Biomarkers increase detection of active smoking and secondhand smoke exposure in critically ill patients.
Biomarkers increase detection of active smoking and secondhand smoke exposure in critically ill patients.
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DOI：
10.1097/ccm.0b013e3181fa4196
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发表时间：
2011-01
影响因子：
8.8
通讯作者：
Calfee CS
中科院分区：
文献类型：
--
作者：
Hsieh SJ;Ware LB;Eisner MD;Yu L;Jacob P 3rd;Havel C;Goniewicz ML;Matthay MA;Benowitz NL;Calfee CS
烟草烟雾暴露与危重病之间的关系尚未得到很好的研究，主要是因为很难从危重病患者中获得准确的吸烟史。生物标志物可以提供有关主动吸烟和二手烟暴露的定量数据。我们试图在一组危重患者中比较通过生物标志物测量的香烟烟雾暴露与自我报告的暴露，并确定香烟烟雾暴露的生物标志物在该人群中相互关联的程度。在田纳西州的一个三级学术医学中心，对60名入选观察性危重受试者队列的受试者进行了血清和尿液可替宁和反式-3 ′-羟基可替宁、尿液4-（甲基亚硝胺）-1-（3-吡啶基）-1-丁醇以及头发和指甲尼古丁水平的测量。从患者、其代理人或病历中获得吸烟史。将通过生物标志物测量的香烟烟雾暴露与通过病史测量的暴露进行比较。根据吸烟史，29例受试者被确定为吸烟者，28例被确定为不吸烟者，3例被确定为未知。血清可替宁和尿4-（甲基亚硝胺）-1-（3-吡啶基）-1-丁醇的组合确定了27/28例非吸烟者的历史，无论是积极吸烟者（n = 6，21%）或暴露于二手烟（n = 21，75%）。所有生物标志物水平彼此强烈相关（r = 0.69 - 0.95，p <0.0001）。血清可替宁和尿4-（甲基亚硝胺）-1-（3-吡啶基）-1-丁醇的组合识别出比吸烟史更多的活跃吸烟者，并检测出危重人群中二手烟暴露的高患病率。这些标志物对于未来研究主动吸烟和二手烟暴露与危重疾病之间的关系将是重要的。
The association between tobacco smoke exposure and critical illness is not well studied, largely because obtaining an accurate smoking history from critically ill patients is difficult. Biomarkers can provide quantitative data on active and secondhand cigarette smoke exposure. We sought to compare cigarette smoke exposure as measured by biomarkers to exposure by self-report in a cohort of critically ill patients and to determine how well biomarkers of cigarette smoke exposure correlate with each other in this population. Serum and urine cotinine and trans-3′-hydroxycotinine, urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, and hair and nail nicotine levels were measured in 60 subjects enrolled in an observational cohort of critically ill subjects at a tertiary academic medical center in Tennessee. Smoking history was obtained from patients, their surrogates, or the medical chart. Cigarette smoke exposure as measured by biomarkers was compared to exposure by history. By smoking history, 29 subjects were identified as smokers, 28 were identified as nonsmokers, and 3 were identified as unknown. The combination of serum cotinine and urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol identified 27 of the 28 nonsmokers by history either as active smokers (n = 6, 21%) or as exposed to secondhand smoke (n = 21, 75%). All biomarker levels were strongly correlated with each other (r = .69–.95, p < .0001). The combination of serum cotinine and urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol identified considerably more active smokers than did smoking history and detected a high prevalence of secondhand smoke exposure in a critically ill population. These markers will be important for future studies investigating the relationship between active smoking and secondhand smoke exposure and critical illness.