Martin-Blondel Guillaume, Koskas Fabien, Cacoub Patrice, Sène Damien
Department of Internal Medicine, Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France.
Ann Vasc Surg. 2011 May;25(4):469-73. doi: 10.1016/j.avsg.2011.01.007.
Cannabis implication in the pathophysiology of distal arteritis remains controversial. The aim is to assess whether cannabis co-exposure influences presentation and outcome of thromboangiitis obliterans (TAO) in tobacco smokers.
All consecutive patients presenting with a definite TAO were retrospectively reviewed according to their tobacco and cannabis consumption status.
A total of 38 patients with a definite TAO were included in this study. In all, 10 patients (26%) used tobacco together with cannabis (δ9-trans-tetrahydrocannabinol [THC], THC(+)), whereas 28 patients (74%) were only tobacco smokers (THC(-)). Tobacco exposure was comparable in both groups (21.7 ± 12 vs. 26.7 ± 17 pack-years). THC(+) patients were younger than THC(-) patients at onset of symptoms (28.5 ± 7 years vs. 36.6 ± 10.5 years, p = 0.02) and have more frequently unilateral involvement of lower limbs (44% vs. 7%, p = 0.02). Although 66% of patients presented with critical ischemia of lower limbs, THC(+) patients exhibited more often rest pain without ischemic ulcers (50% vs. 5%, p = 0.048). Upper limbs were clinically affected in 50% of THC(+) patients and 32% of THC(-) patients. Repeated infusions of iloprost were required in 84% of patients. Outcome and rate of minor and major amputations (10%) did not differ between groups.
Cannabis exposure influences the age at onset and presentation of TAO, but not the outcome. The data of present study suggest that cannabis represent a co-factor of tobacco that may accelerate TAO onset and presentation.
大麻在远端动脉炎病理生理学中的作用仍存在争议。目的是评估大麻共同暴露是否会影响吸烟者血栓闭塞性脉管炎（TAO）的表现和预后。
根据烟草和大麻消费状况，对所有连续出现明确TAO的患者进行回顾性研究。
本研究共纳入38例明确诊断为TAO的患者。其中，10例患者（26%）同时使用烟草和大麻（δ9-反式-四氢大麻酚[THC]，THC阳性），而28例患者（74%）仅为吸烟者（THC阴性）。两组的烟草暴露情况相当（21.7±12包年 vs. 26.7±17包年）。THC阳性患者在症状出现时比THC阴性患者更年轻（28.5±7岁 vs. 36.6±10.5岁，p = 0.02），下肢单侧受累更为频繁（44% vs. 7%，p = 0.02）。尽管66%的患者出现下肢严重缺血，但THC阳性患者更常出现无缺血性溃疡的静息痛（50% vs. 5%，p = 0.048）。50%的THC阳性患者和32%的THC阴性患者上肢出现临床受累。84%的患者需要反复输注伊洛前列素。两组之间的预后以及小截肢和大截肢率（10%）没有差异。
大麻暴露会影响TAO的发病年龄和表现，但不影响预后。本研究数据表明，大麻是烟草的一个协同因素，可能会加速TAO发病和表现。
