一手烟害自己,二手烟害身边人!BMJ子刊:二手烟或增加口腔癌的风险

2021-04-29 K.K MedSci原创

全球与癌症相关的死亡人群中,每五个人就有一个是烟草烟雾导致的。

全球与癌症相关的死亡人群中,每五个人就有一个是烟草烟雾导致的。其中,口腔癌就可能与吸烟有关,它的患病风险因素有吸烟、食用无烟烟草、槟榔和饮酒,又吸烟又饮酒还可能会导致口腔癌风险增加。2007年10月,发表在INTERNATIONAL JOURNAL OF CANCER上的研究认为,除了吸烟是口腔癌的一个重要风险因素,口腔还会受到二手烟的影响。2009年国际癌症研究机构(IARC)的评估认为二手烟可能会导致肺癌、喉癌及咽癌。二手烟(SHS)包含主流烟(即吸烟者在吸入香烟后呼出的烟雾)和 侧流烟(即从烟头中吸入的烟雾)。

根据192个国家的数据分析,接触二手烟的人群有男性非吸烟者(33%)、女性非吸烟者(45%)和儿童(40%)。4月26日,一项发表在BMJ子刊的研究,分析了人群暴露在二手烟中可能会对健康造成的不利影响。

Lorena C. Mariano et al.Secondhand smoke exposure and oral cancer risk: a systematic review and meta-analysis, Tobacco Control (2021). DOI: 10.1136/tobaccocontrol-2020-056393

研究人员对暴露于二手烟环境下与未暴露的人群进行了敏感性分析,从不吸烟饮酒的人中发现当暴露在二手烟环境下,口腔癌的集合OR(优势比)为1.43(95% CI 1.12~1.83,p=0.004),没有观察到明显的异质性。OR是流行病学研究中病例对照研究中的一个常用指标。当OR值大于1,表示该因素是危险因素。

4项研究进行荟萃分析显示,暴露在二手烟与患口腔癌风险存在正相关,OR值为1.51。各项研究的异质性大小并不明显

按二手烟暴露时间分析,与从未接触二手烟的人相比,接触少于10年或15年的患者OR值为1.56(95% CI 1~2.43,P=0.05),由此,暴露10年或15年或是风险因素。

当研究人员调整了混杂因素,与非暴露患者相比,二手烟环境暴露超过10年meta-OR值为1.93(95% CI 1.35~2.77,p=0.0003)。对于未暴露10年或15年的OR值则为1.39(95%CI为0.84~2.31)。

 

观察到与未暴露者相比,暴露于SHS超过10或15年时,口腔癌的风险增加(OR 2.07,95% CI 1.54~2.79,P<0.00001)

与未暴露的患者相比,暴露于2或3小时以上的患者OR为2.15(95% CI 1.22~3.77,P=0.008),暴露少于2或3小时的OR值为1.65(95%CI为1.11~2.45,P=0.01),无明显异质性。

通过调整混杂因素,与未暴露的病例相比,暴露于2或3小时以上的OR为1.69(95% CI 0.91~3.13,p=0.1),暴露于2或3小时以下的OR为1.41(95% CI 0.82~2.42,p=0.21),均无明显异质性。

2011年1月,发表在《柳叶刀》上的研究显示,在中低收入国家中,超过三分之一的非吸烟且育龄期妇女可能会接触到二手烟。怀孕期间暴露在烟草烟雾,对胎儿发育还可能会导致不良后果。接触二手烟可能会增加死胎(OR 1.23,95% CI 1.09~1.38)、先天性畸形(OR 1.13,95% CI 1.01~1.26)和低出生体重婴儿(风险比1.16;95% CI 0.99~1.36)的风险。

2011年4月,发表在Pediatrics上的研究认为,中低收入国家的妇女暴露在二手烟环境中比自身吸烟对妊娠、分娩更可能造成不良结果。从优势比来看,主动吸烟(OR 1.4)和体重指数大于30 kg/m2(OR 1.6)的死胎风险与被动吸烟(OR 1.23)的风险相当。2019年7月,发表在BMJ子刊的一项研究分析了30个中低收入国家的妇女在怀孕期间主动吸烟和暴露于二手烟的情况,总得来看。每天接触二手烟的妇女发生几率从6%~73%不等。

Sian Reece et al, Secondhand smoke exposure during pregnancy: a cross-sectional analysis of data from Demographic and Health Survey from 30 low-income and middle-income countries, Tobacco Control (2018). DOI: 10.1136/tobaccocontrol-2018-054288

怀孕期间接触二手烟的几率高于自身吸烟几率。每日接触二手烟的几率在东南亚最高(57%的孕妇),拉丁美洲国家最低(10%的孕妇)

Sian Reece et al, Secondhand smoke exposure during pregnancy: a cross-sectional analysis of data from Demographic and Health Survey from 30 low-income and middle-income countries, Tobacco Control (2018). DOI: 10.1136/tobaccocontrol-2018-054288

从拥有的财富方面来看,妇女生活中日常接触二手烟的概率随财富的增加而下降。在教育程度方面,具备小学学历的妇女在家庭中,接触二手烟的概率最高,其次是未受教育、中学及以上教育。城市家庭中的孕妇比农村有更高的接触几率。

而从二手烟导致的分娩不良后果来看,死产的人群归因分值从0.01到0.14不等。人群归因分值(PAF),或称人群归因危险度百分比,表示总体人群中某病归因于某因素引起的发病(或死亡)占全部发病(或死亡)的比例。在30个国家中,因家庭暴露于二手烟所致死产的PAF与主动吸烟所致死产的PAF相当。

主动吸烟和日常生活暴露在二手烟环境中导致死胎的PAF

中低收入国家母亲和儿童容易暴露在家庭的二手烟环境中,包括了做饭或取暖时的烟雾中。其实,这些燃料含有大量的有害污染物(包括一氧化碳、苯和1,3-丁二烯),与健康问题和分娩不良后果有关。

据世界卫生组织的数据显示:中国人口占世界人口的比例不到五分之一,但烟草的消费却占全世界的三分之一,居全世界第一位,比第二到第五位(印度尼西亚、日本、俄罗斯和美国)加起来都多。手里的烟不仅在害你自己,甚至还在害越来越多的人!对于二手烟草烟雾,通风或过滤,甚至两者相结合,都不能将室内接触降低到被认为可接受的程度,只有100%的无烟环境可提供有效的保护。

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    2021-12-17 gaoxiaoe
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    2021-05-08 ms6000001624652641

    戒烟,戒二手烟

    0

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    2021-05-04 ms2000000663876436

    远离吸烟

    0

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    2021-05-02 ms2000001361349190

    哎,烟草是大户

    0

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  6. [GetPortalCommentsPageByObjectIdResponse(id=1849237, encodeId=2a63184923eeb, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri Dec 17 21:03:34 CST 2021, time=2021-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963815, encodeId=707096381563, content=戒烟,戒二手烟, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd5b5469613, createdName=ms6000001624652641, createdTime=Sat May 08 22:15:05 CST 2021, time=2021-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=962622, encodeId=2e4396262246, content=远离吸烟, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5bad5492002, createdName=ms2000000663876436, createdTime=Tue May 04 13:57:26 CST 2021, time=2021-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=962337, encodeId=d1d796233eba, content=哎,烟草是大户, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=dffa5465843, createdName=ms2000001361349190, createdTime=Sun May 02 19:50:20 CST 2021, time=2021-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1340137, encodeId=44dc134013e28, content=<a href='/topic/show?id=77b0239266a' target=_blank style='color:#2F92EE;'>#二手烟#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23926, encryptionId=77b0239266a, topicName=二手烟)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1dfd2500156, createdName=12498c24m69暂无昵称, createdTime=Sat May 01 01:03:34 CST 2021, time=2021-05-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=961515, encodeId=a20696151563, content=好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=285e5488776, createdName=ms4000001508223685, createdTime=Thu Apr 29 14:46:42 CST 2021, time=2021-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=961509, encodeId=be519615091e, content=远离二手烟, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210429/2d85476edcaa48f0b106538965841941/8ec00023c08b4fb882673313e1bc876e.jpg, createdBy=eaef5488992, createdName=vivian3675, createdTime=Thu Apr 29 14:09:31 CST 2021, time=2021-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=961501, encodeId=ce48961501fb, content=吸烟有害健康, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201214/b3170121d995432ea306ae3a7809cc05/2cfb236f361b4d3c80ef8fdef4301832.jpg, createdBy=8ad35400531, createdName=ZJY要积极努力向上, createdTime=Thu Apr 29 13:38:36 CST 2021, time=2021-04-29, status=1, ipAttribution=)]
    2021-04-29 ms4000001508223685

    好文章

    0

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    2021-04-29 vivian3675

    远离二手烟

    0

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    2021-04-29 ZJY要积极努力向上

    吸烟有害健康

    0

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