Underner M, Perriot J
Service de Pneumologie, Unité de Tabacologie, Pavillon René-Beauchant, CHU La-Milétrie, BP 577, 2, rue Milétrie, 86021 Poitiers cedex, France.
Rev Mal Respir. 2011 Oct;28(8):978-94. doi: 10.1016/j.rmr.2011.08.003. Epub 2011 Oct 1.
Use of smokeless tobacco (ST) (chewing tobacco and snuff) can lead to a number of consequences detrimental to health. ST rapidly delivers high doses of nicotine, which can lead to dependence and is also a source of carcinogenic nitrosamines. Changes usually develop in the mouth area where the ST is most often placed. Non-malignant oral lesions include leuko-oedema, hyperkeratotic lesions of the oral mucosa and localised periodontal disease. Oral premalignant lesions are leukoplakia, erythroplakia, submucosal fibrosis and lichen planus. Betel chewing, with or without tobacco, may increase the incidence of oral cancer. There is conflicting evidence with regard to snuff users about the risk of oral and gastro-oesophageal cancer. ST use is a risk factor for pancreatic cancer and may increase the risk of fatal myocardial infarction and ischemic stroke. During pregnancy, ST is associated with an increase in pre-eclampsia, preterm delivery and stillbirth. Nicotine replacement therapy and bupropion reduce withdrawal symptoms and tobacco craving during ST cessation. However, they have not been shown to help long-term abstinence. Information concerning the potential hazards of ST products should be incorporated into educational programmes to discourage its use and to help users to quit. Smokeless tobacco is not recommended to help smoking cessation.
使用无烟烟草（ST）（嚼烟和鼻烟）会导致许多对健康有害的后果。无烟烟草能迅速释放高剂量的尼古丁，这会导致成瘾，同时它也是致癌亚硝胺的一个来源。变化通常发生在最常放置无烟烟草的口腔部位。非恶性口腔病变包括白色水肿、口腔黏膜角化过度病变和局限性牙周病。口腔癌前病变有白斑、红斑、黏膜下纤维化和扁平苔藓。无论是否与烟草一起使用，嚼槟榔都可能增加口腔癌的发病率。关于鼻烟使用者患口腔癌和胃食管癌的风险，证据存在矛盾。使用无烟烟草是胰腺癌的一个风险因素，可能会增加致命心肌梗死和缺血性中风的风险。在怀孕期间，使用无烟烟草与子痫前期、早产和死产的增加有关。尼古丁替代疗法和安非他酮可减轻无烟烟草戒断期间的戒断症状和烟草渴望。然而，尚未证明它们有助于长期戒烟。关于无烟烟草产品潜在危害的信息应纳入教育计划，以劝阻其使用并帮助使用者戒烟。不建议使用无烟烟草来辅助戒烟。
