抽菸会增加女性的膀胱症状


  【24drs.com】根据发表于9月号妇产科(Obstetrics & Gynecology)期刊一篇人口基础世代研究的问卷调查结果,抽菸者的急尿和频尿情况是未曾抽菸者的3倍之多。
  
  芬兰Tampere大学医院、Hameenlinna、Kanta-Hame中心医院妇产科Riikka M. Tahtinen医师等人表示,虽然抽菸会增加许多疾病的发生,抽菸和下泌尿道症状之间的关联还不清楚;稍早的研究结果并不一致,或许是因为无法分辨尿失禁类型、或是将所有的泌尿道症状视为单一群聚。因为各种膀胱症状或许有不同的病源,汇整在一起可能会模糊了重要的关联。
  
  研究目标是评估抽菸状态和频率强度、夜尿、压力性尿失禁、急尿、急尿型尿失禁等的关联。
  
  研究人员利用芬兰人口登记资料,随机检视了18-79岁的3,000名妇女,邮寄问卷给他们,问卷问题包括压力性尿失禁、急尿、急尿型尿失禁的发生率(从未、很少、通常、经常)。排尿频率定义为最长的排尿间隔小于2小时,夜尿定义为每晚排尿2次以上。搜集的资料包括共病症、药物、社会人口流行病学、生活型态、生育因素、其它可能的干扰因素等,使用多变项分析评估关联性。
  
  问卷回覆率为67.0%,7.1%的妇女表示有频尿、12.6%有夜尿、11.2%为压力型尿失禁、9.7%为急尿、3.1%为急尿型尿失禁。对于抽菸者及未曾抽菸者,与抽菸有关的有急尿、胜算比(OR)为2.7 (95%信心区间[CI]为1.7 - 4.2),如果是曾经抽菸者和未曾抽菸者相比,OR为1.8(95% CI,1.2 - 2.9)。抽菸也与抽菸者的频尿有关(OR为3.0 [95% CI,1.8 - 5.0];曾抽菸者的OR为1.7 [95% CI,1.0 - 3.1]),不过,抽菸与夜尿或压力型尿失禁无关。
  
  校正之后,未曾抽菸者和目前有抽菸者的急尿及频尿盛行率差异分别是6.0%(95% CI,3.0% - 9.1%)和6.0% (95% CI,3.3% - 8.7%);目前有抽菸者中,高浓度香菸和淡菸相比,急尿和频尿的额外风险胜算比分别是2.1(95% CI,1.1 - 3.9)和2.2(95% CI,1.2 - 4.3)。
  
  研究限制包括,缺乏每年抽几包菸的资料、可能分类错误、无法校正给予模式、回覆率只有67%、采用的是自我报告资料、横断面研究设计无法判定因果关联、无法一般化到其它人口。
  
  研究作者写道,目前有抽菸者的急尿和频尿几乎是未曾抽菸者的3倍,急尿和频尿与抽菸强度的关联间存在有剂量反应关系。对于因为膀胱症状就医的女性,这些结果提供了另一个戒菸的理由,并强调了这类症状之间的差异。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_logon=W&x_idno=6606&x_classno=0
  

Smoking May Increase Bladder Symptoms in Women

By Laurie Barclay, MD
Medscape Medical News

August 29, 2011 — Urinary urgency and frequency among women are about 3 times more common among current than never smokers, according to the results of a questionnaire survey in a population-based cohort reported in the September issue of Obstetrics & Gynecology.

"Although smoking increases illness burden for many conditions, the relation between smoking and lower urinary tract symptoms remains unclear," Riikka M. Tahtinen, MD, from the Department of Obstetrics and Gynecology at Kanta-Hame Central Hospital, Hameenlinna, and Tampere University Hospital, Finland, and colleagues. "Earlier studies have been inconsistent, perhaps as a result of failing to distinguish among [urinary incontinence (UI)] types or by analyzing all urinary symptoms as a single cluster. Because various bladder symptoms probably have different etiologies, combining them may have obscured important associations."

The study goal was to evaluate the association of smoking status and intensity on frequency, nocturia, stress UI (SUI), urgency, and urgency UI.

Using the Finnish Population Register, the investigators randomly identified 3000 women aged 18 to 79 years and mailed them questionnaires including questions on occurrence (never, rarely, often, always) of SUI, urgency, and urgency UI. Urinary frequency was defined as longest voiding interval less than 2 hours, and nocturia as 2 or more voids per night. Information was collected concerning comorbidities, medications, sociodemographic, lifestyle, and reproductive factors, and other potential confounders. Associations were studied using multivariable analyses.

Response rate was 67.0%, with 7.1% of women reporting frequency, 12.6% nocturia, 11.2% SUI, 9.7% urgency, and 3.1% urgency UI. Smoking was associated with urinary urgency, with an odds ratio (OR) of 2.7 (95% confidence interval [CI], 1.7 - 4.2) for current vs never smokers and an OR of 1.8 (95% CI, 1.2 - 2.9) for former vs never smokers. Smoking was also associated with urinary frequency (OR, 3.0 [95% CI, 1.8 - 5.0] for current smokers; OR, 1.7 [95% CI, 1.0 - 3.1] for former smokers). However, smoking was not associated with nocturia or SUI.

After adjustment, prevalence differences between never and current smokers were 6.0% for urgency (95% CI, 3.0% - 9.1%) and 6.0% (95% CI, 3.3% - 8.7%) for frequency. Among current smokers, heavy compared with light smoking was associated with additional risk for urgency (OR, 2.1; 95% CI, 1.1 - 3.9) and frequency (OR, 2.2; 95% CI, 1.2 - 4.3).

Limitations of this study include the lack of data on pack-years of smoking, a possible misclassification bias, the inability to adjust for delivery mode, a response rate of 67%, reliance on self-report, the cross-sectional design precluding conclusions about causality, and a lack of generalizability to other populations.

"Urgency and frequency are approximately three times more common among current than never smokers," the study authors write. "Parallel associations for urgency and frequency with smoking intensity suggest a dose–response relationship.... These results suggest an additional rationale for smoking cessation in women seeking medical attention for bladder symptoms and highlight the diversity between such symptoms."

This study was supported by unrestricted grants from the Competitive Research Funding of the Pirkanmaa Hospital District and Pfizer Inc. Dr. Tahtinen was supported by an unrestricted grant from the Competitive Research Funding of the Kanta-Hame Central Hospital. A second study author was supported by unrestricted grants from the Finnish Medical Society and the Finnish Cultural Foundation. Some of the study authors report various financial relationships with Merck Sharp & Dohme Corp, Pfizer, Ferring, Johnson & Johnson, Amgen, Astellas, GlaxoSmithKline, and/or Orion Pharma.

Obstet Gynecol. 2011;118:643-648.

    
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