Cole C W, Hill G B, Farzad E, Bouchard A, Moher D, Rody K, Shea B
Division of Vascular Surgery, University of Ottawa, Ontario, Canada.
Surgery. 1993 Oct;114(4):753-6; discussion 756-7.
The importance of cigarette smoking in the etiology of peripheral arterial occlusive disease is well known, but there have been few studies that have quantified this relationship.
A case-control study design was used in which the case subjects were men with a history of claudication for at least 1 year and abnormal findings on noninvasive blood flow studies or on arteriography; control subjects were men attending the same hospital for conditions other than cancer, with no history of cancer or vascular disease and with a normal ankle-brachial index. Case and control subjects were interviewed by a trained nurse interviewer using a pilot-tested questionnaire. Current smoking status was confirmed by serum cotinine level estimation. Univariate odds ratios for smoking and other potential risk factors were calculated, and their significance was tested by comparison with the chi-squared distribution. Logistic regression analysis was used to adjust the effect of smoking for confounding variables, and the regression equation was used to estimate the proportion of disease attributable to smoking.
Of the patients approached, 94% of the eligible case subjects and 93% of the eligible control subjects agreed to participate. Recruitment ended with 102 cases of peripheral arterial occlusive disease and 99 controls. Most of the control subjects were attending clinics for other surgical specialties. Compared with men who had never smoked the relative risk was 7 for exsmokers and 16 for current smokers (p < 0.001). The relative risk increased directly with the lifetime number of cigarettes smoked, the chi-squared test for trend being highly significant (p < 0.001). Age, lipoprotein concentration, body mass index, and history of hypertension or heart disease were also significant risk factors.
After adjustment for confounding variables the estimate of the fraction of disease attributable to smoking was 76%.
吸烟在周围动脉闭塞性疾病病因学中的重要性众所周知，但很少有研究对这种关系进行量化。
采用病例对照研究设计，病例组为有至少1年间歇性跛行病史且无创血流研究或动脉造影有异常发现的男性；对照组为因非癌症疾病在同一家医院就诊、无癌症或血管疾病病史且踝臂指数正常的男性。由经过培训的护士访员使用经过预试验的问卷对病例组和对照组进行访谈。通过血清可替宁水平测定来确认当前吸烟状态。计算吸烟及其他潜在危险因素的单变量比值比，并通过与卡方分布比较来检验其显著性。使用逻辑回归分析来调整吸烟对混杂变量的影响，并使用回归方程来估计归因于吸烟的疾病比例。
在接触的患者中，94%的合格病例组受试者和93%的合格对照组受试者同意参与。研究共招募了102例周围动脉闭塞性疾病患者和99名对照。大多数对照受试者在其他外科专科门诊就诊。与从不吸烟的男性相比，既往吸烟者的相对风险为7，当前吸烟者为16（p<0.001）。相对风险随终生吸烟量直接增加，趋势卡方检验具有高度显著性（p<0.001）。年龄、脂蛋白浓度、体重指数以及高血压或心脏病史也是显著的危险因素。
在对混杂变量进行调整后，归因于吸烟的疾病比例估计为76%。
