烟草与衰老性疾病的关系研究课件.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,#,烟草与衰老性疾病的关系研究,解放军305医院,郑州烟草研究院,烟草与衰老性疾病的关系研究解放军305医院,1,前言,大量的流行病调查和生物学证据表明吸烟与典型的衰老性疾病帕金森病和阿尔茨海默病存在负性相关关系，因此，我们将对吸烟与此两种疾病相关的流行病证据进行回顾，阐述烟草成分神经性保护作用的可能机理，展望烟草成分在上述疾病治疗应用中的前景前言,2,一、烟草神经性保护作用的流行病资料回顾,一、烟草神经性保护作用的流行病资料回顾,3,表1 吸烟与帕金森病关系病例对照研究,序号,作者,危险度估计（RR),注释,男性,女性,合计,1,Kessler（,1971）,0.57,0.74,0.69,分层调整,2,Dennis G（,1981）,0.46,性别、种族和年龄匹配,3,Ogawa（,1984,）,0.34,0.37,0.51,医院对照,0.42,0.58,0.64,邻居对照,4,Butterfield（,1993）,0.37,PD早发,5,Semchuk（,1993,）,0.48,多因素分析无显著性,6,C Tzourio（,1993,）,1.1,未调整,0.40,年龄调整,7,Kuopio A（,1999）,0.92,差异无显著性,8,Herishanu（,2001,）,0.37,配对,9,Zorzon M（,2002,）,0.70,表1 吸烟与帕金森病关系病例对照研究序号作者,4,表2 吸烟与帕金森病关系的前瞻性研究,序号,作者,危险度估计（RR),注释,男性,女性,合计,1,Dorn(1959),0.36,2,Kahn（,1966）,0.23,3,Hammond(1966),0.76,差异无显著性,Doll and Peto(1976),0.43,差异无显著性,4,Hirayama(1985),0.57,5,Grandinetti(1994),0.39,6,Moren(1996),0.40,26年跟踪调查,表2 吸烟与帕金森病关系的前瞻性研究 序号作者 危险度估,5,表3 吸烟及戒烟与PD的剂量反应关系,Smoking history,Adjusted OR,(95%CI),Never smoking,1(reference),Current light smoking,0.6(0.2-1.5),Current heavy smoking,0.1(0.01-0.6),Former heavy smoking-stopped20 years ago,0.9(0.4-1.8),Former heavy smoking-stopped 1-20 years ago,0.4(0.2-0.7),表3 吸烟及戒烟与PD的剂量反应关系Smoking hist,6,表4,吸烟与PD关系研究,病例组及对照组社会人口学特征,特,征,病例,(n=114),对照,(n=205),No.,%,No.,%,性别,男,60,52.6,96,46.8,女,54,47.4,109,53.2,婚姻状况,已婚,84,73.7,137,66.8,离婚,/,分居,1,0.9,1,0.5,丧偶,29,25.4,67,32.7,教育年限,12,年,69,60.5,172,83.9,12,年,45,39.5,33,16.1,表4 吸烟与PD关系研究病例组及对照组社会人口学特征特,7,表5,吸烟与,PD,相关性的单因素分析,(吸烟史),研究因素,研究对象,病例,对照,x,2,P,值,OR,95%CI,非 吸 烟,77,104,1.00,曾经吸烟,37,101,8.4096,0.01,0.49,0.30,0.79,现在吸烟,15,46,6.2135,0.05,0.44,0.23,0.86,过去吸烟,22,55,4.4408,0.05,0.54,0.30,0.96,表5 吸烟与PD相关性的单因素分析(吸烟史)研究因素 研究,8,表6 吸烟与,PD,相关性的单因素分析,(吸烟年限),吸烟年限(年),研究对象,病例,对照,x,2,P,值,OR,95%CI,0,77,104,1.00,0.05,0.61,0.35,1.07,20,12,46,8.9367,0.05,0.61,0.35,1.07,20,12,46,8.9367,0.01,0.35,0.18,0.70,现吸烟,15,46,6.2135,0.05,0.44,0.23,0.86,表7 吸烟与PD相关性的单因素分析(戒烟年限)戒烟年限(年,10,表8,吸烟与,PD,相关性的单因素分析(吸烟量),吸烟量,(盒/天),研究对象,病例,对照,x,2,P,值,OR,95%CI,0,77,104,1.00,0.5,32,80,5.7601,0.5,5,21,5.1643,0.05,0.53,0.12,0.86,趋势检验（值）,0.002,表8 吸烟与PD相关性的单因素分析(吸烟量)吸烟量(盒/天,11,表,9,吸烟及饮酒与,PD,相关性的单因素分析,*,饮酒,非饮酒,病例,对照,OR,95%CI,病例,对照,OR,95%CI,不吸烟,18,58,1.0,0.10,0.77,19,43,1.0,0.34,1.18,吸 烟,11,10,0.28,66,94,0.63,*,Mantel-Haenszel test OR=0.51(95%CI:0.30,0.86),Brewlow-Day test for homogeneity of the odds ratios:Chi-square=1.78,P=0.18,表9 吸烟及饮酒与PD相关性的单因素分析*饮酒 非饮酒,12,表10 喝茶及吸烟与,PD,相关性的单因素分析,*,喝茶,不喝茶,病例,对照,OR,95%CI,病例,对照,OR,95%CI,不吸烟,24,62,1.0,0.22,0.96,53,42,1.00,0.41,1.68,吸 烟,14,79,0.46,23,22,0.83,*,Mantel-Haenszel test OR=0.62(95%CI:0.37,1.00),Brewlow-Day test for homogeneity of the odds ratios:Chi-square=1.29,P=0.26,表10 喝茶及吸烟与PD相关性的单因素分析*喝茶 不喝茶,13,表11 吸烟与PD相关性的非条件logistic回归分析,研究因素,值,标准误,x,2,P,值,OR,性别,0.936,1.247,9.821,0.009,1.716,年龄,0.030,0.299,4.612,0.032,1.031,吸烟,-0.619,0.315,3.866,0.049,0.538,喝茶,-1.616,0.283,32.619,0.000,0.199,饮酒,-0.031,0.339,0.009,0.926,0.969,表11 吸烟与PD相关性的非条件logistic回归分析,14,表12 吸烟与AD关系研究,Findings,Number of case-control studies,Number of follow-up studies,Inconclusive results,14,Smoking is a risk factor,3,2,Smoking is a protective factor,5/2(studies/metanalysis),No association,3,表12 吸烟与AD关系研究FindingsNumber of,15,表13,吸烟与AD关系研究,病例组及对照组特征,特,征,病例,(n=282),对照,(n=282),P值,%,%,性别,男,87,30.9,87,30.9,女,195,69.1,195,69.1,年龄 y,80.57.7,80.47.0,0.4460,受教育时间 a,2.274.07,2.294.02,0.6783,病况,中度痴呆,238,84.4,重度痴呆,44,15.6,发病年龄 a,76.08.2,平均病程 a,4.52.7,表13 吸烟与AD关系研究病例组及对照组特征特 征 病例,16,表14 吸烟与AD的单因素分析（吸烟史）,Group,n,Cigarette smoking,N-smoking,C-smoking,E-smoking,Cases,282,204(72.43),38(13.48),40(14.18),Controls,282,194(68.79),46(16.31),42(14.89),OR,1,0.818,0.792,95%,CI,0.4391.525,0.4291.378,P,0.5278,0.3777,表14 吸烟与AD的单因素分析（吸烟史）GroupnCiga,17,表15 吸烟与AD的单因素分析（青春期吸烟量）,Group,n,Cigarette smoking（1524years old),N-smoking,0.19.9 pack-years,10 pack-years,Cases,282,245(88.45),38(13.48),1(0.36),Controls,282,242(87.36),34(12.27),1(0.36),OR,1,0.931,0.867,95%,CI,0.5511.572,0.3042.473,P,0.7893,表15 吸烟与AD的单因素分析（青春期吸烟量）GroupnC,18,表16 吸烟与AD的单因素分析（中年期吸烟量）,Group,n,Cigarette smoking（2549years old),N-smoking,0.19.9 pack-years,10 pack-years,Cases,282,216(77.98),28(10.11),33(11.91),Controls,282,206(74.37),33(11.91),38(13.72),OR,1,0.864,0.746,95%,CI,0.6491.149,0.4211.320,P,0.3138,表16 吸烟与AD的单因素分析（中年期吸烟量）GroupnC,19,表17 吸烟与AD的单因素分析（老年期吸烟量）,Group,n,Cigarette smoking（50 years old),N-smoking,0.19.9 pack-years,10 pack-years,Cases,282,213(70.90),38(13.72),26(9.39),Controls,282,199(71.84),34(12.27),44(15.88),OR,1,0.749,0.561,95%,CI,0.5591.004,0.3131.008,P,0.0532,表17 吸烟与AD的单因素分析（老年期吸烟量）GroupnC,20,表18 吸烟与AD的单因素分析（吸烟量）,Group,n,Cigarette smoking（15 years old),N-smoking,0.19.9 pack-years,10 pack-years,Cases,282,204(73.65),26(9.39),47(16.97),Controls,282,194(70.04),24(8.66),59(21.30),OR,1,0.859,0.738,95%,CI,0.6641.110,0.4411.232,P,0.2449,表18 吸烟与AD的单因素分析（吸烟量）GroupnCiga,21,按性别分层后，吸烟量对男性和女性患者患AD的影响无显著意义；在不同年龄段被动吸烟的量对AD的危险性无显著意义,。

按性别分层后，吸烟量对男性和女性患者患AD的影,22,吸烟与AD关系的多因素分析,以是否患AD为因变量并以在1524岁、2549岁以及50岁3个不同年龄段时吸卷烟的量、被动吸卷烟的量以及可能的混杂因素为自变量引入Logistic回归分析吸烟与AD关系的多因素分析 以是否患AD为因,23,吸烟与AD关系的多因素分析结果,去除婚姻状态（P=0。