성인 남성에서 흡연에 따른 백혈구증가증 빈도
Leukocytosis Prevalence according to Smoking among Men
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연구배경: 흡연은 폐에서 폐포성 대식세포를 활성화시키며 이로 인해 염증성 싸이토카인 및 혈액형성 조혈인자를 분비시켜 결과적으로 골수에서 백혈구의 증가를 유도한다. 외국의 역학 연구에서 백혈구증가증과 하루 흡연량 및 총흡연량이 관련있음이 알려졌으나 현재 우리나라 남성을 대상으로 시행된 연구 결과는 없다. 이에 본 연구에서는 한국 성인 남성에서 흡연에 따른 백혈구수 증가, 백혈구증가증 유병률을 알아보고자 한다. 방법: 2005년 1월부터 12월까지 일개 대학병원 건강검진센터를 방문한 20세 이상의 건강한 성인 남성 2,270명을 대상으로 신체검사와 흡연행태에 대한 설문지 및 혈액검사 결과를 구했다. 흡연여부에 따라 백혈구수를 비교하였으며, 하루 흡연량과 총흡연량에 따라 백혈구증가증(＞9,300/ul) 유병률 및 백혈구증가증에 이환될 교차비를 알아보았다. 결과: 평균 백혈구수는 흡연군에서 6,500±169/ul로 비흡연군(6,014±147/uL)과 과거흡연군(6,182±159/ul)보다 높았다. 흡연군의 하루 흡연량이 증가할수록, 총흡연량이 커질수록 평균 백혈구수와 백혈구증가증 유병률이 증가하였다(P=0.000). 비흡연군을 기준으로 비교하였을 때, 하루 흡연량이 반갑~한갑 흡연자의 백혈구증가증에 이환될 교차비는 1.98 (95% 신뢰구간 1.01∼3.88), 한갑 이상 흡연자의 교차비는 4.17 (95% 신뢰구간 1.83∼9.48)로 높은 수치를 보였고, 총흡연량이 20∼30갑년 흡연자의 백혈구증가증에 이환될 교차비는 2.58 (95% 신뢰구간 1.22∼5.42), 30∼40갑년 흡연자의 교차비는 3.31 (95% 신뢰구간 1.38∼7.93), 40갑년 이상 흡연자의 교차비는 5.17 (95% 신뢰구간 2.00∼13.32)로 총흡연량이 증가하면서 백혈구증가증에 이환될 위험도도 현저히 높아졌다. 결론: 한국 성인 남성흡연자에서 비흡연군에 비해 하루 흡연량 증가 및 총흡연량의 증가는 백혈구수와 백혈구증가증 유병률을 증가시켰다.
Abstract
Leukocytosis Prevalence according to Smoking among MenGwi Sun Kim, M.D., Il Joong Park, M.D., Mi Hee Kong, M.D., Tae Young Lee, M.D., Nam Seok Joo, M.D., Kwang Min Kim, M.D.† Background: Cigarette smoke exposure accelerates the release of leukocytes from the bone marrow, which is postulated to be mediated by inflammatory cytokines and haematopoietic growth factors released from the lung. Methods: The study population consisted of 2,270 healthy men above 20 years of age who had visited a health promotion center in a university hospital from January 2005 to December 2005. Baseline health check, self- reported cigarette smoking habit and blood sample were evaluated. The mean count of leukocytes and the leukocytosis prevalence according to smoking amounts were investigated. Results: As the daily smoking amount was increased and as pack years smoked was increased, the mean total WBC count values and the prevalence of leukocytosis were higher (P=0.000). The odds ratio (OR) for leukocytosis according to daily smoking amount compared to no smokers was 1.98 (95% confidence interval (CI) 1.01∼3.88) in those who smoked 1/2∼1 pack per day and 4.17 (95% CI 1.83∼9.48) in those who smoked more than 1 pack per day. The OR for leukocytosis according to smoking pack years compared to no smokers was 2.58 (95% CI 1.22∼5.42) in those who smoked 20∼30 pack years, 3.31 (95% CI 1.38∼7.93) in those who smoked 30∼40 pack years and 5.17 (95% CI 2.00∼13.32) in those who smoked more than 40 pack years. Conclusion: The mean count of leukocytes and the prevalence of leukocytosis were higher in current smokers than no smokers and ex-smokers. (J Korean Acad Fam Med 2007;28:762-767)
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