Active and Passive Cigarette Smoking and Acute Lung Injury after Severe Blunt Trauma
Active and Passive Cigarette Smoking and Acute Lung Injury after Severe Blunt Trauma
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DOI：
10.1164/rccm.201011-1802oc
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发表时间：
2011-06-15
影响因子：
24.7
通讯作者：
Cohen, Mitchell J.
中科院分区：
文献类型：
--
作者：
Calfee, Carolyn S.;Matthay, Michael A.;Cohen, Mitchell J.
理由：在实验室研究中已经证明吸烟对肺上皮和内皮功能的影响与在急性肺损伤（ALI）中观察到的相似。然而，主动和被动香烟烟雾暴露与ALI易感性之间的关系尚未进行前瞻性研究。目的：我们假设主动和被动香烟烟雾暴露与严重钝伤后ALI易感性增加有关。方法：我们测量了可替宁的水平，可替宁是尼古丁的代谢物，也是烟草使用的有效生物标志物，144名成年受试者在严重钝伤后到达急诊室时立即获得的血浆样本中。测量和主要结果：血浆可替宁四分位数的增加与ALI的发展相关（在最高可替宁四分位数中发展ALI的比值比[OR]为3.25; 95%置信区间[CI]为1.22-8.68;跨四分位数趋势的P <0.017）。中度至重度被动吸烟暴露与主动吸烟者发生ALI的几率几乎相同（中度至重度被动吸烟与无暴露或低水平暴露相比的OR为3.03; 95%CI，1.15-8.04;主动吸烟的OR为2.77; 95%CI，1.28-5.99）。调整后的其他预测因素的ALI，包括损伤严重程度评分和alcohol abuse.Conclusions：中度至重度被动吸烟和主动吸烟与严重钝伤后ALI的发展独立相关。这一发现对公众健康和理解ALI的发病机制都有重要意义。
Rationale: Cigarette smoking has been demonstrated in laboratory studies to have effects on lung epithelial and endothelial function similar to those observed in acute lung injury (ALI). However, the association between active and passive cigarette smoke exposure and susceptibility to ALI has not been prospectively studied.Objectives: We hypothesized that both active and passive cigarette smoke exposure would be associated with increased susceptibility to ALI after severe blunt trauma.Methods: We measured levels of cotinine, a metabolite of nicotine and validated biomarker of tobacco use, in plasma samples obtained immediately on arrival at the emergency department from 144 adult subjects after severe blunt trauma. Patients were then followed for the development of ALI.Measurements and Main Results: Increasing quartiles of plasma cotinine were associated with the development of ALI (odds ratio [OR] for developing ALI in highest cotinine quartile, 3.25; 95% confidence interval [CI], 1.22-8.68; P 5 0.017 for trend across quartiles). Moderate to heavy passive smoke exposure was associated with nearly the same odds of developing ALI as active smoking (OR for moderate to heavy passive smoking compared with no exposure or low level exposure, 3.03; 95% CI, 1.15-8.04; OR for active smoking, 2.77; 95% CI, 1.28-5.99). This association persisted after adjusting for other predictors of ALI, including Injury Severity Score and alcohol abuse.Conclusions: Both moderate to heavy passive smoking and active smoking are independently associated with the development of ALI after severe blunt trauma. This finding has important implications both for public health and for understanding the pathogenesis of ALI.