主动和被动吸烟在慢性阻塞性肺疾病及全身炎症中的作用：中国一项为期 12 年的前瞻性研究。
The Role of Active and Passive Smoking in Chronic Obstructive Pulmonary Disease and Systemic Inflammation: A 12-year Prospective Study in China.
机构信息
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China.
School of Health Humanities, Peking University, Beijing, 100191, China.
出版信息
J Epidemiol Glob Health. 2024 Sep;14(3):1332-1340. doi: 10.1007/s44197-024-00290-w. Epub 2024 Sep 3.
BACKGROUND
There is no consensus on the cause and effect of systemic chronic inflammation (SCI) regarding chronic obstructive pulmonary disease (COPD). The impact of second-hand smoke (SHS) on COPD has reached inconsistent conclusions.
METHODS
The China Kadoorie Biobank cohort was followed up from the 2004-08 baseline survey to 31 December 2018. Among the selected 445,523 participants in the final analysis, Cox and linear regressions were performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of tobacco exposure with COPD risk and baseline levels of log-transformed inflammatory factors [βs (95% CIs)], respectively.
RESULTS
Participants were followed up for a median of 12.1 years and 11,825 incident COPD events were documented. Ever-smokers were associated with a higher risk of COPD than non-smokers with non-weekly SHS exposure. A younger age to start smoking, a greater amount of daily tobacco consumption, and deeper inhalation were associated with increased risk of COPD and correlated with elevated levels of plasma high-sensitivity C-reactive protein (hs-CRP, all P < 0.001) even two years before COPD onset. Among former smokers, COPD risk declined with longer smoking cessation (P < 0.001) and those quitting smoking for over ten years presented no difference in COPD risk and hs-CRP level from non-smokers [HR (95% CI) = 1.05 (0.89, 1.25), β (95% CI) = 0.17 (- 0.09, 0.43)]. Among non-smokers, weekly SHS exposure was associated with a slightly higher COPD risk [HR (95% CI) = 1.06 (1.01, 1.12)].
CONCLUSIONS
Incremental exposure to tobacco smoke was related to elevated SCI level before COPD onset, then an increase in COPD susceptibility. Quitting smoking as early as possible is suggested as a practical approach to reducing COPD risk in smokers. Given the high prevalence of both COPD and SHS exposure, the risk associated with SHS exposure deserves attention.
背景
关于慢性阻塞性肺疾病（COPD），系统性慢性炎症（SCI）的因果关系尚无定论。二手烟（SHS）对 COPD 的影响得出的结论也不一致。
方法
中国慢性病前瞻性研究（CKB）于 2004-08 年基线调查开始随访，至 2018 年 12 月 31 日结束。在最终分析的 445523 名入选者中，使用 Cox 和线性回归分别估计吸烟与 COPD 风险的暴露比（HRs）和炎症因子（βs）的基线水平[βs（95%置信区间）]。
结果
参与者中位随访时间为 12.1 年，共记录了 11825 例 COPD 事件。与非吸烟者相比，有 SHS 暴露的非重度吸烟者发生 COPD 的风险更高。起始吸烟年龄较小、每日吸烟量较大、吸入更深与 COPD 风险增加相关，且在 COPD 发病前两年即可观察到与血浆高敏 C 反应蛋白（hs-CRP）水平升高相关（均 P<0.001）。在既往吸烟者中，随着戒烟时间的延长，COPD 风险下降（P<0.001），戒烟超过 10 年的人群 COPD 风险和 hs-CRP 水平与非吸烟者无差异[HR（95%CI）=1.05（0.89，1.25），β（95%CI）=0.17（-0.09，0.43）]。非吸烟者中，每周暴露于 SHS 与 COPD 风险略有增加相关[HR（95%CI）=1.06（1.01，1.12）]。
结论
吸烟量的增加与 COPD 发病前 SCI 水平的升高有关，继而增加 COPD 的易感性。尽早戒烟被建议为减少吸烟者 COPD 风险的一种实用方法。鉴于 COPD 和 SHS 暴露的高患病率，SHS 暴露的风险值得关注。
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