Jung Hyun-Suk, Kim Yeol, Son Jungsik, Jeon Young-Jee, Seo Hong-Gwan, Park So-Hee, Huh Bong Ryul
Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea.
Asian Pac J Cancer Prev. 2012;13(11):5483-8. doi: 10.7314/apjcp.2012.13.11.5483.
Although nicotine dependence plays a role as a main barrier for smoking cessation, there is still a lack of solid evidence on the validity of biomarkers to determine nicotine dependence in clinical settings. This study aimed to investigate whether urinary cotinine levels could reflect the severity of nicotine dependence in active smokers.
Data regarding general characteristics and smoking status was collected using a self-administered smoking questionnaire. The Fagerstrom test for nicotine dependence (FTND) was used to determine nicotine dependence of the participants, and a total of 381 participants were classified into 3 groups of nicotine dependence: low (n=205, 53.8%), moderate (n=127, 33.3%), and high dependence groups (n=49, 12.9%). Stepwise multiple linear regression model and receiver operating characteristic (ROC) curves analyses were used to determine the validity of urinary cotinine for high nicotine dependence.
In correlation analysis, urinary cotinine levels increased with FTND score (r=0.567, P<0.001). ROC curves analysis showed that urinary cotinine levels predicted the high-dependence group with reasonable accuracy (optimal cut-off value=1,000 ng/mL; AUC=0.82; P<0.001; sensitivity=71.4%; specificity=74.4%). In stepwise multiple regression analysis, the total smoking period (β=0.042, P=0.001) and urinary cotinine levels (β=0.234, P<0.001) were positively associated with nicotine dependence, whereas an inverse association was observed between highest education levels (>16 years) and nicotine dependence (β=-0.573, P=0.034).
The results of this study support the validity of using urinary cotinine levels for assessment of nicotine dependence in active smokers.
尽管尼古丁依赖是戒烟的主要障碍，但在临床环境中，关于生物标志物用于确定尼古丁依赖有效性的可靠证据仍然不足。本研究旨在调查尿可替宁水平是否能反映现吸烟者尼古丁依赖的严重程度。
使用自行填写的吸烟问卷收集有关一般特征和吸烟状况的数据。采用尼古丁依赖的Fagerstrom测试（FTND）来确定参与者的尼古丁依赖程度，共有381名参与者被分为3组尼古丁依赖：低依赖组（n = 205，53.8%）、中度依赖组（n = 127，33.3%）和高依赖组（n = 49，12.9%）。采用逐步多元线性回归模型和受试者工作特征（ROC）曲线分析来确定尿可替宁对高尼古丁依赖的有效性。
在相关性分析中，尿可替宁水平随FTND评分升高而增加（r = 0.567，P < 0.001）。ROC曲线分析表明，尿可替宁水平对高依赖组的预测具有合理的准确性（最佳截断值 = 1000 ng/mL；AUC = 0.82；P < 0.001；敏感性 = 71.4%；特异性 = 74.4%）。在逐步多元回归分析中，总吸烟时长（β = 0.042，P = 0.001）和尿可替宁水平（β = 0.234，P < 0.001）与尼古丁依赖呈正相关，而最高教育水平（> 16年）与尼古丁依赖呈负相关（β = -0.573，P = 0.034）。
本研究结果支持使用尿可替宁水平评估现吸烟者尼古丁依赖的有效性。
