opinion+advice
作者:李雷博士
都说吸烟有害健康,到底有哪些危害呢?
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今天从分子机制,医学证据和流行病调查这三个方面来说说吸烟对健康的危害。
第一,分子证据:
1,吸烟引发癌变
![](https://p0.ssl.img.360kuai.com/t0107d5ded131cf8ea9.jpg)
说明:p53是标准的抑癌基因,突变致癌。吸烟会导致个体p53突变增加,从而增加癌风险。
参考:Brennan J A, Boyle J O, Koch W M, et al. Association between cigarette smoking and mutation of the p53 gene in squamous-cell carcinoma of the head and neck[J].New England Journal of Medicine, 1995, 332(11): 712-717.
2,吸烟跟肺癌
![](https://p0.ssl.img.360kuai.com/t0168754399148c6636.jpg)
The expression of CCL20 in lung cancer. (A–C) The expression of CCL20 in lung cancers was evaluated by real-time PCR (A), Western blot (B), and immunohistochemical (IHC) assays (C). N, normal; T, tumor. (D) Serum concentration of CCL20 in samples from healthy donors (HD), smoker (S) or non-smoker (NS) NSCLCs detected by ELISA.
这是比较新的一篇文献,讲述的吸烟引起趋化因子CCL20,从而促进肺癌。
同种分别检测了基因表达,蛋白表达,免疫组化以及血清浓度等。可以看到吸烟者的CCL20明显增加。这属于新证据内容。
参考文献(Wang G Z, Cheng X, Li X C, et al. Tobacco smoke induces production of chemokine CCL20 to promote lung cancer[J]. Cancer letters, 2015, 363(1): 60-70.)
3,吸烟引起精子改变并遗传
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cigarette smoke inducesspecific differencesin thespermatozoal microRNAcontent of human smokers compared with non-smokers, and that thesealtered microRNAsappear to predominantly mediate pathways vital for healthy sperm and normal embryo development, particularly cell death and apoptosis
说明:吸烟导致男性精子小RNA的改变,这些小RNA对精子的健康和胚胎发育至关重要,参与到了细胞凋亡和死亡通路。由于男性的精子参与了下一代的形成,因此吸烟的后果会遗传到下一代。
参考文献:Marczylo E L, Amoako A A, Konje J C, et al. Smoking induces differential miRNA expression in human spermatozoa: a potential transgenerational epigenetic concern?[J]. Epigenetics, 2012, 7(5): 432-439.
第二,医学证据
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Representative light micrographs of lung tissues of mice following subacute (5 days) nose‐only air (control, A and C) or water pipe smoke (WPS, B and D) exposure. Note that the bronchiolar (br) epithelium of the lung of mice exposed to WPS is (1.5 fold) shorter compared with control (short arrows). al, alveolus.
Nemmar A, Al Hemeiri A, Al Hammadi N, et al. Early pulmonary events of nose‐only water pipe (shisha) smoking exposure in mice[J]. Physiological reports, 2015, 3(3): e12258.
本部分讲述的是用小鼠的肺来做实验,左侧是空气对照,右侧是烟。可以看到表皮细胞的心态变化。(ps:此处删了一张图片,因为受不了没完没了的去解释了。)
有些人总以为看了只言片语就掌握了真理。大家都知道成人肺是黑色的,可是我附的图片写的很明确是青少年的肺,然而他们始终注意不到这个核心细节。所以就删除图片了。
有兴趣的,可以去看各种视频,现场给你用烟熏一个肺。这个证据实在是太明显,也太简单了。
所以说,你永远叫不醒一个装睡的人。
第三,流行病学证据
Tobacco kills nearly 6 million people each year, and 90% of the annual 1.59 million lung cancer deaths worldwide are caused by cigarette smoke 这句话来自一篇文献,吸烟每年导致6百万人死亡,其中90%的肺癌死亡是因为吸烟。世界卫生组织有专门的网页来介绍禁烟WHO | Tobacco 并且每年发布调查结果,WHO report on the global tobacco epidemic,可以免费查阅。
目前,作为一个常规数据,各国一直在公布这些数据美国的数据
![](https://p0.ssl.img.360kuai.com/t01b1c408ffb49a7f91.jpg)
中国也在公布,由中国疾病预防控制中心每年公布。每年,中国有超过 100 万人死于烟草导致的相关疾病
社会和政策 中共中央办公厅、国务院办公厅2013年12月29日印发了《关于领导干部带头在公共场所禁烟有关事项的通知》 第二个问题,二手烟和一手烟危害问题,没有证据认为不吸烟者比吸烟者健康受到更大威胁。部分学者认为二手烟危害大可能原因是产生支流烟的燃烧,温度比产生主流烟的低,因不完全燃烧产生的致癌物多环芳香烃所占比例确实较高,有部分实验证据。但是!!!目前,学界主要用动物模型研究烟雾的致癌作用。截至目前,有些研究者发现处在总颗粒物相同的前提下,支流烟中的小鼠健康指标受影响更大,也有研究者认为暴露在主流烟中的大鼠,肺癌发生率显著较高,但在兔子和狗身上的实验结果则差异不明显!也没有流行病调查数据支持这个结论!另外,抛开剂量谈毒性是耍流氓。如果你呼吸同等量的二手烟和一手烟,没有过滤嘴和不充分燃烧的烟,自己想吧。
但是,这不等于不存在伤害
WHO强烈建议孕妇避免烟草伤害,指出孕期使用烟草,包括使用无烟烟草,会使诸如流产、死产、异位妊娠和早产等严重妊娠结局的风险增加。孕期吸烟 妇女所分娩的婴儿更容易发生早产和低出 生体重(小于2500克)(WHO | WHO recommendations for the prevention and management of tobacco use and second-hand smoke exposure in pregnancy)。
文献,随手选的,从1902年到2016年
Silagy C, Stead L F. Physician advice for smoking cessation (Cochrane Review)[J]. The Cochrane Library, 1902, 2.
Lampson R S. A quantitative study of the vasoconstriction induced by smoking[J]. Journal of the American Medical Association, 1935, 104(22): 1963-1966.
Levin M L, Goldstein H, Gerhardt P R. Cancer and tobacco smoking: a preliminary report[J]. Journal of the American Medical Association, 1950, 143(4): 336-338.
Phillips D H, Hewer A, Martin C N, et al. Correlation of DNA adduct levels in human lung with cigarette smoking[J]. Nature, 1988, 336(6201): 790-792.
Asami S, Manabe H, Miyake J, et al. Cigarette smoking induces an increase in oxidative DNA damage, 8-hydroxydeoxyguanosine, in a central site of the human lung[J]. Carcinogenesis, 1997, 18(9): 1763-1766.
Lee S H, Goswami S, Grudo A, et al. Antielastin autoimmunity in tobacco smoking–induced emphysema[J]. Nature medicine, 2007, 13(5): 567-569.
Mariani T J. Respiratory disorders: Ironing out smoking-related airway disease[J]. Nature, 2016
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温雨瑞3208opinion怎么读 -
唐善忠13617729615 ______ opinion 英 [ə'pɪnjən] 美 [ə'pɪnjən] n.意见;主张;看法;判断 用作名词 (n.) I can't agree with your opinion in this respect.在这方面,我不赞同你的意见.No matter what you say, I shall stick to my opinion.不管你说什么,我都坚持我的主张.
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