Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Usefulness of Urinary Cotinine Test to Distinguish Smokers from Nonsmokers

흡연자 선별을 위한 요중 코티닌 검사의 유용성

Kang, Yoon-Hee;Lee, Young-Joon;Kim, Hyun-Kyung;Yun, Young-Ho;Jeong, Seung-Yong;Lee, Jin-Soo;Park, Jae-Gahb
강윤희;이영준;김현경;윤영호;정승용;이진수;박재갑

  • Published : 20030000
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Abstract

Background : Self-reports of smoking may not always be reliable. A number of biochemical markers have been used to validate claims of nonsmoking, among which the most widely used specific marker has been the nicotine metabolite cotinine. This study was conducted to evaluate the performance of the enzyme immunoassay (EIA) for urinary cotinine to determine smoking status. Methods : Questionnaires on smoking and urinary cotinine measures were studied in 287 persons. Urinary cotinine concentration was measured by the Cotinine Enzyme Immunoassay (Diagnostic Reagents, Inc., CA, USA) on the 502X Multiple Chemistry Unit (A&T Co., Tokyo, Japan). Results : Using cutoffs of 0 ng/mL, 20 ng/mL or 100 ng/mL for urinary cotinine measured by the EIA method, the sensitivities were 100%, 97.6%, and 94.4% respectively and the specificities were 97.5%, 98.8%, and 100% respectively. By retrograde telephone questionnaires, 3.8% of the subjects were confirmed as deceiving their smoking status. Active smokers of <10 cigarettes per day had a lower mean cotinine level (492 ng/mL) than those who smoked $\geq$10 cigarettes (1,052 ng/mL). Conclusions : Urinary cotinine measured by EIA is a rapid, lab-based test that can reliably determine smoking status. Considering the various purpose of the test, different cut-offs should be used.

배경: 흡연에 대한 설문 또는 문진 방법은 신뢰성이 낮다. 이를 위해 흡연 상태를 객관적으로 나타내는 생물학적 지표들이 연구되었으며, 이중 널리 인정받고 있는 지표가 코티닌이다. 본 연구는 효소면역법에 의한 요중 코티닌 검사의 흡연 여부검출에 대한민감도 및 특이도 흡연량과의 상관관계 등을 분석하였다. 방법: 국립암센터 암예방검진센터 방문자와 검사실 직원중 자원자 287명을 대상으로 하였다. 흡연에 관한 설문조사를 하였고 요중 코티닌 검사상 양성이 나온 경우 후향적인 전화 문진을 실시하였다. 요중 코티닌은 Cotinine Enzyme Immunoassay (Diagnostic Reagents, Inc, CA, USA) 시약으로 502X Multiple Chemistry Unit (A&T Co, Tokyo, Japan) 장비에서 검사하였다. 결과: 효소면역법으로 측정한 요중 코티닌 검사의 흡연여부를 감별하기 위한 기준값 0 ng/mL, 20 ng/mL, 100 ng/mL에서 민감도는 각각100%, 976%, 944%이었고 특이도는 각각 975%, 988%, 100%이었다. 요중 코티닌 검사결과에 따른 후향적 전화 문진결과 설문응답의 38%가 부정직하였다. 일일흡연량 10개피 이하군이 10개피 초과군에 비해서 유의하게 낮은 요중 코티닌 수치를 보였다. 결론: 효소면역법은 기존 검사실의 자동화 장비를 활용하여 간편하게 검사할 수 있는 장점이 있으므로 금연 클리닉에서의 흡연자검사 역학연구 등에 유용하게 사용할 수 있겠다. 그러나 요중 코티닌 검사의 목적에 따라 적절한 기준값을 적용하는 것이 필요하다.

Keywords

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