伊利诺伊州和威斯康星州与电子烟使用相关的肺部疾病-最终报告。
Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Final Report.
机构信息
From the Illinois Department of Public Health, Springfield (J.E.L., I.G., L.N., M.T.P., L.S.-H.); the Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (I.G., I.P., A.K., M.W.T., P.P.S.), National Center for Environmental Health (M.L.), the Division of State and Local Readiness, Center for Preparedness and Response (L.N.), the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control (B.H., J.G.S., C.A.M.), and the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (B.A.K.), Centers for Disease Control and Prevention, and Emory University School of Medicine (M.L.) - all in Atlanta; and the Wisconsin Department of Health Services (I.P., M.E., J.M.), the Wisconsin Division of Public Health, Bureau of Communicable Disease (T.H.), and the Department of Radiology, University of Wisconsin School of Medicine and Public Health (J.K.) - all in Madison.
出版信息
N Engl J Med. 2020 Mar 5;382(10):903-916. doi: 10.1056/NEJMoa1911614. Epub 2019 Sep 6.
BACKGROUND
E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of lung injury associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation.
METHODS
We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools.
RESULTS
There were 98 case patients, 79% of whom were male; the median age of the patients was 21 years. The majority of patients presented with respiratory symptoms (97%), gastrointestinal symptoms (77%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging. A total of 95% of the patients were hospitalized, 26% underwent intubation and mechanical ventilation, and two deaths were reported. A total of 89% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018.
CONCLUSIONS
Case patients presented with similar clinical characteristics. Although the definitive substance or substances contributing to injury have not been determined, this initial cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes.
背景
电子烟是一种通过电池供电加热液体并将气溶胶化产品输送给使用者的设备。已经报告了与电子烟使用相关的肺部疾病，但尚未描述大型系列。2019 年 7 月，威斯康星州卫生服务部和伊利诺伊州公共卫生部收到了与电子烟（也称为蒸气）使用相关的肺部损伤报告，并发起了一项协调的公共卫生调查。
方法
我们将病例患者定义为在症状发作前 90 天内报告使用电子烟装置和相关产品且影像学显示肺部浸润且其疾病归因于其他原因的人。使用标准化工具进行病历摘录和病例患者访谈。
结果
共有 98 例病例患者，其中 79%为男性；患者的中位年龄为 21 岁。大多数患者出现呼吸道症状（97%）、胃肠道症状（77%）和全身症状（100%）。所有病例患者的胸部影像学均有双侧浸润。共有 95%的患者住院，26%接受插管和机械通气，报告了两例死亡。共有 89%的患者报告在电子烟装置中使用了四氢大麻酚产品，尽管报告了各种各样的产品和装置。伊利诺伊州的综合征监测数据显示，2019 年 6 月至 8 月，严重呼吸道疾病就诊的月平均率是 2018 年同期的两倍。
结论
病例患者表现出相似的临床特征。尽管尚未确定导致损伤的确切物质，但这一初始疾病集群代表了一种新兴的临床综合征或综合征。需要进一步的工作来描述病理生理学并确定明确的原因。
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