The Observation And Analysis Of The Relativity Between Cigarette Smoking And Palmar Erythema Related To Smoking

Cigarettes are composed of more than 2540 kinds of components,which could take complicated physical and chemical changes after being burnt.One of the most harmful components is nicotine.The rest are tar,carbon monoxide,cyanide and radioactive materials.Our country is a nation which is abounding at cigarette producing and consuming.According to an epidemiologic survey in 1996,there are 66.8%men smokers and 4.2%women smokers in our country.According to a long-term observation,we have found that cigarette smokers often have erythema on their palms.One kind of appearances is that redness on the hypothenar and thenar eminence,finger tips and basis of the fingers.The other kind is that uniformity redness on the whole palms including the fingers.There are no pruritus,haphalgesia or other subjective symptoms.The palmar erythema is congested and can turn faded after being pressed.The appearance of some smokers' palms is much similar to the palmar erythema of patients with chronic liver disease,cirrhosis in particular. However,the subjects have no clinical signs of chronic liver disease or liver cirrhosis. This phenomenon has never been described or recorded in previous medical literature. We call it palmar erythema related to smoking.To investigate the interesting phenomenon,the present study observed the relationship between palmar erythema and the paramaters of cigarette smoking and,as well,the relationship between palmar erythema and the parameters of erythrocytes. We also made morphology contrast between palmar erythema related to smoking and palmar erythema related to liver cirrhosis.In view of the fact that alcohol consumption is often associated with smoking,the effect of alcohol drinking on development of palmar erythema was also assessed as an important confounding factor.An epidemiologic survey of 4 Chinese regions indicated that the alcohol drinking rate of general people is 59.15%,including 84.16%males and 29.14% females.In addition,respecting the influence of long-term smoking on RBC in circulation,the relationship between palmer erythema and the parameters of erythrocytes has been approached.ObjectiveWe have found that cigarette smokers often have erythema on their palms.The appearance of some smokers' palms is much similar to the palmer erythema of patients with chronic liver disease,cirrhosis in particular.To investigate the interesting phenomenon,the present study observed the relationship between palmer erythema and the parameters of cigarette smoking and,as well,the relationship between palmer erythema and the parameters of erythrocytes.MethodsWe have investigated 1535 healthy men who came to second order hospitals for health check.To avoid sampling error,different kinds of occupations have been involved including 737 non-manual workers and 798 manual workers. There are 805 smokers aged 21～68(41±13.9) and 730 non-smokers aged 22～69(42±12.7).The difference of the ages between the two groups has no statistically significant.Internalizing standards:The medical examination is normal.There are no HTN,chronic bronchitis,COPD or DM history.The liver function and renal function are normal.The abdominal hypersound is normal.All the examiners have no splenohepatomegalia.Morphological observes of palmer erythema:the observation is made under natural light.We have observed the boundary between the palm and its back.To avoid bias,case history was acquired after the palmer observation.We have taken photos of the palms of all the examiners.Discrimination of smoking or not:This study adopted the definition which is given by Molarius:present smokers including everyday smokers and occasionally smokers.Non-smokers are people who never smoke.smoking index calculation:smoking index=daily smoking quantity×(age-begin smoking age-stop smoking age)Stop smoking standard:ex-smokers are people who had stopped smoking for more than one year.They have been divided into two groups of stopping smoking 1～10 years and longer than 10 years.Alcohol drinking standard:People who drink more than two times a week and more than 20g alcohol one time are judged as alcohol users.Smoking parameters include daily quantity of smoking,duration of smoking and smoking index,and the parameters of erythrocytes include red blood cell(RBC), hemoglobin(Hgb),hematocrit(Hct),mean cell vo;ume(MCV),mean cell hemoglobin(MCH) and mean cell hemoglobin concentration(MCHC).1535 healthy males participating in annual health check-up were enrolled into the study and the relationship between the frequency of palmar erythema and smoking was analyzed.. In view of the fact that alcohol consumption is often associated with smoking,the effect of alcohol drinking on development of palmar erythema was also assessed as an important confounding factor..The linkage between palmar erythema and smoking parameters,and alcohol drinking was analyzed using logistic regression.Factorial ANOVA was used to evaluate the relations between smoking,drinking and Hgb.Results1.The relationship between the frequency of palmar erythema and smoking:The OR value of smoking is 4.4(p＜0.05),which shows that the frequency of palmar erythema and smoking are positive correlative.2.After exclusion of drinking effect as a confounding factor,the frequency of palmar erythema in smokers is singnificantly higher than that in non-smokers (OR=5.72).3.The relationship between the frequency of palmar erythema and the parameters of cigarette smoking:The frequency of palmar erythema and daily quantity of smoking,duration of smoking and smoking index are positive correlative.4.The analysis between parameters of cigarette smoking,drinking and the frequency of palmar erythema:Palmar erythema is closely correlated in order with quantity of smoking,smoking index and duration of smoking.5.The ex-smokers have been divided into two groups of stopping smoking 1～10 years and longer than 10 years.The frequency of palmar erythema of the two groups have no statistically significant.6.The correlation between palmar erythema and RBC,Hgb and Hct is statistically significant.Hgb in smokers is higher than that in non-smokers.Alcohol drinking is not correlated with Hgb and superimposes no significant impact on palmar erythema in smokers.ConclusionThe frequency of palmar erythema in cigarette smokers is statistically higher than that in non-smokers.The frequency of palmar erythema and daily quantity of smoking,duration of smoking and smoking index are positive correlative.Palmar erythema is closely correlated in order with quantity of smoking,smoking index and duration of smoking.The correlation between palmar erythema and RBC,Hgb and Hct is statistically significant.Hgb in smokers is higher than that in non-smokers. Alcohol drinking is not correlated with Hgb and superimposes no significant impact on palmar erythema in smokers.The ex-smokers have been divided into two groups of stopping smoking1～10 years and longer than 10 years.The frequency of palmar erythema of the two groups have no statistically significant.The palmar erythema related to smoking morphologically resembles palmar erythema related to liver cirrhosis but physiopathologically differs from one another.Smoker's palmar erythema developed in otherwise healthy people and differentiation of the two types of palmar erythema clearly implys clinical significance.