NEJM:中国人吸烟致死的疾病研究

发布者：中国医学论坛报 发布时间：2009-1-13

中国医学科学院阜外心血管病医院，美国杜兰大学医学院，约翰霍普金斯大学的研究人员发现中国40－79岁人群中由吸烟所致死亡的前三大类疾病分别是癌症、心血管疾病和呼吸系统疾病。2005年全国67.3万人死于与吸烟相关的肺癌、心血管病或慢性阻塞性肺疾病(COPD)。这一研究成果公布在1月8日的《新英格兰医学杂志》(N Engl J Med )（2007年影响因子52.589）上。
文章的通讯作者是阜外心血管病医院的顾东风教授，其1983年毕业于南京医科大学，曾在美国明尼苏达大学、加拿大多伦多大学心脏分子遗传实验室和英国南安普敦大学进行人类遗传学系研究，目前任阜外心血管病医院群体遗传学及人群防治研究室主任，中国协和医科大学教授、博士生导师，美国杜兰大学医学中心流行病学兼职教授，英国南安普敦大学人类遗传系客座教授。
据顾东风介绍，他们根据一项大型前瞻性队列研究项目的数据对中国人群中由吸烟所致具体死亡人数进行了详尽深入的研究。该研究覆盖全国17个省市近17万名40岁以上成年人，从1991-2000年历时10年。根据这项基线研究的结果，研究者采用多变量校正相对危险、吸烟率、死亡率和各年龄组的总人数，计算2005年吸烟造成的死亡人数。
结果显示，2005年我国40~79岁年龄段人群中因吸烟所致死亡总数高达67.30万人，其中男性53.82万人，女性13.48万人。中国40~79岁年龄段人群中由吸烟所致死亡的前3大类疾病是：癌症(死亡数26.82万人)、心血管疾病(死亡数14.62万人)和呼吸道疾病(死亡数6.68万人)。男性由吸烟所致死亡的前3位具体疾病分别是：肺癌(死亡数11.30万人)、卒中(死亡数8.25万人)和COPD(死亡数4.73万人);女性的前3位具体疾病是：COPD(死亡数1.71万人)、肺癌(死亡数1.6万人)和卒中(死亡数9800人)。男性和女性中因肺癌、卒中和COPD这3种疾病导致的总死亡中，由吸烟作为罪魁祸首所致的死亡分别占45.1%和31.8%。
顾东风教授指出，在我国履行落实联合国《烟草控制框架公约》和制订《健康中国2020》战略规划时，该研究所报告的吸烟升高死亡风险、吸烟所致具体疾病死亡专率、以及吸烟每年导致的惊人的死亡人数，将为促进政府全面履行公约提供有力的科学证据，也有助我国开展预防吸烟和戒烟为重点的健康促进。此外，顾教授强调，面对吸烟引起的死亡风险和惊人的死亡人数，我国需要一个更强力的国家烟草控制方案以应对这一公共卫生领域的挑战，保护公民健康。
The New England Journal of Medicine Volume 360:121-128 January 8, 2009
A Strategy to Control Transmission of Schistosoma japonicum in China
Long-De Wang, M.D., Hong-Gen Chen, Ph.D., Jia-Gang Guo, Ph.D., Xiao-Jun Zeng, M.D., Xian-Lin Hong, Ji-Jie Xiong, Xiao-Hua Wu, M.Sc., Xian-Hong Wang, Ph.D., Li-Ying Wang, Gang Xia, M.Sc., Yang Hao, M.Sc., Daniel P. Chin, M.D., and Xiao-Nong Zhou, Ph.D.
ABSTRACT
Background Schistosoma japonicum causes an infection involving humans, livestock, and snails and is a significant cause of morbidity in China.
Methods We evaluated a comprehensive control strategy in two intervention villages and two control villages along Poyang Lake in the southeastern province of Jiangxi, where annual synchronous chemotherapy is routinely used. New interventions, implemented from 2005 through 2007, included removing cattle from snail-infested grasslands, providing farmers with mechanized farm equipment, improving sanitation by supplying tap water and building lavatories and latrines, providing boats with fecal-matter containers, and implementing an intensive health-education program. During the intervention period, we observed changes in S. japonicum infection in humans, measured the rate of infection in snails, and tested the infectivity of lake water in mice.
Results After three transmission seasons, the rate of infection in humans decreased to less than 1.0% in the intervention villages, from 11.3% to 0.7% in one village and from 4.0% to 0.9% in the other (P<0.001 for both comparisons). The rate of infection in humans in control villages fluctuated but remained at baseline levels. In intervention villages, the percentage of sampling sites with infected snails decreased from 2.2% to 0.1% in one grassland area and from 0.3% to no infection in the other (P<0.001 for both comparisons). The rate of infection in mice after exposure to lake water decreased from 79% to no infection (P<0.001).
Conclusions A comprehensive control strategy based on interventions to reduce the rate of transmission of S. japonicum infection from cattle and humans to snails was highly effective. These interventions have been adopted as the national strategy to control schistosomiasis in China.