Billa Aishwarya Lakshmi, Sukhabogi Jagadeeswara Rao, Doshi Dolar, Athe Ramesh
Department of Public Health Dentistry, Government Dental College and Hospital, Hyderabad, Telangana, India.
Department of Data Science and Artificial Intelligence, Indian Institute of Information Technology, Dharwad, Karnataka, India.
Asian Pac J Cancer Prev. 2025 Jul 1;26(7):2327-2338. doi: 10.31557/APJCP.2025.26.7.2327.
This systematic review and meta-analysis aimed to evaluate the effects of e-cigarette use on systemic and salivary cytokine levels among adults.
This systematic review and meta-analysis, registered under PROSPERO (Prospective Register of Systematic Reviews, CRD42024571203), was conducted in compliance with Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. Studies assessing systemic and salivary cytokines (e.g., IL-6 [Interleukin-6], TNF-α [Tumor Necrosis Factor-alpha], IL-10 [Interleukin-10]) among adult e-cigarette users, traditional smokers, mixed smokers, and non-smokers were included based on Population-Intervention-Comparators-Outcomes (PICO) criteria. Data were extracted, risk of bias was assessed using the Joanna Briggs Institute tool, and the quality of evidence was graded with GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Meta-analysis was performed using SPSS (Statistical Package for the Social Sciences) and R software, reporting standardized mean differences (SMD) with 95% confidence intervals (CI); p ≤ 0.05 was considered significant.
A total of 286 studies were screened, with 10 meeting the inclusion criteria. The studies, conducted in the U.S., Saudi Arabia, Kuwait, Latvia, and India, included 48 to 3,614 participants. Cytokines such as, TNF-α (SMD 0.88, 95% CI 0.23-1.13; p = 0.003) and IL-1RA (SMD 0.31, 95% CI 0.10-0.52; p = 0.004), were significantly elevated in e-cigarette users compared to conventional smokers and non-smokers. INF-γ and CRP levels did not significantly differ between groups (p = 0.81 and 0.29, respectively). Meta-analyses showed elevated levels of pro-inflammatory cytokines in e-cigarette users, with substantial heterogeneity across studies. Sensitivity analyses and publication bias tests were also conducted.
Systemic and salivary cytokine levels were significantly elevated among e-cigarette users compared to non-smokers and conventional smokers, indicating a heightened inflammatory response associated with e-cigarette use.
本系统评价和荟萃分析旨在评估使用电子烟对成年人全身和唾液细胞因子水平的影响。
本系统评价和荟萃分析已在国际前瞻性系统评价注册库（PROSPERO，注册号CRD42024571203）注册，按照Cochrane和系统评价与荟萃分析优先报告项目（PRISMA）标准进行。根据人群-干预措施-对照-结局（PICO）标准，纳入评估成年电子烟使用者、传统吸烟者、混合吸烟者和非吸烟者全身和唾液细胞因子（如白细胞介素-6 [IL-6]、肿瘤坏死因子-α [TNF-α]、白细胞介素-10 [IL-10]）的研究。提取数据，使用乔安娜·布里格斯研究所工具评估偏倚风险，并采用推荐分级的评估、制定与评价（GRADE）方法对证据质量进行分级。使用社会科学统计软件包（SPSS）和R软件进行荟萃分析，报告标准化均数差（SMD）及95%置信区间（CI）；p≤0.05被视为具有统计学意义。
共筛选出286项研究，其中10项符合纳入标准。这些研究在美国、沙特阿拉伯、科威特、拉脱维亚和印度开展，纳入了48至3614名参与者。与传统吸烟者和非吸烟者相比，电子烟使用者的TNF-α（SMD 0.88，95% CI 0.23 - 1.13；p = 0.003）和白细胞介素-1受体拮抗剂（IL-1RA，SMD 0.31，95% CI 0.10 - 0.52；p = 0.004）等细胞因子显著升高。各组间干扰素-γ（INF-γ）和C反应蛋白（CRP）水平无显著差异（p分别为0.81和0.29）。荟萃分析显示，电子烟使用者的促炎细胞因子水平升高，各研究间存在较大异质性。还进行了敏感性分析和发表偏倚检验。
与非吸烟者和传统吸烟者相比，电子烟使用者的全身和唾液细胞因子水平显著升高，表明与使用电子烟相关的炎症反应增强。
