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JACC:陈旧二手烟损伤肺功能

2012-05-24 国际医学新闻 国际医学新闻

近日,《美国心脏病学会杂志》(Journal of American College of Cardiology )刊载的一份研究报告显示,暴露于“陈旧”二手烟,哪怕只是很少量,暴露时间很短,也会对内皮功能造成损伤。 美国旧金山总医院心脏病科的Paul F. Frey博士及其同事指出,“陈旧”二手烟是指吸烟者吸完烟后在室内区域停留≥30分钟的烟雾,研究已经证实它对呼吸道上皮的毒性大于“新鲜”二手

近日,《美国心脏病学会杂志》(Journal of American College of Cardiology )刊载的一份研究报告显示,暴露于“陈旧”二手烟,哪怕只是很少量,暴露时间很短,也会对内皮功能造成损伤。

美国旧金山总医院心脏病科的Paul F. Frey博士及其同事指出,“陈旧”二手烟是指吸烟者吸完烟后在室内区域停留≥30分钟的烟雾,研究已经证实它对呼吸道上皮的毒性大于“新鲜”二手烟。开展这项研究是为了确定暴露于低水平的陈旧二手烟是否也会损伤内皮功能,因为人们在公共场合很可能会遇到这种情况。内皮功能异常是心血管疾病各个分期的重要机制之一。
 
在吸烟者的家里或者餐厅或者其他允许吸烟的公共场合检测到的陈旧二手烟浓度通常大约为100 mcg/m3可吸入悬浮颗粒物(RSPs),在吸烟者聚集的酒吧或者娱乐场所检测到的陈旧二手烟浓度大约为400 mcg/m3 RSPs。研究者总共纳入了33例不吸烟的健康成年人,年龄介于18~40岁。所有受试者在参与研究前的1个月内没有暴露于二手烟,也不存在任何可能对内皮功能造成不良影响的疾病,比如糖尿病、高血压、呼吸道疾病、肾病、冠状动脉疾病或心衰。
 
这些受试者分别暴露于过滤后的无烟空气(11例)、100 mcg/m3 RSPs(11例)或400 mcg/m3 RSPs(11例)。研究所用二手烟雾在停留了60分钟后被输送至受试者佩戴的面罩,受试者暴露于烟雾的时间为30分钟。试验期间持续监测RSP浓度。采用高分辨率超声波检查评估受试者的内皮功能,测定暴露前后肱动脉流量介导性舒张的最大百分比。
 
结果显示,暴露于2种浓度陈旧二手烟的受试者均出现了内皮功能损伤,受影响程度与剂量相关。RSP浓度每增加100 mcg/m3,肱动脉流量介导性舒张的最大百分比就会下降0.67%。
 
Frey博士及其同事指出:“我们的研究进一步证实了二手烟即使浓度很低,暴露时间很短,也会对人体的心血管健康造成危害。”这也再一次强调了制定避免公众暴露于二手烟的政策法规的重要性。
 
研究者还补充道,试验所设置的情形可能还低估了现实生活中陈旧二手烟对健康的危害。受试者在暴露于二手烟的过程中始终处于休息状态,而且暴露时间只有半个小时。但在现实生活中,人们的暴露时间要长得多,而且在暴露过程中可能身体还在运动,这会增加每分钟的通气量。此外,“我们的受试者都是健康成年人,与患有血管疾病的患者相比,他们受到内皮功能下降的影响可能要小得多,而血管疾病患者因二手烟诱发急性心血管事件的风险更大”。
 
该研究的部分经费由美国加州大学旧金山分校的烟草相关疾病研究项目组以及乘务员医学研究所Bland Lane二手烟优化管理中心提供。一名作者声明与开发或销售戒烟药物的药厂之间存在利益关系,并且在烟草公司诉讼案中担任专家证人,并因此获得酬劳。

doi:10.1016/j.jacc.2012.02.025
PMC:

PMID:

The Exposure-Dependent Effects of Aged Secondhand Smoke on Endothelial Function

Paul F. Frey, MD, MPH*, Peter Ganz, MD*,*, Priscilla Y. Hsue, MD*, Neal L. Benowitz, MD, Stanton A. Glantz, PhD, John R. Balmes, MD and Suzaynn F. Schick, PhD

Objectives: The aim of this study was to investigate whether exposure to a range of relatively low concentrations of aged secondhand smoke (SHS), similar to those encountered commonly in the community, would impair endothelial function in a concentration-dependent manner.

Background: Exposure to SHS impairs endothelial function in humans. The concentration-dependent relationship for aged SHS effects on endothelial function after an exposure of short duration is unknown.

Methods: Thirty-three healthy nonsmokers were exposed to 1 of 2 low levels of aged SHS or to conditioned filtered air for 30 min. The primary end point was change in maximal percent brachial artery flow-mediated dilation after exposure.

Results: In a linear regression model for each increase in SHS exposure by 100 μg/m3 respirable suspended particles, the absolute maximal percent brachial artery flow-mediated dilation was reduced by 0.67%. We did not find evidence of a threshold for the effect of SHS on flow-mediated dilation.

Conclusions: Short-term exposure to real-world levels of aged SHS for 30 min resulted in a concentration-dependent decrease in endothelial function as measured by flow-mediated dilation.

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    2013-01-09 hbwxf
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