吸烟与吸烟者红掌的初步观察及相关性分析
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摘要
香烟中有2540多种成分,燃烧后发生复杂的物理化学变化,其中对人体危害最大的是尼古丁,其次是焦油、一氧化碳、氰化物及放射性物质。我国是烟草生产和消费大国,据据1996年的流行病学调查,我国男性有66.8%吸烟,女性有4.2%吸烟。经过长期观察,我们发现吸烟者的手部掌侧常有红掌样变化,表现为大小鱼际及手指指尖及基部皮肤发红或整个手掌面包括手指呈比较一致的红色,无瘙痒、触痛等自觉症状,为充血性,压之褪色。有些与肝病者的肝掌颇为相似,使人联想到肝病的可能。然而,受检者并无慢性肝病或肝硬变的其他临床征象,这种现象在以前的以往的医学文献中从未被描述和记载。我们将其暂称为吸烟者手掌或吸烟者红掌。鉴于吸烟者手掌的皮色变化分布有所差别,我们又将其分为肝掌样红掌和普红样红掌。
为了初步解释吸烟者出现红掌这一现象,本研究通过前瞻性设计,观察了吸烟对发生红掌样变化的影响并对其进行相关性分析,探讨了吸烟及其各项参数与出现红掌的关系,从而对其影响因素及成因提供了线索。并对吸烟者红掌与肝掌体征做了形态学对比。因吸烟者常伴有饮酒习惯,对我国4大地区饮酒情况的流行病学调查表明,一般人群的饮酒率为59.15%,其中男性84.16%,女性29.14%,人均年饮酒量316 L纯酒精。并且饮酒对多项红参数亦有影响,故将饮酒作为一种混淆因素,一并对其与红掌的发生进行了相关性讨论。此外,鉴于长期吸烟对循环中红细胞的影响,故对多项红细胞参数与吸烟者红掌的关系也做了初步的探讨。
研究目的
我们发现吸烟者常伴有手部掌侧红掌样改变,有些形态类似肝病引起的肝掌,为初步说明这种现象,本研究通过观察吸烟对出现红掌样变化的影响及其相关性分析,探讨了吸烟及其各项参数与出现红掌的关系,从而对其影响因素及成因提供线索。并对吸烟者红掌与肝掌体征做形态学对比。此外,还对多项红细胞参数与吸烟者红掌的关系也做了初步探讨。
对象与方法
1.对象
观察对象为随机调查的2008年8月至2009年1月至二级以上医院健康查体的1535例健康男性。为尽量避免抽样误差,观察对象纳入不同职业人群,包括非体力劳动者737人,体力劳动者798人。其中吸烟者805人,年龄21～68岁(平均41±13.9岁),非吸烟者730人,年龄22～69岁(平均42±12.7岁),两组年龄差别无统计学意义。
纳入标准:除体检正常外,无高血压、慢性支气管炎或慢性阻塞性肺病及糖尿病等慢性疾病史,肝功能和肾功能正常,腹部B超正常,无肝脾肿大。
2.方法
红掌的大体观察:观察在良好的自然光线下完成。将手掌尽力平伸时观察,除掌面外,同时观察手背侧和掌侧皮肤交汇处是否有清晰的分界。所有病例均为先判定有无红掌,再询问烟酒史及其他病史,以排除判定结果的偏倚。对所有被检查者拍摄手掌照片以备参考。
吸烟者红掌的大体观判断标准:手掌掌侧皮肤呈现明显的红色或粉红色。根据手掌的变化又进一步分为类肝掌样红掌及普红样红掌。吸烟者红掌的尺侧背掌面皮肤交汇处分界明显,红掌为充血性,压之褪色,无主观和客观感觉障碍。实验室检查方法:清晨抽空腹血,常规检查肝功能、肾功能和全血细胞计数(CBC)。
吸烟与否的判别:本研究采用的是Molarius等参与WHO MONICA项目时的定义:当前吸烟者(即参加研究时仍吸烟)包括每日吸烟者和偶尔吸烟者,从未吸烟为不吸烟者。在确定是否吸烟后,再询问相关吸烟参数。
吸烟指数计算:按量时效应原则,吸烟指数=每日吸烟量(支/天)×(年龄—开始吸烟年龄—戒烟年限)(年)
戒烟判断标准:连续戒烟至查体时一年及以上者为戒烟者,将戒烟者分为戒烟＜10年与戒烟≥10年两组。
饮酒判断标准:因饮酒的判断是采用现场问答的方式,难以设定严格的定量标准,故凡饮酒每周超过两次,饮酒折合酒精量每次超过20g者作为饮酒者。
酒精量换算公式为:酒精量(g)=饮酒量(mL)×酒精含量(%)×0.8(酒精比重)
分析方法:调查常规健康查体的1535例健康男性的吸烟参数(包括吸烟量、吸烟年限及吸烟指数)和红细胞参数(包括红细胞计数(RBC)、血红蛋白(Hgb)、红细胞比容(Hct)、平均红细胞体积(MCV)、平均红细胞血红蛋白量(MCH)、平均红细胞血红蛋白浓度(MCHC))及与发生红掌的相关性。鉴于单纯饮酒亦可引起红掌,且吸烟者多有饮酒习惯,故将其视为重要混杂因素,一并对其与红掌的关系进行相关性分析。对吸烟诸参数及饮酒与红掌做logistic回归分析,并对吸烟、饮酒与Hgb进行析因设计的方差分析。
结果
1.吸烟与否与红掌发生率的关系:吸烟与不吸烟者总红掌发生率的OR=4.40(p＜0.05),说明吸烟与肝掌成正相关。
2.对吸烟、饮酒与肝掌样红掌进行分层分析,饮酒者中吸烟与不吸烟的OR_饮=4.97,不饮酒者中吸烟与不吸烟的OR_(不饮)=10.31;对各层进行一致性检验,P＞0.05,表明各层OR无显著性差异,计算总OR=5.72,x~2=77.95,P＜0.01,即排除饮酒这一混杂因素后,吸烟与肝掌样红掌仍为正相关。对吸烟、饮酒与普红样红掌进行分层分析,OR_饮=1.78,OR_(不饮)=2.30;对各层进行一致性检验,P＞0.05,表明各层OR无显著性差异,计算总OR=1.90,P＜0.01,即排除饮酒这一混杂因素后,吸烟与普红样红掌亦为正相关。
3.吸烟参数与红掌发生率的关系:对不同吸烟量、吸烟年限、吸烟指数与红掌做趋势x~2检验,吸烟量与普红样红掌发生率P＞0.05,其余均为P＜0.05。即肝掌样红掌的发生率随吸烟量的增加、吸烟年限的延长及吸烟指数的增加而增加。
4.吸烟参数及饮酒与红掌发生率的关联度分析:对饮酒、吸烟量、吸烟年限、吸烟指数与红掌做logistic回归分析,结果显示红掌相关因素关联程度依次为吸烟量、吸烟指数、吸烟年限。
5.将戒烟者分为戒烟1～10年与10年以上两组与未戒烟者相比,红掌发生率的差别均无统计学意义。
6.红掌及吸烟与否与红细胞参数的关系:红掌者与无红掌者、吸烟与不吸烟者分别比较其RBC、HGB、HCT、MCV、MCH、MCHC水平,其中RBC、HGB、HCT差别有统计学意义,红掌者高于无红掌者,吸烟者高于不吸烟者,其余均无统计学意义。并对吸烟、饮酒与HGB进行析因设计的方差分析,吸烟者比不吸烟者HGB高,饮酒对HGB的影响无统计学意义,两者间无交互作用。
结论
吸烟者红掌发生率明显高于不吸烟者。肝掌样红掌的发生率随吸烟量的增加、吸烟年限的延长及吸烟指数的增加而增加。吸烟量是吸烟者发生红掌最主要的因素。其他红掌相关因素依次为吸烟指数、吸烟年限。将戒烟者分为戒烟1～10年与10年以上两组与未戒烟者相比,红掌发生率的差别均无统计学意义。红掌者RBC、HGB、HCT高于无红掌者,吸烟者RBC、HGB、HCT高于不吸烟者。吸烟者比不吸烟者HGB高,饮酒对HGB的影响无统计学意义,两者间无交互作用。吸烟者与肝硬化发生的肝掌有相似之处,我们称之为吸烟者红掌,两者的鉴别有一定的临床意义。
Cigarettes are composed of more than 2540 kinds of components,which could take complicated physical and chemical changes after being burnt.One of the most harmful components is nicotine.The rest are tar,carbon monoxide,cyanide and radioactive materials.Our country is a nation which is abounding at cigarette producing and consuming.According to an epidemiologic survey in 1996,there are 66.8%men smokers and 4.2%women smokers in our country.According to a long-term observation,we have found that cigarette smokers often have erythema on their palms.One kind of appearances is that redness on the hypothenar and thenar eminence,finger tips and basis of the fingers.The other kind is that uniformity redness on the whole palms including the fingers.There are no pruritus,haphalgesia or other subjective symptoms.The palmar erythema is congested and can turn faded after being pressed.The appearance of some smokers' palms is much similar to the palmar erythema of patients with chronic liver disease,cirrhosis in particular. However,the subjects have no clinical signs of chronic liver disease or liver cirrhosis. This phenomenon has never been described or recorded in previous medical literature. We call it palmar erythema related to smoking.
To investigate the interesting phenomenon,the present study observed the relationship between palmar erythema and the paramaters of cigarette smoking and,as well,the relationship between palmar erythema and the parameters of erythrocytes. We also made morphology contrast between palmar erythema related to smoking and palmar erythema related to liver cirrhosis.In view of the fact that alcohol consumption is often associated with smoking,the effect of alcohol drinking on development of palmar erythema was also assessed as an important confounding factor.An epidemiologic survey of 4 Chinese regions indicated that the alcohol drinking rate of general people is 59.15%,including 84.16%males and 29.14% females.In addition,respecting the influence of long-term smoking on RBC in circulation,the relationship between palmer erythema and the parameters of erythrocytes has been approached.
Objective
We have found that cigarette smokers often have erythema on their palms.The appearance of some smokers' palms is much similar to the palmer erythema of patients with chronic liver disease,cirrhosis in particular.To investigate the interesting phenomenon,the present study observed the relationship between palmer erythema and the parameters of cigarette smoking and,as well,the relationship between palmer erythema and the parameters of erythrocytes.
Methods
We have investigated 1535 healthy men who came to second order hospitals for health check.To avoid sampling error,different kinds of occupations have been involved including 737 non-manual workers and 798 manual workers. There are 805 smokers aged 21～68(41±13.9) and 730 non-smokers aged 22～69(42±12.7).The difference of the ages between the two groups has no statistically significant.
Internalizing standards:The medical examination is normal.There are no HTN,chronic bronchitis,COPD or DM history.The liver function and renal function are normal.The abdominal hypersound is normal.All the examiners have no splenohepatomegalia.
Morphological observes of palmer erythema:the observation is made under natural light.We have observed the boundary between the palm and its back.To avoid bias,case history was acquired after the palmer observation.We have taken photos of the palms of all the examiners.
Discrimination of smoking or not:This study adopted the definition which is given by Molarius:present smokers including everyday smokers and occasionally smokers.Non-smokers are people who never smoke.
smoking index calculation:smoking index=daily smoking quantity×(age-begin smoking age-stop smoking age)
Stop smoking standard:ex-smokers are people who had stopped smoking for more than one year.They have been divided into two groups of stopping smoking 1～10 years and longer than 10 years.
Alcohol drinking standard:People who drink more than two times a week and more than 20g alcohol one time are judged as alcohol users.
Smoking parameters include daily quantity of smoking,duration of smoking and smoking index,and the parameters of erythrocytes include red blood cell(RBC), hemoglobin(Hgb),hematocrit(Hct),mean cell vo;ume(MCV),mean cell hemoglobin(MCH) and mean cell hemoglobin concentration(MCHC).1535 healthy males participating in annual health check-up were enrolled into the study and the relationship between the frequency of palmar erythema and smoking was analyzed.. In view of the fact that alcohol consumption is often associated with smoking,the effect of alcohol drinking on development of palmar erythema was also assessed as an important confounding factor..The linkage between palmar erythema and smoking parameters,and alcohol drinking was analyzed using logistic regression.Factorial ANOVA was used to evaluate the relations between smoking,drinking and Hgb.
Results
1.The relationship between the frequency of palmar erythema and smoking:The OR value of smoking is 4.4(p＜0.05),which shows that the frequency of palmar erythema and smoking are positive correlative.
2.After exclusion of drinking effect as a confounding factor,the frequency of palmar erythema in smokers is singnificantly higher than that in non-smokers (OR=5.72).
3.The relationship between the frequency of palmar erythema and the parameters of cigarette smoking:The frequency of palmar erythema and daily quantity of smoking,duration of smoking and smoking index are positive correlative.
4.The analysis between parameters of cigarette smoking,drinking and the frequency of palmar erythema:Palmar erythema is closely correlated in order with quantity of smoking,smoking index and duration of smoking.
5.The ex-smokers have been divided into two groups of stopping smoking 1～10 years and longer than 10 years.The frequency of palmar erythema of the two groups have no statistically significant.
6.The correlation between palmar erythema and RBC,Hgb and Hct is statistically significant.Hgb in smokers is higher than that in non-smokers.Alcohol drinking is not correlated with Hgb and superimposes no significant impact on palmar erythema in smokers.
Conclusion
The frequency of palmar erythema in cigarette smokers is statistically higher than that in non-smokers.The frequency of palmar erythema and daily quantity of smoking,duration of smoking and smoking index are positive correlative.Palmar erythema is closely correlated in order with quantity of smoking,smoking index and duration of smoking.The correlation between palmar erythema and RBC,Hgb and Hct is statistically significant.Hgb in smokers is higher than that in non-smokers. Alcohol drinking is not correlated with Hgb and superimposes no significant impact on palmar erythema in smokers.The ex-smokers have been divided into two groups of stopping smoking1～10 years and longer than 10 years.The frequency of palmar erythema of the two groups have no statistically significant.The palmar erythema related to smoking morphologically resembles palmar erythema related to liver cirrhosis but physiopathologically differs from one another.Smoker's palmar erythema developed in otherwise healthy people and differentiation of the two types of palmar erythema clearly implys clinical significance.
为了初步解释吸烟者出现红掌这一现象,本研究通过前瞻性设计,观察了吸烟对发生红掌样变化的影响并对其进行相关性分析,探讨了吸烟及其各项参数与出现红掌的关系,从而对其影响因素及成因提供了线索。并对吸烟者红掌与肝掌体征做了形态学对比。因吸烟者常伴有饮酒习惯,对我国4大地区饮酒情况的流行病学调查表明,一般人群的饮酒率为59.15%,其中男性84.16%,女性29.14%,人均年饮酒量316 L纯酒精。并且饮酒对多项红参数亦有影响,故将饮酒作为一种混淆因素,一并对其与红掌的发生进行了相关性讨论。此外,鉴于长期吸烟对循环中红细胞的影响,故对多项红细胞参数与吸烟者红掌的关系也做了初步的探讨。
研究目的
我们发现吸烟者常伴有手部掌侧红掌样改变,有些形态类似肝病引起的肝掌,为初步说明这种现象,本研究通过观察吸烟对出现红掌样变化的影响及其相关性分析,探讨了吸烟及其各项参数与出现红掌的关系,从而对其影响因素及成因提供线索。并对吸烟者红掌与肝掌体征做形态学对比。此外,还对多项红细胞参数与吸烟者红掌的关系也做了初步探讨。
对象与方法
1.对象
观察对象为随机调查的2008年8月至2009年1月至二级以上医院健康查体的1535例健康男性。为尽量避免抽样误差,观察对象纳入不同职业人群,包括非体力劳动者737人,体力劳动者798人。其中吸烟者805人,年龄21～68岁(平均41±13.9岁),非吸烟者730人,年龄22～69岁(平均42±12.7岁),两组年龄差别无统计学意义。
纳入标准:除体检正常外,无高血压、慢性支气管炎或慢性阻塞性肺病及糖尿病等慢性疾病史,肝功能和肾功能正常,腹部B超正常,无肝脾肿大。
2.方法
红掌的大体观察:观察在良好的自然光线下完成。将手掌尽力平伸时观察,除掌面外,同时观察手背侧和掌侧皮肤交汇处是否有清晰的分界。所有病例均为先判定有无红掌,再询问烟酒史及其他病史,以排除判定结果的偏倚。对所有被检查者拍摄手掌照片以备参考。
吸烟者红掌的大体观判断标准:手掌掌侧皮肤呈现明显的红色或粉红色。根据手掌的变化又进一步分为类肝掌样红掌及普红样红掌。吸烟者红掌的尺侧背掌面皮肤交汇处分界明显,红掌为充血性,压之褪色,无主观和客观感觉障碍。实验室检查方法:清晨抽空腹血,常规检查肝功能、肾功能和全血细胞计数(CBC)。
吸烟与否的判别:本研究采用的是Molarius等参与WHO MONICA项目时的定义:当前吸烟者(即参加研究时仍吸烟)包括每日吸烟者和偶尔吸烟者,从未吸烟为不吸烟者。在确定是否吸烟后,再询问相关吸烟参数。
吸烟指数计算:按量时效应原则,吸烟指数=每日吸烟量(支/天)×(年龄—开始吸烟年龄—戒烟年限)(年)
戒烟判断标准:连续戒烟至查体时一年及以上者为戒烟者,将戒烟者分为戒烟＜10年与戒烟≥10年两组。
饮酒判断标准:因饮酒的判断是采用现场问答的方式,难以设定严格的定量标准,故凡饮酒每周超过两次,饮酒折合酒精量每次超过20g者作为饮酒者。
酒精量换算公式为:酒精量(g)=饮酒量(mL)×酒精含量(%)×0.8(酒精比重)
分析方法:调查常规健康查体的1535例健康男性的吸烟参数(包括吸烟量、吸烟年限及吸烟指数)和红细胞参数(包括红细胞计数(RBC)、血红蛋白(Hgb)、红细胞比容(Hct)、平均红细胞体积(MCV)、平均红细胞血红蛋白量(MCH)、平均红细胞血红蛋白浓度(MCHC))及与发生红掌的相关性。鉴于单纯饮酒亦可引起红掌,且吸烟者多有饮酒习惯,故将其视为重要混杂因素,一并对其与红掌的关系进行相关性分析。对吸烟诸参数及饮酒与红掌做logistic回归分析,并对吸烟、饮酒与Hgb进行析因设计的方差分析。
结果
1.吸烟与否与红掌发生率的关系:吸烟与不吸烟者总红掌发生率的OR=4.40(p＜0.05),说明吸烟与肝掌成正相关。
2.对吸烟、饮酒与肝掌样红掌进行分层分析,饮酒者中吸烟与不吸烟的OR_饮=4.97,不饮酒者中吸烟与不吸烟的OR_(不饮)=10.31;对各层进行一致性检验,P＞0.05,表明各层OR无显著性差异,计算总OR=5.72,x~2=77.95,P＜0.01,即排除饮酒这一混杂因素后,吸烟与肝掌样红掌仍为正相关。对吸烟、饮酒与普红样红掌进行分层分析,OR_饮=1.78,OR_(不饮)=2.30;对各层进行一致性检验,P＞0.05,表明各层OR无显著性差异,计算总OR=1.90,P＜0.01,即排除饮酒这一混杂因素后,吸烟与普红样红掌亦为正相关。
3.吸烟参数与红掌发生率的关系:对不同吸烟量、吸烟年限、吸烟指数与红掌做趋势x~2检验,吸烟量与普红样红掌发生率P＞0.05,其余均为P＜0.05。即肝掌样红掌的发生率随吸烟量的增加、吸烟年限的延长及吸烟指数的增加而增加。
4.吸烟参数及饮酒与红掌发生率的关联度分析:对饮酒、吸烟量、吸烟年限、吸烟指数与红掌做logistic回归分析,结果显示红掌相关因素关联程度依次为吸烟量、吸烟指数、吸烟年限。
5.将戒烟者分为戒烟1～10年与10年以上两组与未戒烟者相比,红掌发生率的差别均无统计学意义。
6.红掌及吸烟与否与红细胞参数的关系:红掌者与无红掌者、吸烟与不吸烟者分别比较其RBC、HGB、HCT、MCV、MCH、MCHC水平,其中RBC、HGB、HCT差别有统计学意义,红掌者高于无红掌者,吸烟者高于不吸烟者,其余均无统计学意义。并对吸烟、饮酒与HGB进行析因设计的方差分析,吸烟者比不吸烟者HGB高,饮酒对HGB的影响无统计学意义,两者间无交互作用。
结论
吸烟者红掌发生率明显高于不吸烟者。肝掌样红掌的发生率随吸烟量的增加、吸烟年限的延长及吸烟指数的增加而增加。吸烟量是吸烟者发生红掌最主要的因素。其他红掌相关因素依次为吸烟指数、吸烟年限。将戒烟者分为戒烟1～10年与10年以上两组与未戒烟者相比,红掌发生率的差别均无统计学意义。红掌者RBC、HGB、HCT高于无红掌者,吸烟者RBC、HGB、HCT高于不吸烟者。吸烟者比不吸烟者HGB高,饮酒对HGB的影响无统计学意义,两者间无交互作用。吸烟者与肝硬化发生的肝掌有相似之处,我们称之为吸烟者红掌,两者的鉴别有一定的临床意义。
Cigarettes are composed of more than 2540 kinds of components,which could take complicated physical and chemical changes after being burnt.One of the most harmful components is nicotine.The rest are tar,carbon monoxide,cyanide and radioactive materials.Our country is a nation which is abounding at cigarette producing and consuming.According to an epidemiologic survey in 1996,there are 66.8%men smokers and 4.2%women smokers in our country.According to a long-term observation,we have found that cigarette smokers often have erythema on their palms.One kind of appearances is that redness on the hypothenar and thenar eminence,finger tips and basis of the fingers.The other kind is that uniformity redness on the whole palms including the fingers.There are no pruritus,haphalgesia or other subjective symptoms.The palmar erythema is congested and can turn faded after being pressed.The appearance of some smokers' palms is much similar to the palmar erythema of patients with chronic liver disease,cirrhosis in particular. However,the subjects have no clinical signs of chronic liver disease or liver cirrhosis. This phenomenon has never been described or recorded in previous medical literature. We call it palmar erythema related to smoking.
To investigate the interesting phenomenon,the present study observed the relationship between palmar erythema and the paramaters of cigarette smoking and,as well,the relationship between palmar erythema and the parameters of erythrocytes. We also made morphology contrast between palmar erythema related to smoking and palmar erythema related to liver cirrhosis.In view of the fact that alcohol consumption is often associated with smoking,the effect of alcohol drinking on development of palmar erythema was also assessed as an important confounding factor.An epidemiologic survey of 4 Chinese regions indicated that the alcohol drinking rate of general people is 59.15%,including 84.16%males and 29.14% females.In addition,respecting the influence of long-term smoking on RBC in circulation,the relationship between palmer erythema and the parameters of erythrocytes has been approached.
Objective
We have found that cigarette smokers often have erythema on their palms.The appearance of some smokers' palms is much similar to the palmer erythema of patients with chronic liver disease,cirrhosis in particular.To investigate the interesting phenomenon,the present study observed the relationship between palmer erythema and the parameters of cigarette smoking and,as well,the relationship between palmer erythema and the parameters of erythrocytes.
Methods
We have investigated 1535 healthy men who came to second order hospitals for health check.To avoid sampling error,different kinds of occupations have been involved including 737 non-manual workers and 798 manual workers. There are 805 smokers aged 21～68(41±13.9) and 730 non-smokers aged 22～69(42±12.7).The difference of the ages between the two groups has no statistically significant.
Internalizing standards:The medical examination is normal.There are no HTN,chronic bronchitis,COPD or DM history.The liver function and renal function are normal.The abdominal hypersound is normal.All the examiners have no splenohepatomegalia.
Morphological observes of palmer erythema:the observation is made under natural light.We have observed the boundary between the palm and its back.To avoid bias,case history was acquired after the palmer observation.We have taken photos of the palms of all the examiners.
Discrimination of smoking or not:This study adopted the definition which is given by Molarius:present smokers including everyday smokers and occasionally smokers.Non-smokers are people who never smoke.
smoking index calculation:smoking index=daily smoking quantity×(age-begin smoking age-stop smoking age)
Stop smoking standard:ex-smokers are people who had stopped smoking for more than one year.They have been divided into two groups of stopping smoking 1～10 years and longer than 10 years.
Alcohol drinking standard:People who drink more than two times a week and more than 20g alcohol one time are judged as alcohol users.
Smoking parameters include daily quantity of smoking,duration of smoking and smoking index,and the parameters of erythrocytes include red blood cell(RBC), hemoglobin(Hgb),hematocrit(Hct),mean cell vo;ume(MCV),mean cell hemoglobin(MCH) and mean cell hemoglobin concentration(MCHC).1535 healthy males participating in annual health check-up were enrolled into the study and the relationship between the frequency of palmar erythema and smoking was analyzed.. In view of the fact that alcohol consumption is often associated with smoking,the effect of alcohol drinking on development of palmar erythema was also assessed as an important confounding factor..The linkage between palmar erythema and smoking parameters,and alcohol drinking was analyzed using logistic regression.Factorial ANOVA was used to evaluate the relations between smoking,drinking and Hgb.
Results
1.The relationship between the frequency of palmar erythema and smoking:The OR value of smoking is 4.4(p＜0.05),which shows that the frequency of palmar erythema and smoking are positive correlative.
2.After exclusion of drinking effect as a confounding factor,the frequency of palmar erythema in smokers is singnificantly higher than that in non-smokers (OR=5.72).
3.The relationship between the frequency of palmar erythema and the parameters of cigarette smoking:The frequency of palmar erythema and daily quantity of smoking,duration of smoking and smoking index are positive correlative.
4.The analysis between parameters of cigarette smoking,drinking and the frequency of palmar erythema:Palmar erythema is closely correlated in order with quantity of smoking,smoking index and duration of smoking.
5.The ex-smokers have been divided into two groups of stopping smoking 1～10 years and longer than 10 years.The frequency of palmar erythema of the two groups have no statistically significant.
6.The correlation between palmar erythema and RBC,Hgb and Hct is statistically significant.Hgb in smokers is higher than that in non-smokers.Alcohol drinking is not correlated with Hgb and superimposes no significant impact on palmar erythema in smokers.
Conclusion
The frequency of palmar erythema in cigarette smokers is statistically higher than that in non-smokers.The frequency of palmar erythema and daily quantity of smoking,duration of smoking and smoking index are positive correlative.Palmar erythema is closely correlated in order with quantity of smoking,smoking index and duration of smoking.The correlation between palmar erythema and RBC,Hgb and Hct is statistically significant.Hgb in smokers is higher than that in non-smokers. Alcohol drinking is not correlated with Hgb and superimposes no significant impact on palmar erythema in smokers.The ex-smokers have been divided into two groups of stopping smoking1～10 years and longer than 10 years.The frequency of palmar erythema of the two groups have no statistically significant.The palmar erythema related to smoking morphologically resembles palmar erythema related to liver cirrhosis but physiopathologically differs from one another.Smoker's palmar erythema developed in otherwise healthy people and differentiation of the two types of palmar erythema clearly implys clinical significance.
引文
[1]Verdecchia P,Schilaci G,Borgioni C,et allCigarette smoking,am2bulatory blood pressure and cardiac hypertrophy in essential hyperten2sionlJ Hypertens,1995,13:1209-12151
[2]Kool MF,Hoeks APG,Boudier HAJ,et aliShort and long-term ef2fects of smoking on arterial wall properties in habitual smokerslJ Am Cool Caridiol,1993,22:1881-18861
[3]胡榕,王伟民,江瑛1 吸烟与冠状动脉病变程度相关性的探讨1中国临床医学,2003,10:366-3681
[4]陈传福,吴广利,刘世文,牟卫平,许春华。吸烟对肝炎肝硬变血液流变学的影响。世界华人消化杂志,2000;8(5):602-603
[5]黄斌.一氧化氮与肝硬化高动力循环的研究进展.临床内科杂志,2000,17:81-82.
[6]Makajima M,Iwata K,Yamamoto T,Fume Y,Yoshida T,Kuroiwa Y,Nicotine metabolism in liver microscomes from rats with acute hepatitis or cirrhosis.Drug Metab Dispute,1998;26:36-41
[7]张丕利,梁扩寰1 血管扩张物质与肝硬化门脉高压高动力循环[J].国外医学消化系疾病分册,1995,15(3):131-133.
[8]李席如,吴金生,何泽生1 门脉高压症高动力循环产生机理[J].临床肝胆病杂导,1998,14(1):13-15.
[9]Webster-Gandy JD,How C,Harrold K;Palmar-plantar erythrodysesthesia (PPE):A literature review with commentary on experience in a cancer centre.Eur J Oncol Nurs.2007 Jul;11(3):238-46.Epub 2007 Mar 9.
[10]J.P.Noble;S.Boisnic;M.C.Branchet-Gumila;M.Poisson Dermatology;Palmar Erythema:Cutaneous Marker of Neoplasms.Academic Research Library.2002;204,3;pg.209
[11]陈晓婷,童明庆,蒋理,转铁蛋白对酒精性肝病的诊断 临床检验杂志,2003,21(5):277-278
[12]郭希超,陈晓刚,急性酒精中毒后红细胞脆性检查 临床检验杂志,2001,19(3):186
[13]陈祥银,程显声,徐希胜 吸烟者血清α1-抗胰蛋白酶、中性粒细胞弹性蛋白酶及组胺的变化。基础医学与临床 2003年 第23卷 第04期
[14]关玉娟 男性肝硬变“三联征”的病机探讨。中国综合临床 2003年1月第19卷 第1期
[15]Oberhausen,C.Niederau;Cutaneous signs of liver disease:value for prognosis of severe fibrosis and cirrhosis.Liver International.2008;28(5):659-66
[16]刘福其 于晓军 李志坚 饮酒对凝血纤溶机制的影响及其临床意义 临床血液学杂志2008年3月第21卷第3期:174-176
[17]翁心植主编1984年全国吸烟抽样调矗资料汇编.人民卫生出版社1988.204216
[2]Kool MF,Hoeks APG,Boudier HAJ,et aliShort and long-term ef2fects of smoking on arterial wall properties in habitual smokerslJ Am Cool Caridiol,1993,22:1881-18861
[3]胡榕,王伟民,江瑛1 吸烟与冠状动脉病变程度相关性的探讨1中国临床医学,2003,10:366-3681
[4]陈传福,吴广利,刘世文,牟卫平,许春华。吸烟对肝炎肝硬变血液流变学的影响。世界华人消化杂志,2000;8(5):602-603
[5]黄斌.一氧化氮与肝硬化高动力循环的研究进展.临床内科杂志,2000,17:81-82.
[6]Makajima M,Iwata K,Yamamoto T,Fume Y,Yoshida T,Kuroiwa Y,Nicotine metabolism in liver microscomes from rats with acute hepatitis or cirrhosis.Drug Metab Dispute,1998;26:36-41
[7]张丕利,梁扩寰1 血管扩张物质与肝硬化门脉高压高动力循环[J].国外医学消化系疾病分册,1995,15(3):131-133.
[8]李席如,吴金生,何泽生1 门脉高压症高动力循环产生机理[J].临床肝胆病杂导,1998,14(1):13-15.
[9]Webster-Gandy JD,How C,Harrold K;Palmar-plantar erythrodysesthesia (PPE):A literature review with commentary on experience in a cancer centre.Eur J Oncol Nurs.2007 Jul;11(3):238-46.Epub 2007 Mar 9.
[10]J.P.Noble;S.Boisnic;M.C.Branchet-Gumila;M.Poisson Dermatology;Palmar Erythema:Cutaneous Marker of Neoplasms.Academic Research Library.2002;204,3;pg.209
[11]陈晓婷,童明庆,蒋理,转铁蛋白对酒精性肝病的诊断 临床检验杂志,2003,21(5):277-278
[12]郭希超,陈晓刚,急性酒精中毒后红细胞脆性检查 临床检验杂志,2001,19(3):186
[13]陈祥银,程显声,徐希胜 吸烟者血清α1-抗胰蛋白酶、中性粒细胞弹性蛋白酶及组胺的变化。基础医学与临床 2003年 第23卷 第04期
[14]关玉娟 男性肝硬变“三联征”的病机探讨。中国综合临床 2003年1月第19卷 第1期
[15]Oberhausen,C.Niederau;Cutaneous signs of liver disease:value for prognosis of severe fibrosis and cirrhosis.Liver International.2008;28(5):659-66
[16]刘福其 于晓军 李志坚 饮酒对凝血纤溶机制的影响及其临床意义 临床血液学杂志2008年3月第21卷第3期:174-176
[17]翁心植主编1984年全国吸烟抽样调矗资料汇编.人民卫生出版社1988.204216