烟草烟雾暴露水平与血细胞计数的关系研究

Relationship between internal exposure to tobacco smoke and blood cell counts

目的探究烟草烟雾的暴露水平与血细胞计数的关系,寻找与吸烟相关的健康监测指标。方法本研究的受试者是在山西省776名体检人员,采用问卷调查以收集研究人群的基线资料,同时收集血常规检查结果。高效液相色谱-串联质谱法测定工人尿中尼古丁及其代谢物可替宁、反式3′-羟基可替宁水平。应用广义线性模型和Logistic回归模型分析尼古丁、可替宁、反式3′-羟基可替宁与血细胞计数的关系。结果尿样中尼古丁及其代谢物可替宁、反式3′-羟基可替宁三者之间高度相关;尼古丁及其代谢物可替宁、反式3′-羟基可替宁的增加均与白细胞计数、中性粒细胞计数、淋巴细胞计数的增加有关。以尿中可替宁浓度为代表,四分位数间距每增加1个单位,白细胞计数超出正常值范围的危险性增加3.75倍(OR=3.75),中性粒细胞计数超出正常值范围的危险性增加2.41倍(OR=2.41)。结论尿中尼古丁及其代谢物可替宁、反式3′-羟基可替宁均可作为生物标志物探讨烟草烟雾对血液系统的影响;暴露于烟草烟雾主要引起血液系统中白细胞计数的增加,白细胞计数的升高可以作为与烟草烟雾暴露相关的较稳定的健康监测指标。

Objective To determine the relationship between the exposure to tobacco smoke and blood cell counts,and to investigate health monitoring indicators related to smoking.Methods A total of 776 subjects who underwent physical examination in Shanxi province,China were included in the study.Questionnaires were used to collect baseline data of the study population as well as the results of blood routine examination.High performance liquid chromatography tandem mass spectrometry(HPLC-MS/MS)was used to determine the levels of urinary nicotine,and its metabolites cotinine and trans-3′-hydroxycotinine.Generalized linear model and logistic regression model were used to examine the relationship between nicotine,cotinine,trans-3′-hydroxycotinine and blood cell counts.Results There was a high correlation between nicotine and its metabolites cotinine and trans-3′-hydroxycotinine in urine samples.The increase of nicotine and its metabolites cotinine and trans-3′-hydroxycotinine were all related to the increase of white blood cell counts,neutrophil counts and lymphocyte counts.As represented by the concentration of cotinine in urine,the risk of white blood cell count exceeding the normal range increased by 3.75 times(OR=3.75)for every 1 unit increase in the interquartile interval,and the risk of neutrophil count exceeding the normal range increased by 2.41 times(OR=2.41).Conclusion Nicotine and its metabolites cotinine and trans-3′-hydroxycotinine may be used as biomarkers to investigate the effects of tobacco smoke on blood system.Exposure to tobacco smoke mainly causes an increase in the white blood cell count in blood system,and the increase in the white blood cell count may be used as a relatively stable health monitoring indicator related to exposure to tobacco smoke.