吸烟对慢性阻塞性肺疾病及呼吸道症状的影响

查震球; 何玉琢; 徐伟; 陈叶纪; 刘心勇; 刘志荣; 叶冬青

doi:10.16462/j.cnki.zhjbkz.2020.01.010

吸烟对慢性阻塞性肺疾病及呼吸道症状的影响

doi: 10.16462/j.cnki.zhjbkz.2020.01.010

1.
230601 合肥, 安徽省疾病预防控制中心慢性非传染性疾病防治科
2.
245000 黄山, 黄山市疾病预防控制中心
3.
230032 合肥, 安徽医科大学公共卫生学院流行病与卫生统计学系

基金项目: 国家重点研发计划项目(2016YFC1303905);安徽省科技重大专项计划项目(201903a07020015)

详细信息

通讯作者:
刘志荣, E-mail:lzr@ahcdc.com.cn

叶冬青, E-mail:ydq@ahmu.edu.cn

中图分类号: R181.2;R562
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- 被引次数: 0
出版历程
- 收稿日期: 2019-07-19
- 修回日期: 2019-10-08
- 刊出日期: 2020-01-10

Effects of smoking on chronic obstructive pulmonary disease and respiratory symptoms

1.
Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
2.
Huangshan Center for Disease Control and Prevention, Huangshan 245000, China
3.
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China

Funds: National Key Research and Development Program(2016YFC1303905); Major Science and Technology Plan Project of Anhui Province(201903a07020015)

More Information

Corresponding author: LIU Zhi-rong, E-mail:lzr@ahcdc.com.cn; YE Dong-qing, E-mail:ydq@ahmu.edu.cn

摘要

摘要: 目的探讨吸烟对慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)及呼吸道症状的影响。方法利用多阶段分层整群随机抽样的方法在安徽5个COPD监测点抽取≥40岁调查对象, 并对其进行问卷调查、身体测量和肺功能检测。利用复杂抽样Logistic回归分析模型分析吸烟对COPD及呼吸道症状的影响。结果 ≥30包年的吸烟者在总人群中占13.9%(95% CI:10.3%~17.5%, P < 0.001), ≥40年的吸烟者在总人群中占8.5%(95% CI:6.7%~10.3%, P < 0.001)。吸烟者平均吸烟年数为32.4 (95% CI:31.2~33.5)年, 吸烟者日均吸烟量为21.1 (95% CI:19.6~22.7)支/天。调整混杂因素后, COPD和呼吸道症状的患病风险均随吸烟包年和吸烟年数的增加而呈上升趋势(均有P_trend < 0.001)。结论吸烟增加COPD及呼吸道症状的患病风险, 吸烟包年和吸烟年数越多, 慢阻肺和呼吸道症状的患病风险越大。
- 吸烟 /
- 慢性阻塞性肺疾病 /
- 呼吸道症状 /
- 横断面研究 /
- 流行病学
Abstract: Objective To investigate the effects of smoking on chronic obstructive pulmonary disease(COPD) and respiratory symptoms. Methods A multi-stage, stratified cluster sampling strategy was used to select participants aged 40 or older in 5 surveillance points of Anhui Province. Questionnaires, body measurements and spirometry were used to collect data. Based on complex sampling design, Logistic regression model was conducted to analyze the effects of smoking on COPD and respiratory symptoms. Results The smokers who had smoked for ≥30 pack-years accounted for 13.9%(95% CI:10.3%-17.5%, P < 0.001) of the total population. And the smokers who had smoked for ≥40 years accounted for 8.5%(95%CI:6.7%-10.3%, P < 0.001) of the total population. On average, one smoker had smoked for 32.4 years(95%CI:31.2-33.5). Average daily cigarette consumption of daily smokers was 21.1 cigarettes(95% CI:19.6-22.7). As shown by multiple-variables Logistic regression analyses, the risk of COPD and respiratory symptoms increased with the increment of smoking pack-years and duration(all P_trend < 0.001). Conclusions Smoking was associated with COPD and respiratory symptoms. The risk of developing COPD and respiratory symptoms was greater with the increment of smoking pack-years and duration.
- Smoking /
- Chronic obstructive pulmonary disease /
- Respiratory symptoms /
- Cross-sectional studies /
- Epidemiology

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表 1 调查对象基本特征

Table 1. Demographic characteristics of responders

项目	合计		吸烟者(n=1 011)	从不吸烟者(n=1 754)	χ²值	P值
项目	调查人数(人)	构成比[%(95%CI)]	构成比[%(95%CI)]	构成比[%(95%CI)]	χ²值	P值
城乡
城镇	1 668	62.5(38.0~86.9)	62.7(37.2~88.1)	62.4(38.3~86.4)	0.02	0.898
乡村	1 102	37.5(13.1~62.0)	37.3(11.9~62.8)	37.6(13.6~61.7)
年龄(岁)
40~	1 047	41.0(30.6~51.3)	37.7(30.3~45.2)	42.8(30.0~55.7)	13.25	0.001
50~	788	30.1(25.0~35.1)	27.4(21.4~33.4)	31.6(25.0~38.1)
≥60	935	29.0(18.5~39.5)	34.9(23.3~46.5)	25.6(15.1~36.1)
性别
男	1 362	48.1(42.2~54.0)	96.0(93.5~98.4)	20.9(13.5~28.3)	340.60	< 0.001
女	1 408	51.9(46.0~57.8)	4.0(1.6~6.5)	79.1(71.7~86.5)
教育水平
小学及以下	1 690	57.5(45.5~69.5)	46.1(36.9~55.4)	63.9(51.4~76.4)	67.98	< 0.001
初中毕业	774	29.2(25.4~33.0)	36.7(23.6~49.9)	25.0(21.5~28.4)
高中及以上	305	13.3(0.0~27.4)	17.1(0.0~35.2)	11.1(0.0~22.6)
儿童期严重呼吸系统感染
无	2 716	98.1(97.1~99.0)	97.8(95.5~100.0)	98.2(97.3~99.1)	0.25	0.618
有	53	1.9(1.0~2.9)	2.2(0.0~4.5)	1.8(0.9~2.7)
肺结核病史
无	2 723	98.5(97.5~99.6)	98.3(96.6~100.0)	98.6(97.6~99.6)	0.44	0.505
有	46	1.5(0.4~2.5)	1.7(0.0~3.4)	1.4(0.4~2.4)
呼吸病家族史
无	2 276	80.3(74.0~86.7)	77.1(70.5~83.6)	82.3(76.0~88.6)	26.23	< 0.001
有	493	19.7(13.3~26.0)	22.9(16.4~29.5)	17.7(11.4~24.0)
BMI (kg/m²)
< 18.5	42	1.5(0.0~3.3)	1.6(0.0~3.3)	1.4(0.0~3.3)	2.15	0.341
18.5~	1 173	41.7(31.1~52.4)	43.4(36.7~50.0)	40.8(27.4~54.2)
≥24.0	1 555	56.8(44.4~69.2)	55.1(46.9~63.2)	57.8(42.7~73.0)
职业粉尘和/或有害气体暴露
无	1 571	58.2(41.7~74.7)	52.2(34.5~70.0)	61.6(44.7~78.5)	5.74	0.017
有	1 198	41.8(25.3~58.3)	47.8(30.0~65.5)	38.4(21.5~55.3)
被动吸烟
无	1 360	43.1(19.8~66.3)	33.9(12.3~55.5)	48.3(22.6~74.0)	6.42	0.011
有	1 409	56.9(33.7~80.2)	66.1(44.5~87.7)	51.7(26.0~77.4)
室内空气污染
否	1 502	50.3(7.9~92.6)	48.4(11.6~85.3)	51.3(5.7~96.9)	0.57	0.449
是	1 267	49.7(7.4~92.1)	51.6(14.7~88.4)	48.7(3.1~94.3)
合计	2 770	100.0		36.3(27.5~45.1)		63.7(54.9~72.5)

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表 2 调查对象的吸烟状况

Table 2. Smoking status of the respondents

项目	合计		城镇	乡村	P值
项目	调查人数(人)	%(95%CI)	%(95%CI)	%(95%CI)	P值
吸烟(包年)
0	1 754	64.9(55.3~74.5)	64.7(56.0~73.4)	65.3(53.3~77.3)	0.053
< 15	269	10.9(7.8~13.9)	12.2(7.5~16.8)	8.7(5.9~11.5)
< 30	297	10.3(6.1~14.5)	10.0(5.6~14.4)	10.8(7.2~14.4)
≥30	398	13.9(10.3~17.5)	13.1(11.4~14.9)	15.2(8.6~21.8)
吸烟年数(年)
0	1 754	65.2(56.2~74.2)	65.0(56.7~73.3)	65.5(54.3~76.8)	0.479
< 30	422	16.2(9.3~23.0)	16.1(8.6~23.7)	16.2(9.9~22.5)
< 40	276	10.2(8.0~12.3)	10.9(8.2~13.6)	8.9(6.4~11.5)
≥40	261	8.5(6.7~10.3)	8.0(6.7~9.2)	9.3(4.3~14.4)
吸烟者吸烟年数(年)^a	959	32.4(31.2~33.5)	32.2(29.7~34.6)	32.7(31.1~34.3)	0.702
每日吸烟者日均吸烟量(支/天)^a	905	21.1(19.6~22.7)	20.8(18.9~22.7)	21.6(20.2~23.1)	0.201
吸烟者开始吸烟年龄(岁)^a	960	21.1(18.9~23.4)	20.9(19.9~22.0)	21.4(16.6~26.2)	0.773
开始每日吸烟年龄(岁)^a	885	23.6(21.5~25.7)		23.6(21.9~25.3)		23.7(18.7~28.8)	0.952
注：^a括号外数据为相应变量的均数，括号内数据为95% CI。%(95% CI)为经抽样权重和无应答权重计算后的数值。

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表 3 不同吸烟状态者的COPD及呼吸道症状患病率[% (95% CI)]

Table 3. Prevalence of COPD and respiratory symptoms of different smoking status[% (95% CI)]

项目	COPD	轻度COPD	中重度COPD	有呼吸道症状
吸烟(包年)
0	5.6(3.0~8.2)	4.6(1.7~7.5)	1.0(0.4~1.6)	9.1(6.1~12.1)
< 15	12.5(4.5~20.4)	10.4(3.7~17.2)	2.0(0.0~4.9)	8.9(2.2~15.7)
< 30	12.1(5.4~18.9)	8.0(3.9~12.2)	4.1(0.5~7.7)	11.7(4.7~18.8)
≥30	26.6(17.6~35.6)	20.0(12.9~27.2)	6.6(2.3~10.8)	22.5(13.0~31.9)
趋势性χ²检验	76.42	35.57	132.69	101.51
P_trend值	< 0.001	< 0.001	< 0.001	< 0.001
吸烟年数(年)
0	5.6(3.0~8.2)	4.6(1.7~7.5)	1.0(0.4~1.6)	9.1(6.1~12.1)
< 30	8.0(5.4~10.6)	6.3(4.4~8.2)	1.7(0.1~3.2)	9.4(5.4~13.3)
< 40	17.1(10.5~23.7)	13.1(7.8~18.4)	4.0(0.0~8.9)	17.1(12.7~21.4)
≥40	38.3(24.9~51.7)	26.7(14.9~38.5)	11.6(6.9~16.3)	24.1(9.5~38.7)
趋势性χ²检验	95.70	31.15	76.07	25.53
P_trend值	< 0.001	< 0.001	< 0.001	< 0.001
注：%(95% CI)为经抽样权重和无应答权重计算后的数值。

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表 4 吸烟对COPD及呼吸道症状的影响

Table 4. Effects of smoking on COPD and respiratory symptoms

项目	COPD				呼吸道症状
	单因素		多因素^a		单因素		多因素^a
	OR(95%CI)值	P值	OR(95%CI)值	P值	OR(95%CI)值	P值	OR(95%CI)值	P值
吸烟(包年)
0	1.00		1.00		1.00		1.00
< 15	2.35(1.83~3.03)	< 0.001	1.55(1.12~2.14)	0.008	1.13(0.67~1.91)	0.638	1.21(0.81~1.81)	0.345
< 30	3.23(1.98~5.26)	< 0.001	2.16(1.39~3.36)	0.001	1.59(1.08~2.33)	0.019	1.87(1.16~3.01)	0.010
≥30	5.82(4.21~8.05)	< 0.001	2.57(1.96~3.37)	< 0.001	2.68(2.10~3.43)	< 0.001	2.18(1.33~3.58)	0.002
P_trend值	< 0.001		< 0.001		< 0.001		0.002
吸烟年数(年)
0	1.00		1.00		1.00		1.00
< 30	1.74(1.20~2.51)	0.003	1.41(1.07~1.85)	0.015	1.12(0.92~1.37)	0.248	1.43(0.92~2.22)	0.112
< 40	4.39(3.46~5.59)	< 0.001	2.30(1.89~2.80)	< 0.001	2.11(1.57~2.84)	< 0.001	2.00(1.45~2.77)	< 0.001
≥40	7.99(4.68~13.63)	< 0.001	2.76(1.64~4.64)	0.001	3.00(2.04~4.42)	< 0.001	2.08(1.30~3.32)	0.002
P_trend值	< 0.001			< 0.001			< 0.001		0.001
注：^a表示调整城乡、年龄、性别、教育水平、BMI、儿童期严重呼吸系统感染、肺结核病史、呼吸病家族史、职业粉尘和/或有害气体暴露、被动吸烟、室内空气污染。吸烟量、吸烟年数分别进行多因素分析。

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项目	合计		吸烟者(n=1 011)	从不吸烟者(n=1 754)	χ²值	P值
项目	调查人数(人)	构成比[%(95%CI)]	构成比[%(95%CI)]	构成比[%(95%CI)]	χ²值	P值
城乡
城镇	1 668	62.5(38.0~86.9)	62.7(37.2~88.1)	62.4(38.3~86.4)	0.02	0.898
乡村	1 102	37.5(13.1~62.0)	37.3(11.9~62.8)	37.6(13.6~61.7)
年龄(岁)
40~	1 047	41.0(30.6~51.3)	37.7(30.3~45.2)	42.8(30.0~55.7)	13.25	0.001
50~	788	30.1(25.0~35.1)	27.4(21.4~33.4)	31.6(25.0~38.1)
≥60	935	29.0(18.5~39.5)	34.9(23.3~46.5)	25.6(15.1~36.1)
性别
男	1 362	48.1(42.2~54.0)	96.0(93.5~98.4)	20.9(13.5~28.3)	340.60	< 0.001
女	1 408	51.9(46.0~57.8)	4.0(1.6~6.5)	79.1(71.7~86.5)
教育水平
小学及以下	1 690	57.5(45.5~69.5)	46.1(36.9~55.4)	63.9(51.4~76.4)	67.98	< 0.001
初中毕业	774	29.2(25.4~33.0)	36.7(23.6~49.9)	25.0(21.5~28.4)
高中及以上	305	13.3(0.0~27.4)	17.1(0.0~35.2)	11.1(0.0~22.6)
儿童期严重呼吸系统感染
无	2 716	98.1(97.1~99.0)	97.8(95.5~100.0)	98.2(97.3~99.1)	0.25	0.618
有	53	1.9(1.0~2.9)	2.2(0.0~4.5)	1.8(0.9~2.7)
肺结核病史
无	2 723	98.5(97.5~99.6)	98.3(96.6~100.0)	98.6(97.6~99.6)	0.44	0.505
有	46	1.5(0.4~2.5)	1.7(0.0~3.4)	1.4(0.4~2.4)
呼吸病家族史
无	2 276	80.3(74.0~86.7)	77.1(70.5~83.6)	82.3(76.0~88.6)	26.23	< 0.001
有	493	19.7(13.3~26.0)	22.9(16.4~29.5)	17.7(11.4~24.0)
BMI (kg/m²)
< 18.5	42	1.5(0.0~3.3)	1.6(0.0~3.3)	1.4(0.0~3.3)	2.15	0.341
18.5~	1 173	41.7(31.1~52.4)	43.4(36.7~50.0)	40.8(27.4~54.2)
≥24.0	1 555	56.8(44.4~69.2)	55.1(46.9~63.2)	57.8(42.7~73.0)
职业粉尘和/或有害气体暴露
无	1 571	58.2(41.7~74.7)	52.2(34.5~70.0)	61.6(44.7~78.5)	5.74	0.017
有	1 198	41.8(25.3~58.3)	47.8(30.0~65.5)	38.4(21.5~55.3)
被动吸烟
无	1 360	43.1(19.8~66.3)	33.9(12.3~55.5)	48.3(22.6~74.0)	6.42	0.011
有	1 409	56.9(33.7~80.2)	66.1(44.5~87.7)	51.7(26.0~77.4)
室内空气污染
否	1 502	50.3(7.9~92.6)	48.4(11.6~85.3)	51.3(5.7~96.9)	0.57	0.449
是	1 267	49.7(7.4~92.1)	51.6(14.7~88.4)	48.7(3.1~94.3)
合计	2 770	100.0		36.3(27.5~45.1)		63.7(54.9~72.5)

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吸烟对慢性阻塞性肺疾病及呼吸道症状的影响

doi: 10.16462/j.cnki.zhjbkz.2020.01.010

通讯作者:
刘志荣, E-mail:lzr@ahcdc.com.cn

叶冬青, E-mail:ydq@ahmu.edu.cn

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Effects of smoking on chronic obstructive pulmonary disease and respiratory symptoms

Corresponding author: LIU Zhi-rong, E-mail:lzr@ahcdc.com.cn; YE Dong-qing, E-mail:ydq@ahmu.edu.cn

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吸烟对慢性阻塞性肺疾病及呼吸道症状的影响

doi: 10.16462/j.cnki.zhjbkz.2020.01.010

通讯作者: 刘志荣, E-mail:lzr@ahcdc.com.cn 叶冬青, E-mail:ydq@ahmu.edu.cn

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Effects of smoking on chronic obstructive pulmonary disease and respiratory symptoms

Corresponding author: LIU Zhi-rong, E-mail:lzr@ahcdc.com.cn; YE Dong-qing, E-mail:ydq@ahmu.edu.cn

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通讯作者:
刘志荣, E-mail:lzr@ahcdc.com.cn

叶冬青, E-mail:ydq@ahmu.edu.cn