Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Final Report
Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Final Report
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DOI：
10.1056/nejmoa1911614
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发表时间：
2020-03-05
影响因子：
158.5
通讯作者：
Meiman, Jonathan
中科院分区：
文献类型：
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作者：
Layden, Jennifer E.;Ghinai, Isaac;Meiman, Jonathan
电子烟是一种电池驱动的设备，它加热液体并将雾化产品输送给用户。与电子烟使用有关的肺部疾病有报道，但没有大规模的系列报道。2019年7月，威斯康星州卫生服务部和伊利诺伊州公共卫生部收到了与使用电子烟（也称为vaping）相关的肺损伤报告，并发起了一项协调一致的公共卫生调查。方法我们将病例患者定义为在症状出现前90天内报告使用电子烟设备和相关产品，影像学上有肺部浸润，且疾病非归因于其他原因的患者。使用标准化工具进行病历提取和病例患者访谈。结果98例患者中男性占79%；患者的中位年龄为21岁。大多数患者表现为呼吸道症状（97%）、胃肠道症状（77%）和体质症状（100%）。所有病例均有双侧浸润。95%的患者住院，26%接受插管和机械通气，2例死亡。总共有89%的患者报告在电子烟设备中使用过四氢大麻酚产品，尽管报告的产品和设备种类繁多。伊利诺伊州的综合征监测数据显示，2019年6月至8月，与严重呼吸系统疾病相关的平均每月就诊率是2018年同期的两倍。结论两例患者临床特征相似。虽然导致损伤的最终物质尚未确定，但这一最初的疾病群代表了一种或多种新出现的临床综合征。需要进一步的工作来描述病理生理学特征并确定最终原因。电子烟的使用迅速增加。在这份来自威斯康星州和伊利诺伊州公共卫生部门的最终报告中，描述了一种严重的呼吸道疾病，在其他健康的年轻人中。在本次调查中发现的98例患者中，95%住院，26%插管，2人死亡。
Background E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of lung injury associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation.Methods We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools.Results There were 98 case patients, 79% of whom were male; the median age of the patients was 21 years. The majority of patients presented with respiratory symptoms (97%), gastrointestinal symptoms (77%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging. A total of 95% of the patients were hospitalized, 26% underwent intubation and mechanical ventilation, and two deaths were reported. A total of 89% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018.Conclusions Case patients presented with similar clinical characteristics. Although the definitive substance or substances contributing to injury have not been determined, this initial cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes.Vaping use has rapidly increased. In this final report from the Wisconsin and Illinois departments of public health, a severe respiratory illness in otherwise healthy young people is described. Of the 98 case patients identified in this investigation, 95% were hospitalized, 26% were intubated, and 2 persons died.