-term, smoking cessation does not correct the diminished adrenocortical responses to stress caused by chronic smoking. Cessation reverses smoking's effects on thyroid disorders and may reduce the risk of osteoporosis. Finally, smoking cessation increases transiently food intake and sustained weight gain and is associated with increases in high-density lipoprotein cholesterol levels that occur rapidly on cessation.
Further research may provide insight into post-cessation endocrine changes that may be caused by alterations to central and peripheral systems. Such research may increase the understanding of underlying biological mechanisms that lead to symptoms and clinical features of smoking cessation.
吸烟对心血管、肺部及肿瘤方面的危害已得到充分研究。吸烟还可能对内分泌和代谢系统产生多种影响，涉及垂体、甲状腺和肾上腺；睾丸和卵巢功能；以及能量平衡、脂质和葡萄糖代谢和胰岛素抵抗。关于戒烟过程中患者可能经历的激素和代谢影响，人们了解较少。
本文的目的是系统回顾有关戒烟对内分泌和代谢影响的数据。通过医学文献数据库检索（检索1998年8月1日至2008年7月31日期间发表的文章，包括英文文章、人类受试者研究，包括摘要），使用与戒烟及内分泌或代谢参数相关的关键检索词，获取基于临床试验、随机对照试验和荟萃分析的文章。从所审查文献的参考文献中确定了其他研究。对与检索标准相关的研究进行了审查，共识别出199篇论文，其中57篇与本综述相关。
关于戒烟对下丘脑-垂体-肾上腺轴、性激素、能量稳态以及脂质和葡萄糖代谢的短期和长期影响的数据有限。初步数据表明，戒烟与皮质醇水平降低有关，并且在短期内，戒烟并不能纠正慢性吸烟引起的肾上腺皮质对应激反应减弱的状况。戒烟可逆转吸烟对甲状腺疾病的影响，并可能降低骨质疏松症的风险。最后，戒烟会使食物摄入量短暂增加并导致体重持续增加，且与戒烟后迅速出现的高密度脂蛋白胆固醇水平升高有关。
进一步的研究可能有助于深入了解戒烟后可能由中枢和外周系统改变引起的内分泌变化。此类研究可能会增进对导致戒烟症状和临床特征的潜在生物学机制的理解。
