Comparison of Urine 4-(Methylnitrosamino)-1-(3)Pyridyl-1-Butanol and Cotinine for Assessment of Active and Passive Smoke Exposure in Urban Adolescents.
Comparison of Urine 4-(Methylnitrosamino)-1-(3)Pyridyl-1-Butanol and Cotinine for Assessment of Active and Passive Smoke Exposure in Urban Adolescents.
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DOI：
10.1158/1055-9965.epi-17-0671
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发表时间：
2018-03
期刊：
影响因子：
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通讯作者：
Jacob P 3rd
中科院分区：
文献类型：
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作者：
Benowitz NL;Nardone N;Jain S;Dempsey DA;Addo N;St Helen G;Jacob P 3rd
许多青少年暴露在烟草烟雾中，无论是主动吸烟(CS)还是二手烟暴露(SHS)。烟草暴露的特定生物标志物包括可替宁(检测过去2-4天的使用情况)和4-(甲基亚硝基)-1-(3-吡啶)-1-丁醇(NNAL)(检测使用一个月或更长时间)。NNAL预计将检测到更多间歇性烟草暴露。我们比较了NNAL和可替宁作为城市青少年烟草暴露的生物标志物，并确定了区分CS和SHS暴露的最佳NNAL切入点。对2013-2014年间在扎克伯格旧金山总医院接受儿科健康或紧急护理访问的466名青少年的剩余尿样进行了可替宁和NNAL的检测。94%的青少年有可测量的NNAL水平，而可替宁的这一比例为87%。以潜伏期9.6pg/ml或受试者工作特性分析14.4pg/ml为鉴别CS与SHS的最佳NNAL界值。可替宁和NNAL有很强的相关性，但在活跃的青少年和暴露于SHS的青少年中，相关性斜率不同。在非吸烟者中，非裔美国人的NNAL水平(中位数3.3pg/ml)显著高于其他组(0.9至1.9pg/ml)，这表明暴露于SHS的风险更大。尿NNAL筛查发现，绝大多数(94%)的城市青少年接触过烟草。与其他族裔/种族群体相比，非裔美国人接触到的SHS水平更高。SHS与青少年的重大医学发病率有关。使用NNAL或可替宁进行常规生化筛查可检测到SHS暴露的高流行率，应将其视为减少高危人群SHS暴露的工具。
Many adolescents are exposed to tobacco smoke, from either active smoking (CS) or secondhand smoke exposure (SHS). Tobacco-specific biomarkers of exposure include cotinine (detects use in past 2-4 days) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) (detects use for a month or longer). NNAL is expected to detect more intermittent tobacco exposure. We compared NNAL and cotinine as biomarkers of exposure to tobacco in urban adolescents and determined the optimal NNAL cut point to distinguish CS from SHS exposure. Surplus urine samples, collected from 466 adolescents attending pediatric well or urgent care visits at Zuckerberg San Francisco General Hospital in 2013-2014, were assayed for cotinine and NNAL. 94% of adolescents had measurable levels of NNAL compared to 87% for cotinine. The optimal NNAL cut point to distinguish CS from SHS was 9.6 pg/ml by latent class or 14.4 pg/ml by receiver operating characteristic analysis. Cotinine and NNAL were strongly correlated, but the correlation slopes differed for active vs SHS exposed adolescents. Among nonsmokers, NNAL levels were significantly higher in African American (median 3.3 pg/ml) compared to other groups (0.9 to 1.9 pg/ml), suggesting greater exposure to SHS. Urine NNAL screening finds a large majority (94%) of urban adolescents are exposed to tobacco. African Americans are exposed to higher levels of SHS than other ethnic/racial groups. SHS is associated with significant medical morbidity in adolescents. Routine biochemical screening with NNAL or cotinine detects high prevalence of SHS exposure and should be considered as a tool to reduce SHS exposure in high-risk populations.