吸烟和相关的肺疾病
2009/07/30
目的：在吸烟的过程中，有4000多种有毒物质随着烟草的燃烧产生，可以引起许多种呼吸系统的疾病，包括慢性支气管炎、肺气肿和肺癌，而且感染性疾病也明显增加。另外，吸烟被认为是弥漫性肺间质疾病和支气管肺部疾病发病的主要因素，如呼吸性细支气管炎、间质性肺炎、和成人肺朗格汉斯细胞增多症。尽管对于吸烟者，这些疾病未必是吸烟引起，但是，从临床上和流行病学上的资料来看：吸烟在呼吸性细支气管炎、间质性肺炎、和成人肺朗格汉斯细胞增多症等各种疾病的发病过程中是一项基本的发病因素。另一些证明吸烟是这些疾病发病的重要因素的证明是：对患有这些疾病的人进行戒烟，那么谢谢患者的病情得到了很大的改善。同时，移植肺后再暴露于烟草烟雾中，这些疾病仍出现了很高的复发率。此外，在相同个体的肺组织病理活检中，脱屑性间质性肺炎、成人肺朗格汉斯细胞增多症（合并或不合并肺气肿）的病理组织学检查显示：吸烟是引起这些损伤性疾病的刺激因素。
最近的研究也显示：吸烟对于急性嗜酸粒细胞肺炎、间质性肺炎、风湿样关节炎合并肺炎等疾病是一个潜在的发病因素。
结果：在这篇综述中，考虑到吸烟和不同肺疾病的复杂的关系，我们提出了一个不同的分类，吸烟作为可能的诱发因素对于不同肺疾病的的影响是不可低估的，戒烟是治疗疾病的中心环节，同时药物疗法和其他免疫调节剂应该根据患者不同地应用。
最近的研究也显示：吸烟对于急性嗜酸粒细胞肺炎、间质性肺炎、风湿样关节炎合并肺炎等疾病是一个潜在的发病因素。
结果：在这篇综述中，考虑到吸烟和不同肺疾病的复杂的关系，我们提出了一个不同的分类，吸烟作为可能的诱发因素对于不同肺疾病的的影响是不可低估的，戒烟是治疗疾病的中心环节，同时药物疗法和其他免疫调节剂应该根据患者不同地应用。
（孙力超编译 刘国梁审校）
Drugs. 2008;68(11):1511-1527
Cigarette smoking and diffuse lung disease.
Patel RR, Ryu JH, Vassallo R.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Drugs. 2008;68(11):1511-27
Cigarette smoke, a toxic collection of more than 4000 chemicals generated from combustion of tobacco plant leaves, is known to cause several respiratory ailments, including chronic bronchitis, emphysema and lung cancer, and is associated with an increase in respiratory infections. In addition, cigarette smoking is considered a principal aetiological factor responsible for the development of certain diffuse interstitial and bronchiolar lung diseases, namely respiratory bronchiolitis-interstitial lung disease (RB-ILD), desquamative interstitial pneumonia (DIP) and adult pulmonary Langerhans’ cell histiocytosis (PLCH). Although not exclusively seen in cigarette smokers, substantial clinical and epidemiological data support a central role for smoking as the primary causative agent of most RB-ILD, DIP and PLCH. Additional evidence in support of cigarette smoke as a primary aetiological agent in RB-ILD, DIP and PLCH is the observation that smoking cessation may lead to disease improvement, while recurrence of these disorders has been observed to occur in the transplanted lung upon re-exposure to tobacco smoke. Furthermore, histopathological changes of respiratory bronchiolitis, DIP and PLCH (with or without co-existent emphysema) may be found on lung biopsy in the same individual, implicating smoking as a common inciting agent of these diverse lesions. Recent studies also suggest a role for cigarette smoking as a potential co-factor in the development of acute eosinophilic pneumonia, usual interstitial pneumonia and rheumatoid arthritis-associated interstitial lung disease. In the current review, we propose a novel classification that takes into account the complex relationship between cigarette smoking and diffuse lung diseases. Investigation on the role of smoking as a potential causative factor or modifier of these diverse diffuse lung diseases is important, as smoking cessation utilizing state-of-the-art tobacco cessation efforts should be a central part of therapy, while pharmacotherapy with corticosteroids or other immune modifying agents should be reserved for selected patients.
PMID: 18627208 [PubMed - indexed for MEDLINE]
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吸烟相关的肺间质性疾病
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