住院吸烟患者戒烟成功的影响因素

目的探讨戒炯成功者的特点和戒烟成功的影响因素。方法2010年12月至2012年11月,收集呼吸内科和心血管住院吸烟患者共240例,男性228例,女性12例。采用香港戒烟健康中心的问卷表,南医护人员作为辅导员进行统一问卷调查;采用5A（询问、建议、评估、帮助和随访）技能配合辅导和5R（相关、危害、益处、障碍和重复）的戒烟技巧进行心理辅导戒烟十预,并在出院后6个月内做电话随访。根据白报的戒断情况,确定6个月持续戒烟成功者及失败者的情况并分析戒炯成功的影响因素。结果采用横断面调查和追踪随访研究,240例中6个月持续戒烟成功者65例（成功组）,成功率27％,失败者175例（失败组）。两组问性别、年龄、婚娴状态、文化水平、吸烟开始年龄、每日吸烟量、呼出一氧化碳量、尼卉丁依赖度各项比较差异无统计学意义（P〉0．05）;而戒炯信心、入院前5天戒烟情况、烟龄、戒炯重要性各项比较差异均有统计学意义（P〈0．05）。logistic同归多因素分析显示,人院前5天自动戒烟是戒烟成功的最强影响因子（OR=2．78,95％CI：1．52～5．15）;炯龄越长戒炯成功率越高（OR=2．10,95％C1：1．15～3．85）;戒烟信心越足戒炯成功率越高（OR=1．95．95％C1：1．06～3．59）。结论人院前5天自动戒烟、炯龄时间长、戒烟信心强是住院吸娴患者戒娴成功的独立影响因素。     

Smoking-induced leukocytosis can persist after cessation of smoking

BACKGROUND: Associations between smoking and leukocytosis or elevated hemoglobin concentrations in the blood need to be validated using multivariate analysis. METHODS: A total of 2,511 male subjects aged 25-62 years participated in an annual health examination held at their workplace. The relationship between white blood cells (WBC) and hemoglobin (Hb) levels in blood and smoking status was then evaluated using a cross-sectional survey and multiple logistic regression analysis. Age, body mass index (BMI), smoking and drinking status, diastolic blood pressure, and physical activity were used as covariate factors. RESULTS: Odds ratios (ORs) and 95% confidence intervals (95% CIs) of WBC of >9,000 counts/mm3 of total blood for current smokers and ex-smokers with a period of 5-9.9 years since smoking cessation vs. that of nonsmokers were 12.1 (7.0-21.0) and 3.8 (1.2-12.0), respectively. OR (95% CI) of Hb level >16 g/dL of total blood for current smokers vs. nonsmokers was 1.6 (1.1-2.3). Significant ORs for elevated Hb level in total blood were also observed for age (OR, 1.0; 95% CI, 0.9-1.0), BMI >25 (OR, 2.2; 95% CI, 1.6-3.1), and diastolic blood pressure of >90 mmHg (OR, 2.2; 95% CI, 1.5-3.2). CONCLUSIONS: Current smoking is associated with increase in WBC count and Hb levels in total blood, the former relationship recognized in subjects who have stopped smoking for 5-9.9 years. Obesity and aging are inversely related with Hb level in blood.     

Parkinson＇s Disease and Smoking： An Integral Part of PD＇s Etiological Study

OBJECTIVE: To explore the association of Parkinson's disease (PD) with cigarette smoking. METHODS: One hundred of fourteen PD patients were compared with 205 control subjects who were matched by gender, race and residency. A previously validated questionnaire including smoking, alcohol/tea consumption as well as some other environmental exposure data was administered. RESULTS: With never-smokers as the reference category, we observed reduced risk for PD among ever smokers (OR=0.49, 95% CI: 0.30 to 0.79) current smokers (OR=0.44, 95% CI: 0.23 to 0.86) and ex-smokers (OR=0.54, 95% CI: 0.30 to 0.96). When ever smokers were stratified by years of smoking, there was an inverse correlation between those whose smoking history was longer than 20 years (OR=0.40 95% CI: 0.21 to 0.81) and an even mild protective correlation between those who smoked less than 20 years (OR=0.57, 95% CI: 0.33 to 0.99). Those who had quitted smoking for more than 20 years were less likely to have the disease than never smokers, and those who had quitted for less than 20 years were least likely to have PD, while those who were current smokers were still least likely to have the disease. We found significant inverse gradient with pack-day smoking (trend P<0.05), and the inverse correlation between cigarette smoking and PD was not confounded by alcohol/tea consumption and other confounding bias. CONCLUSIONS: The inverse correlation between Parkinson's disease risk and smoking as well as the trend of gradient dose response is again observed in our study. More future researches are needed to confirm these correlations and to explore further biochemical evidence.     

Sociodemographic characteristics of cigarette smoking initiation in the United States. Implications for smoking prevention policy

Cigarette smoking initiation greatly influences smoking prevalence in the United States. To understand better the initiation of cigarette smoking, we estimated the age-specific incidence of cigarette smoking initiation in relation to race/ethnicity, sex, and educational attainment, using the reported age at smoking onset for 18- to 35-year-old respondents in the 1987 National Health Interview Survey (N = 14764) and the Hispanic Health and Nutrition Examination Survey (N = 3123) conducted during 1982 to 1984. Among white, black, and Hispanic respondents the incidence of smoking initiation increased rapidly after 11 years of age, reaching a peak in groups 17 to 19 years of age, rapidly declining in groups through age 25 years, and gradually declining thereafter. Age-specific smoking initiation rates were generally lower among black than white respondents, similar between white and Hispanic respondents, and appreciably higher among black and Hispanic men than women. Compared with persons who graduated from high school, persons with less than high school education were consistently more likely to start smoking cigarettes during childhood and adolescence. These data indicate that age and educational attainment are the factors most consistently associated with cigarette smoking initiation among all race/ethnic groups in the United States. These data also emphasize the need for smoking-prevention education beginning at an early age, particularly among persons of low socioeconomic status.     

Risk factors for intracranial aneurysm in a Chinese ethnic population

Background Intracranial aneurysm (IAN) is a protruding bubble or a sac on a brain artery that balloons out over time, which may lead to spontaneous subarachnoid hemorrhage (SAH), ultimately disability and mortality. Current research indicates that the disease is due to multiple causes, including environmental factors and various congenital abnormalities of blood vessels. Apart from congenital predisposition, various high-risk factors such as sex, age, hypertension, and atherosclerosis are involved in the formation of intracranial aneurysms. The aim of this study was to investigate the risk factors associated with the formation of sporadic intracranial aneurysms in Chinese Han ethnic patients. Methods A total of 251 patients with intracranial aneurysm and 338 patients with other cerebral diseases (control group) were enrolled in this study. Single factor and logistic regression model were used to analyze the association of intracranial aneurysms with age; sex; cigarette smoking; alcohol or cocaine consumption; history of hypertension, coronary artery disease, diabetes mellitus and inherited connective tissue disease; and the levels of fasting blood glucose and blood fat. The data expressed as mean±standard deviation were processed with the statistical software SPSS13. Quantitative and qualitative data were analyzed by the independent-sample t test, and the chi-square test respectively. Logistic regression method was used to analyze the multiple factors.Results In the 251 patients, 163 (64.94%) were at age of 40 to 60 years. Sex (OR, 1.41; 95% CI, 1.01－1.96), cigarette smoking (OR, 1.81; 95% CI, 1.06－3.10), hypertension (OR, 2.32; 95% CI, 1.30－4.16) and fasting blood glucose were significantly associated with intracranial aneurysm (P&lt;0.05). Intracranial aneurysm was correlated with alcohol consumption, coronary artery disease, and the level of blood lipids (P&gt;0.05). Using logistic regression analysis, we identified female sex and advanced age as significant risk factors for sporadic intracranial aneurysms. Conclusions Sporadic intracranial aneurysms mostly occur in people aged 40 to 60 years. Feminine, cigarette smoking, and hypertension are independent risk factors for the disease, and the gender is the most significant factor. Advanced age can increase the effect of these risk factors.     

Teenage smoking in pregnancy and birthweight: a population study, 2001-2004

OBJECTIVE: To determine the association between smoking in pregnant teenagers and baby birthweight. DESIGN, SETTING AND PARTICIPANTS: A retrospective population-based study of women aged < 20 years who gave birth to liveborn singletons in Australia between January 2001 and December 2004. Data were drawn from the National Perinatal Data Collection. MAIN OUTCOME MEASURES: Maternal smoking, birthweight, low birthweight (LBW). RESULTS: The prevalence of LBW in babies born to teenage smokers was 9.9%, compared with 6.0% in babies born to teenage non-smokers (odds ratio [OR], 1.72 [95% CI, 1.57-1.90]). On average, babies born to teenage smokers were 179.8 g lower in birthweight than babies born to teenage non-smokers (95% CI, 165.5 -194.1 g; t = 24.6, P < 0.001). Smoking, Indigenous status, Socio-Economic Indexes for Areas category and parity were independently associated with LBW (all ORs > 1.3; P < 0.001) after adjusting for maternal age group. Teenagers smoking > 10 cigarettes a day had babies with lower birthweight that those who smoked < or = 10 cigarettes a day, demonstrating a dose-response relationship. The babies of teenage smokers who stopped smoking before 20 weeks' gestation had birthweights similar to those of babies born to teenage non-smokers. One in 15 teenage smokers stopped smoking during pregnancy. CONCLUSION: Babies whose mothers smoked during pregnancy were more likely to have LBW than babies whose mothers did not smoke. Mothers who continue to smoke in the second half of pregnancy increase their baby's risk of LBW. There is significant scope to improve the quitting rate, and health professionals need to target smoking cessation at all contacts with pregnant women who continue to smoke.     

Prevalence of smoking and drinking habits among Form Six students in Petaling District, Selangor

Smoking and alcohol intake patterns may persist from adolescence to adulthood. The aims of this study are to determine the prevalence and factors associated with smoking and drinking habits among Form Six students. This was a cross-sectional study conducted in January 2003 among Form Six students from government schools in the Petaling District, Selangor. A hundred and thirty six self-administered questionnaires were distributed to students selected through multistage stratified sampling. Response rate in this study was 90.1% (136/151). The respondents were mainly Chinese 60 (44.1%) and female 88 (64.7%). The prevalence of smoking was 22.8%, whereas the prevalence of alcohol intake was 47.8%. Only 33.1% of the respondents practiced undetermined activities and 1.5% have undetermined characters. There were significant associations between smoking and males (Adjusted OR 2.56, 95% CI 1.02-6.43) and smoking and alcohol intake (Adjusted OR 2.74, 95% CI 1.11-6.78). Alcohol intake has significant negative association with Malays (Adjusted OR 0.83, 95% CI 0.03-0.27). Smoking habits among adolescents were associated with males and alcohol intake. However, only alcohol intake was negatively associated with Malays. Program interventions to reduce behavioral problems, particularly smoking and alcohol intake should be emphasized.     

Smoking cessation and risk of age-related cataract in men

CONTEXT: Although cigarette smoking has been shown to be a risk factor for age-related cataract, data are inconclusive on the risk of cataract in individuals who quit smoking. OBJECTIVE: To examine the association between smoking cessation and incidence of age-related cataract. DESIGN: Prospective cohort study conducted from 1982 through 1997, with an average follow-up of 13.6 years. SETTING AND PARTICIPANTS: A total of 20,907 US male physicians participating in the Physicians' Health Study I who did not have a diagnosis of age-related cataract at baseline and had reported their level of smoking at baseline. MAIN OUTCOME MEASURES: Incident age-related cataract defined as self-report confirmed by medical record review, diagnosed after study randomization and responsible for vision loss to 20/30 or worse, and surgical extraction of incident age-related cataract, in relation to smoking status and years since quitting smoking. RESULTS: At baseline, 11% were current smokers, 39% were past smokers, and 50% were never smokers. Average reported cumulative dose of smoking at baseline was approximately 2-fold greater in current than in past smokers (35.8 vs 20.5 pack-years). Two thousand seventy-four incident cases of age-related cataract and 1193 cataract extractions were confirmed during follow-up. Compared with current smokers, multivariate relative risks (RRs) of cataract in past smokers who quit smoking fewer than 10 years, 10 to fewer than 20 years, and 20 or more years before the study were 0.79 (95% confidence interval [CI], 0.64-0.98), 0.73 (95% CI, 0.61-0.88), and 0.74 (95% CI, 0.63-0.87), respectively, after adjustment for other risk factors for cataract and age at smoking inception. The RR for never smokers was 0.64 (95% CI, 0.54-0.76). The reduced risk in past smokers was principally due to a lower total cumulative dose (RR of cataract for increase of 10 pack-years of smoking, 1.07; 95% CI, 1.04-1.10). A benefit of stopping smoking independent of cumulative dose was suggested in some analyses. Results for cataract extraction were similar. CONCLUSION: These prospective data indicate that while some smoking-related damage to the lens may be reversible, smoking cessation reduces the risk of cataract primarily by limiting total dose-related damage to the lens. JAMA. 2000;284:713-716     

Factors Associated with Coronary Artery Disease in Young Population （Age≤40）： Analysis with 217 Cases

Objective To investigate the relevant factors of coronary artery disease （CAD） in young people under 40 years of age. Methods The study population was 292 young patients accepting coronary angiography in Fuwai Hospital from July to December 2006, including 272 men and 20 women, with the mean age being 36.7±3.7 years. The diagnosis of CAD was made in the cases presenting ~ 50% stenosis in coronary lumen in coronary angiography. Based on the diagnosis, 217 patients （204 men, 13 women） were assigned to CAD group, and 75 （68 men, 7 women） to non-CAD group. Clinical data and metabolic characteristics of the patients were collected and analyzed using t-test, Z2 test, and multinomial logistic regression with SPSS 8.0 software. Results Most study subjects were current smokers （209/292, 71.6%）, and more than half had body mass index （BMI）〉24 kg/m2 （230/292, 78.8%） and usually took high-fat diet （162/292, 55.5%）. The proportion of heavy smokers （smoking history ≥10 years and t〉20 cigarettes per clay） were significantly higher in the CAD group than in the non-CAD group [20.7% （45/217） vs. 9.3% （7/75）, P=0.015）]. Heavy smoking [odds ratio （OR）, 1.89; 95% confidence interval （CI）, 1.74-2.05], hypertension （OR, 1.56; 95% CI, 1.48-1.65）, alcohol （OR, 1.37; 95% CI, 1.30-1.46）, type 2 diabetes mellitus （OR, 1.37; 95% CI, 1.25-1.50）, high-fat diet （OR, 1.35; 95% CI, 1.28-1.43）, and BMI〉24 kg/m2 （OR, 1.09; 95% CI, 1.03-1.17） were factors related to CAD in the young patients （all P〈0.05）. Total cholesterol （4.56_±1.46 mmol/L vs. 4.09_±1.00 mmol/L）, low-density lipoprotein cholesterol （2.38±1.11 mmol/L vs. 2.14±0.63 rnmol/L）, lipoprotein a （134.97±109.70 mg/L vs. 101.58±58.39 mg/L）, uric acid （359.89_±100.09 μmol/L vs. 336.75±94.36 μmol/L）, erythrocyte sedimentation rate （9.98± 12.19 ram/hour vs. 4.89_±4.92 mm/hour）, high-sensitivity C-reactive protein （3.42±4.39 mg/L vs. 2.80±_3.77 mg/L） and Big endothelin-1 （1.41±1.50 fmol/mL vs. 0.77_±1.13 fmol/mL） in plasma were significantly increased in the CAD group compared with the non-CAD group （all P〈0.05）. Conclusions Heavy smoking, hypertension, alcohol consumption, type 2 diabetes mellitus, high-fat diet and BMI〉24 kg/m2 were significantly related to CAD in patients aged ≤40, with heavy smoking presenting the highest OR. Metabolic syndrome and inflammation were also more common in young CAD patients than in non-CAD patients.     

Cigarette Smoking is Associated with Decreased Sperm Density

Objectives To study the association between cigarette smoking and sperm density in men of reproductive age. Methods We enrolled 224 male employees of a modern petrochemical plant in Nanjing, China. These men had no prior history of infertility or other reproductive diseases. Epidemiologic data, including information on smoking and other occupational and lifestyle exposures were obtained by a questionnaire interview. Semen specimens were collected from each participant and analyzed according to the WHO guidelines. Regression analyses were performed to estimate the effect of smoking on sperm density. Results Approximately 67% of the subjects had ever smoked cigarettes. Different measurements of smoking behavior were each associated with decreased sperm density. There was a significant dose-response trend between the tertites of total smoking amount in pack-years and sperm density. As compared to men who never smoked, current smokers had a significant reduction in sperm density (-13.3×106/ml; 95% CI, - 24     

Tobacco smoking and pulmonary tuberculosis: a case-control study

A case-control study was carried out to assess if the tobacco smoking is associated with development of active pulmonary tuberculosis in 153 cases with active pulmonary tuberculosis and 160 control subjects. Detailed information on smoking habits was collected from cases and controls using questionnaire. It was seen that tobacco smoking was associated with pulmonary tuberculosis. The estimated crude odd's ratio (OR) of the association was 1.66 (95% confidence interval: 1.01-2.73) . The age adjusted OR was 1.70 (95% CI: 1.01-2.88), p < 0.05. The increased risk for pulmonary tuberculosis was significant in men who had smoked for over 20 years (OR 3.07; 95% CI: 1.37-6.86). The adjusted OR for heavy smokers (more than 20 bidis per day) was 2.72 (95% CI: 1.19-6.20). There was a dose-response relationship between the number of bidis smoked daily and the risk of development of pulmonary tuberculosis. The study showed that tobacco smoking is associated with pulmonary tuberculosis, with a dose-response relationship with the number of bidis consumed daily.     

锯齿状息肉与传统腺瘤风险因素对比及结直肠癌适宜筛查年龄

目的 对锯齿状息肉(SPs)及传统腺瘤(CA)相关风险因素进行分析、对比,探讨两类息肉风险因素间异同.方法 收集南方医院消化内镜中心2012～2015行全结肠镜及息肉病理检查的病例.随机选取健康对照103例,SPs100例,CA 115例,采集各病例性别、年龄、身高、体质量等临床数据.运用SPSS软件,先对各因素进行组间多重比较,对具有显著性的因素再纳入多因素logistic回归分析,得到风险因素及其OR值.结果 SPs平均发病年龄48.87岁(95％CI 47.22-50.52),较CA更早(P=0.038).以青年组为参照,中年组发生SPs风险增加2.31倍(95％CI 1.46-3.65)、CA风险增加4.10倍(95％CI 2.50-6.72);老年组发生SPs风险增加2.77倍(95％CI 1.52-5.04)、CA风险增加6.00倍(95％CI 3.26-11.05).其中,年龄与CA的发生较SPs关系更为密切(老年组:OR=2.14,95％CI 1.21-3.78,P=0.009).男性较女性SPs发病风险增加2.75倍(95％CI 1.50-5.07)、CA增加2.19倍(95％CI1.22-3.95).BMI每增加1个单位,SPs发病风险增加1.18倍(95％CI 1.06-1.30)、CA增加1.20倍(95％CI 1.09-1.32).结论 两类息肉风险因素类别相同,可使用同一方案进行高危人群筛查.SPs平均发病年龄早于50岁且有可能快速进展为癌,提早CRC筛查年龄值得考虑.     

宫颈癌相关危险因素致病风险的Meta分析

目的综合评价我国女性宫颈癌相关危险因素的关联强度。方法系统收集1990年1月～2011年6月宫颈癌相关危险因素的研究文献,纳入合格研究文献16篇,共计研究对象11 126例。按照NOS标准对纳入文献进行质量评价;采用Stata10.0软件进行Meta分析,得到各相关危险因素与宫颈癌发病风险关联强度合并的OR值及其95%可信区间。结果文献质量评价A级文献6篇、B级文献10篇。在分析的16个因素中有12个因素差异具有统计学意义,与妊娠相关的危险因素及其OR值(95%可信区间)分别为:怀孕≥3次2.384(95%CI:1.659～3.425)、分娩≥3次2.265(95%CI:1.669～3.074)、流产≥3次3.713(95%CI:2.470～5.581)和初次怀孕年龄≤21岁2.390(95%CI:1.731～3.225);与性行为相关的危险因素分别为:结婚≥2次2.522(95%CI:1.714～3.713)、初次性生活年龄≤20岁3.467(95%CI:2.456～4.893)、性伴侣≥3个2.539(95%CI:1.613～3.996);与妇科疾病相关的因素分别为:性传播疾病史5.861(95%CI:1.048～13.67)、妇科病史4.807(95%CI:2.899～7.971);另外,受教育程度≤9年3.536(95%CI:2.204～5.672)、主动或被动吸烟3.055(95%CI:2.435～3.833)和农村或郊区居住地2.134(95%CI:1.010～4.509)等环境因素也与发病风险相关。结论妊娠等相关因素与我国女性宫颈癌发病风险密切相关。     

中国社区老年人衰弱发病及影响因素分析

目的 了解我国社区60岁及以上老年人衰弱的发病情况,探讨其衰弱发生的主要影响因素。方法 利用中国健康和养老追踪调查2011~2015年的数据,以2011年基线调查时60岁及以上非衰弱的老年人建立研究队列,评估随访至2015年队列人群的衰弱发生情况;采用巢式病例对照研究方法,分析老年人衰弱发生的影响因素。结果 本研究队列人群共计随访14 351人年,随访期内共有248人发生衰弱,衰弱的发病密度为17.28/1000人年,男性（14.63/1000人年）低于女性（20.14/1000人年）,年龄越大衰弱的发病密度越高（60~64、65~69、70~74、75~79、80岁及以上老年人衰弱的发病密度分别为：8.90/1000、16.77/1000、24.04/1000、35.27/1000、64.67/1000人年）。多因素条件logistic回归结果显示,有抑郁症状（OR=2.534,95% CI：1.714~3.748）、吸烟（OR=1.713,95% CI：1.081~2.715）、生活自理能力有困难（OR=1.684,95% CI：1.155~2.456）等因素是老年人衰弱发生的危险因素。未婚/离婚/丧偶（OR=0.432,95% CI：0.278~0.673）、认知功能得分高（OR=0.919,95% CI：0.870~0.970）、小学毕业（OR=0.453,95% CI：0.254~0.806）、饮酒（OR=0.520,95% CI：0.323~0.837）等因素是老年人衰弱发生的保护因素。 结论 我国60岁及以上社区老年人衰弱的发病率低于全球发病水平,不同性别、年龄之间老年人衰弱发病存在差异。有抑郁症状、吸烟、生活自理困难是我国社区老年人衰弱发生的主要危险因素。     

Depressed adolescents grown up.

CONTEXT: Major depressive disorder (MDD) that arises in adolescence impairs functioning and is associated with suicide risk, but little is known about its continuity into adulthood. OBJECTIVE: To describe the clinical course of adolescent-onset MDD into adulthood. DESIGN AND PARTICIPANTS: Prospective case-control study. Seventy-three subjects had onset of MDD based on systematic clinical assessment during adolescence (Tanner stage III-V) and 37 controls had no evidence of past or current psychiatric disorders, and also were assessed in adolescence (assessment years: 1977-1985). Follow-up was conducted 10 to 15 years after the initial assessment by an independent team without knowledge of initial diagnosis (follow-up years: 1992-1996). SETTING: Cases were identified at Columbia Presbyterian Hospital, New York City, NY; controls were recruited from the community. MAIN OUTCOME MEASURES: Suicide and suicide attempts, psychiatric diagnoses, treatment utilization, and social functioning. RESULTS: Clinical outcomes of adolescent-onset MDD into adulthood compared with control subjects without psychiatric illness include a high rate of suicide (7.7%); a 5-fold increased risk for first suicide attempt; a 2-fold increased risk of MDD, but not other psychiatric disorders; an increased occurrence of psychiatric and medical hospitalization; and impaired functioning in work, social, and family life. Thirty-seven percent of those with adolescent MDD survived without an episode of MDD in adulthood vs 69% of the control participants (relative risk, 2.2 [95% confidence interval, 1.0-4.7; P<.05]). CONCLUSION: There is substantial continuity, specificity, morbidity, and potential mortality from suicide into adulthood in adolescent-onset MDD patients. Now that empirically based guides to their treatment are becoming available, early identification and treatment seems warranted.     

GSTM1基因多态性与吸烟因素交互作用影响肺癌发生的病例对照研究

目的:探讨谷胱甘肽硫转移酶基因(GSTMl)多态性和环境因素与肺癌发生相关性。方法:采用病例对照研究方法,调查150例住院肺癌患者和150例健康体检者的生活习惯及家族史等信息,并应用PCR-RFLP技术检测研究对象的GSTM1的基因型,采用Logistic回归分析GSTMl基因型和吸烟因素与肺癌的关系,及其两者间的交互作用。结果:(1)病例组GSTMl缺失率64.0%,对照组45.3%,GSTM1基因缺失型发生肺癌的风险OR值为2.14(95%CI:1.35～3.41);吸烟因素发生肺癌的风险OR值为2.53(95%CI:1.57～4.06);(2)GSTM1基因缺失型联合吸烟的OR值5.58(95%CI:2.71～11.49),大于吸烟因素及GSTMl基因缺失型的风险OR值乘积,交互作用中的超相乘模型;(3)随着吸烟量的增加,交互作用系数γ值分别为2.315、2.088、2.035。结论:GSTMl基因缺失与吸烟是肺癌发生的风险因素,GSTMl基因缺失与吸烟因素两者存在交互作用,GSTMl基因缺失与吸烟量呈低暴露-基因效应。     

Relationship between polymorphisms of genes encoding microsomal epoxide hydrolase and glutathione S-transferase P1 and chronic obstructive pulmonary disease

Background Cigarette smoking is the major risk factor for chronic obstructive pulmonary disease (COPD). However, only 10% -20% of chronic heavy cigarette smokers develop symptomatic disease. COPD is most likely the result of complex interactions between environmental and genetic factors. Genetic susceptibility to COPD might depend on the variations in enzyme activities that detoxify cigarette smoke products, such as microsomal epoxide hydrolase (mEH) and glutathione Stransferase (GST). In this study, we investigated the relationship between polymorphisms in the genes encoding mEH and glutathione S-transferase P1 (GSTP1) and COPD in a Chinese population.Methods Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed to find mEH polymorphism in exon 3 (Tyr113→His), exon 4 (His139→Arg) and GSTP1 polymorphism in exon 5 (Ile105→Val) in 100 COPD patients and 100 age- and sex-matched healthy controls.Results The proportion of mEH exon 3 heterozygotes was significantly higher in patients with COPD than that in the control subjects (42% vs 32% ). The odds ratio (OR) adjusted by age, sex, body mass index (BMI) and cigarette years was 2.96 (95% CI 1.24 - 7. 09). There was no marked difference in very slow activity genotype versus other genotypes between COPD patients and the controls. When COPD patients were non-smokers, the OR of very slow activity genotype versus other genotypes was more than 1.00; and when COPD patients were smokers ( current smokers and exsmokers), the OR was less than 1.00. There was no significant difference in GSTP1 polymorphism adjusted by age, sex, BMI and smoking between COPD patients and the controls.Conclusions mEH exon 3 heterozygotes might be associated with susceptibility to COPD in China.The interaction might exist between mEH genotype and smoke. The gene polymorphism for GSTP1 might not be associated with susceptibility to COPD in the Chinese population.     

Cigarette smoking and the risk of endometrial cancer:A meta-analysis

OBJECTIVE:Epidemiologic findings are inconsistent concerning the association of endometrial cancer risk with cigarette smoking.We conducted a meta-analysis of epidemiologic studies to examine this relation.METHODS:A systematic literature search up to June of 2007 was performed in MEDLINE and EMBASE.Study-specific risk estimates were pooled using a random-effects model.RESULTS:Ten prospective and 24 case-control studies were included in the analysis of the effect of ever smoking.Ever smoking was statistically significantly associated with a reduced risk of endometrial cancer among prospective studies(relative risk 0.81;95% confidence interval[CI],0.74-0.88) and case-control studies(odds ratio 0.72;95% CI,0.66-0.79).The inverse association was significant among current and former smokers.Six prospective and 6 case-control studies were included in the quantitative analysis.We noted that an increase in smoking of 20 cigarettes per day was statistically significantly associated with 16% and 27% reduced risks of endometrial cancer in prospective and case-control studies,respectively.We also found that cigarette smoking was significantly associated with a decreased risk of endometrial cancer among postmenopausal women(relative risk 0.71;95% CI,0.65-0.78) but not among premenopausal women.In addition,the risk reduction seemed to be stronger among hormone replacement therapy users than nonusers.CONCLUSION:Cigarette smoking was found to be significantly associated with a reduced risk of endometrial cancer,especially among postmenopausal women.(C) 2008 Elsevier Inc.All rights reserved.     

Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing

CONTEXT: Sleep-disordered breathing (SDB) is both prevalent and associated with serious chronic illness. The incidence of SDB and the effect of risk factors on this incidence are unknown. OBJECTIVE: To determine the 5-year incidence of SDB overall and as influenced by risk factors. DESIGN, SETTING, AND PARTICIPANTS: Of the 1149 participants in the Cleveland Family Study, those aged 18 years or older, from either case or control families, who had 2 in-home sleep studies 5 years apart. The first had to have been performed before June 30, 1997, and had to have normal results (apnea hypopnea index [AHI] <5). Data included questionnaire information on medical and family history, SDB symptoms; measurement of height, weight, blood pressure, waist and hip circumference, and serum cholesterol concentration; and overnight sleep monitoring. MAIN OUTCOME MEASURE: Apnea hypopnea index, defined as number of apneas and hypopneas per hour of sleep. Sleep-disordered breathing was defined by an AHI of at least 10 (mild to moderate) or of at least 15 (moderate). RESULTS: Forty-seven (16%) of 286 eligible participants, (95% confidence interval [CI], 13%-21%) had a second-study AHI of at least 10 and 29 (10%) participants (95% CI, 7%-14%) had a second-study AHI result of at least 15. For the AHI results of at least 15, we estimate that about 2.5% may represent test variability. By ordinal logistic regression analysis, AHI was significantly associated with age (odds ratio [OR] per 10-year increase, 1.79; 95% CI, 1.41-2.27), body mass index (BMI; OR per 1-unit increase, 1.14; 95% CI, 1.10-1.19), sex (OR for men vs women, 4.12; 95% CI, 2.29-7.43), waist-hip ratio (OR per 0.1 unit increase, 1.61; 95% CI, 1.04-2.28), and serum cholesterol concentration (OR per 10-mg/dL [0.25-mmol/L] increase, 1.11; 95% CI, 1.03-1.19). Interactions were noted between age and both sex (P =.003) and BMI (P =.05). The OR for increased AHI per 10-year age increase was 2.41 in women (95% CI, 1.78-3.26) and 1.15 in men (95% CI, 0.78-1.68), with the male vs female OR decreasing from 5.04 (95% CI, 2.19-11.6) at age 30 years to 0.54 (95% CI, 0.15-1.99) at age 60 years. The OR for increased AHI per 1-unit increase in BMI decreased from 1.21 (95% CI, 1.11-1.31) at age 20 years to 1.05 (95% CI, 0.96-1.15) at age 60 years. CONCLUSIONS: The 5-year incidence is about 7.5% for moderately severe SDB and 16% (or less) for mild to moderately severe SDB. Incidence of SDB is influenced independently by age, sex, BMI, waist-hip ratio, and serum cholesterol concentration. Predominance in men diminishes with increasing age, and by age 50 years, incidence rates among men and women are similar. The effect of BMI also decreases with age and may be negligible at age 60 years.