环境空气PM_(2.5)短期暴露与未确诊COPD人群肺功能的关联性
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摘要
目的分析环境空气中PM_(2.5)短期暴露与未确诊COPD人群肺功能的关联,为该类人群的空气污染防护提供科学依据。方法以肺功能检测筛查的未确诊COPD人群作为受试者;于2018年1、3、8和10月4个时间段,对28名受试者进行了重复测量,包括肺功能检测,及每次测量前5 d的环境PM_(2.5)质量浓度监测、问卷调查;用混合效应模型,分析PM_(2.5)与肺功能的关联性。PM_(2.5)质量浓度对肺功能的影响考虑了滞后效应,按照lag0～lag4滞后日期的浓度代入模型。结果 PM_(2.5)日均质量浓度最高为250.46μg/m~3。单日滞后效应结果显示,FEV_1、MEF_(25)、MEF_(50)和一秒率与PM_(2.5)的质量浓度在lag1有显著的关联性;PM_(2.5)质量浓度每升高10μg/m~3,FEV_1下降0.05 L,MEF_(25)下降0.03 L/s,MEF_(50)下降0.10 L/s,一秒率下降1.09%;FVC、MEF_(75)和PEF与PM_(2.5)质量浓度无关联。滑动平均滞后效应结果中,仅MEF_(50)与PM_(2.5)质量浓度在lag01有一定显著关联性(P<0.1);PM_(2.5)质量浓度每升高10μg/m~3,MEF_(50)下降0.07 L/s。结论环境空气PM_(2.5)可以导致未确诊COPD人群肺功能通气功能指标的下降,应注重此类人群重污染天气的防护。空气污染对小气道的影响更值得关注。
Objectives To analyze the associations between short-term exposure to ambient PM_(2.5) and lung function in undiagnosed COPD population, and to provide a scientific foundation for the protection against air pollution. Methods Subjects were undiagnosed COPD population screened by lung function test. In January, March, August, and October of 2018, 28 subjects were tested repeatedly. For each time, lung function testing, questionnaire survey, and the PM_(2.5) mass concentration monitoring for 5 days before each lung function test were conducted. Mixed effect model was used to analyze the associations between PM_(2.5) and lung function. The lag effect of PM_(2.5) mass concentration on lung function was considered, and the lag0～lag4 PM_(2.5) mass concentration was used in the model. Results The maximum daily PM_(2.5) mass concentration was 250.46 μg/m~3. The result of one-day lag effect showed that FEV_1, MEF_(25), MEF_(50), and FEV_1/FVC were significantly associated with the mass concentration of PM_(2.5) in lag01. As PM_(2.5) mass concentration was increased by 10 μg/m~3, FEV_1, MEF_(25), MEF_(50), and FEV_1/FVC were decreased by 0.05 L, 0.03 L/s, 0.10 L/s, and 1.09%, respectively. FVC, MEF_(75), and PEF were not associated with PM_(2.5) mass concentration. The moving average lag effect showed that only MEF_(50) was significantly associated with PM_(2.5) mass concentration in lag01(P<0.1). As PM_(2.5) mass was increased by 10 μg/m~3, MEF_(50) was decreased by 0.07 L/s. Conclusions Ambient air PM_(2.5) can lead to the decline of pulmonary ventilation function indicators in undiagnosed COPD patients, and it is necessary to pay attention to the protection of this group of people against the heavy pollution weather. The impact of air pollution on small airway deserve more attention.
Objectives To analyze the associations between short-term exposure to ambient PM_(2.5) and lung function in undiagnosed COPD population, and to provide a scientific foundation for the protection against air pollution. Methods Subjects were undiagnosed COPD population screened by lung function test. In January, March, August, and October of 2018, 28 subjects were tested repeatedly. For each time, lung function testing, questionnaire survey, and the PM_(2.5) mass concentration monitoring for 5 days before each lung function test were conducted. Mixed effect model was used to analyze the associations between PM_(2.5) and lung function. The lag effect of PM_(2.5) mass concentration on lung function was considered, and the lag0～lag4 PM_(2.5) mass concentration was used in the model. Results The maximum daily PM_(2.5) mass concentration was 250.46 μg/m~3. The result of one-day lag effect showed that FEV_1, MEF_(25), MEF_(50), and FEV_1/FVC were significantly associated with the mass concentration of PM_(2.5) in lag01. As PM_(2.5) mass concentration was increased by 10 μg/m~3, FEV_1, MEF_(25), MEF_(50), and FEV_1/FVC were decreased by 0.05 L, 0.03 L/s, 0.10 L/s, and 1.09%, respectively. FVC, MEF_(75), and PEF were not associated with PM_(2.5) mass concentration. The moving average lag effect showed that only MEF_(50) was significantly associated with PM_(2.5) mass concentration in lag01(P<0.1). As PM_(2.5) mass was increased by 10 μg/m~3, MEF_(50) was decreased by 0.07 L/s. Conclusions Ambient air PM_(2.5) can lead to the decline of pulmonary ventilation function indicators in undiagnosed COPD patients, and it is necessary to pay attention to the protection of this group of people against the heavy pollution weather. The impact of air pollution on small airway deserve more attention.
引文
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[13] 陆育钿,陈文翰,张乃锦,等.无症状慢性阻塞性肺疾病患者早期干预的临床研究[J].临床医学工程,2018,25(9):1191-1192.(In English:Li YD,Chen WH,Zhang NJ,et al.Clinical study on early intervention in patients with asymptomatic chronic obstructive pulmonary disease[J].Clin Med Eng,2018,25(9):1191-1192.)
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[19] 李娇元,马露,刘历志,等.武汉市秋冬季空气颗粒物暴露对大学生肺功能的短期影响[J].中华预防医学杂志,2013,47(2):155-159.(In English:Li JY,Ma L,Liu LZ,et al.The short-term effects of particulate matter on lung function of college students in autumn and winter in wuhan[J].Chin J Prev Med,2013,47(2):155-159.)
[20] Rice MB,Ljungman PL,Wilker EH,et al.Long-term exposure to traffic emissions and fine particulate matter and lung function decline in the framingham heart study[J].Am J Respirat Crit Care Med,2015,191(6):656-664.
[21] Rice MB,Ljungman PL,Wilker EH,et al.Short-term exposure to air pollution and lung function in the framingham heart study[J].Am J Respirat Crit Care Med,2013,188(11):1351-1357.
[22] 韩建彪.太原市PM2.5对哮喘患者肺功能和生物指标影响的panel研究[D].太原:山西医科大学,2014.(In English:Han JB.A panel study of effects of PM2.5 in Taiyuan on asthma patients pulmonary function and biomarker[D].Taiyuan:Shanxi Medical University,2014.)
[23] 史传见.PM2.5对慢性阻塞性肺疾病患者血清TNF-α、IL-6、IL-8和生活质量影响的panel研究[D].新乡:新乡医学院,2017.(In English:Shi CJ.The effect of PM2.5 on serum levels of TNF-α,IL-6,IL-8 and quality of life in patdents mith chrongc obstructive pulmonary disease by panel study[D].Xinxiang:Xinxiang Medical University,2017.)
[24] Soppa VJ,Schins RP,Hennig F,et al.Respiratory effects of fine and ultrafine particles from indoor sources--a randomized sham-controlled exposure study of healthy volunteers[J].Int J EnvironRes Public Health,2014,11(7):6871-6889.
[25] Hwang BF,Chen YH,Lin YT,et al.Relationship between exposure to fine particulates and ozone and reduced lung function in children[J].Environ Res,2015,137:382-390.
[26] Hogg JC,Macklem PT,Thurlbeck WM.Site and nature of airway obstruction in chronic obstructive lung disease[J].N Engl J Med,1968,278(25):1355-1360.
[27] Singh D.Small airway disease in patients with chronic obstructive pulmonary disease[J].Tubercul Respirat Dis,2017,80(4):317-324.
[28] Churg A,Brauer M.Human lung parenchyma retains PM2.5[J].Am J Respirat Crit Care Med,1997,155(6):2109-2111.
[2] Miri M,Derakhshan Z,Allahabadi A,et al.Mortality and morbidity due to exposure to outdoor air pollution in mashhad metropolis,iran.The airq model approach[J].Environ Res,2016,151:451-457.
[3] DeVries R,Kriebel D,Sama S.Outdoor air pollution and copd-related emergency department visits,hospital admissions,and mortality:A meta-analysis[J].Copd,2016,14(1):113-121.
[4] Pinault LL,Weichenthal S,Crouse DL,et al.Associations between fine particulate matter and mortality in the 2001 canadian census health and environment cohort[J].Environ Res,2017,159:406-415.
[5] Weichenthal S,Bai L,Hatzopoulou M,et al.Long-term exposure to ambient ultrafine particles and respiratory disease incidence in in toronto,canada:A cohort study[J].EnvironHealth,2017,16:64.
[6] Liu LJS,Box M,Kalman D,et al.Exposure assessment of particulate matter for susceptible populations in seattle[J].Environ Health Perspect,2003,111(7):909-918.
[7] Lagorio S,Forastiere F,Pistelli R,et al.Air pollution and lung function among susceptible adult subjects:A panel study[J].Environ Health,2006,5:11.
[8] Ni Y,Wu SW,Ji WJ,et al.The exposure metric choices have significant impact on the association between short-term exposure to outdoor particulate matter and changes in lung function:Findings from a panel study in chronic obstructive pulmonary disease patients[J].Sci Total Environ,2016,542:264-270.
[9] Cortez-Lugo M,Ramírez-Aguilar M,Pérez-Padilla R,et al.Effect of personal exposure to PM2.5 on respiratory health in a mexican panel of patients with copd[J].Int J Environ Res Public Health,2015,12(9):10635-10647.
[10] Lamprecht B,Soriano JB,Studnicka M,et al.Determinants of underdiagnosis of copd in national and international surveys[J].Chest,2015,148(4):971-985.
[11] 张锋英,杭晶卿,李晓峰,等.未诊断呼吸系疾病人群中慢性阻塞性肺疾病患病率调查[J].临床肺科杂志,2007,12(11):1174-1175.(In English:Zhang FY,Hang JQ,Li XF,et al.Prevalence of chronic obstructive pulmonary disease in the population not previously diagnosed with respiratory disease[J].J Clin Pulmonary Med,2007,12(11):1174-1175.)
[12] 姚婉贞,朱红,沈宁,等.无症状慢性阻塞性肺疾病患者特点分析[J].中华结核和呼吸杂志,2005,28(8):513-515.(In English:Yao WZ,Zhu H,Shen N,et al.Characteristics of non-symptomatic chronic obstructive pulmonary disease patients[J].Chin J Tubercul Respirat Dis,2005,28(8):513-515.)
[13] 陆育钿,陈文翰,张乃锦,等.无症状慢性阻塞性肺疾病患者早期干预的临床研究[J].临床医学工程,2018,25(9):1191-1192.(In English:Li YD,Chen WH,Zhang NJ,et al.Clinical study on early intervention in patients with asymptomatic chronic obstructive pulmonary disease[J].Clin Med Eng,2018,25(9):1191-1192.)
[14] 陈思.无症状慢性阻塞性肺疾病患者特点分析[J].临床医学,2013,33(2):23-25.(In English:Chen S.Characteristics of non-symptomatic chronic obstructive pulmonary disease[J].Clin Med,2013,33(2):23-25.)
[15] 何权瀛,高莹慧.关于吸烟问题若干名词定义[J].中华结核和呼吸杂志,2009,32(1):56.
[16] Wang CC,Cai J,Chen RJ,et al.Personal exposure to fine particulate matter,lung function and serum club cell secretory protein (clara)[J].Environ Pollut,2017,225:450-455.
[17] Naeher LP,Holford TR,Beckett WS,et al.Healthy women's pef variations with ambient summer concentrations of PM10,PM2.5,SO,H+,and O3[J].Am J Respirat Crit Care Med,1999,160(1):117-125.
[18] Baccarelli AA,Zheng YN,Zhang X,et al.Air pollution exposure and lung function in highly exposed subjects in Beijing,China:A repeated-measure study[J].Particle Fibre Toxicol,2014,11:51.
[19] 李娇元,马露,刘历志,等.武汉市秋冬季空气颗粒物暴露对大学生肺功能的短期影响[J].中华预防医学杂志,2013,47(2):155-159.(In English:Li JY,Ma L,Liu LZ,et al.The short-term effects of particulate matter on lung function of college students in autumn and winter in wuhan[J].Chin J Prev Med,2013,47(2):155-159.)
[20] Rice MB,Ljungman PL,Wilker EH,et al.Long-term exposure to traffic emissions and fine particulate matter and lung function decline in the framingham heart study[J].Am J Respirat Crit Care Med,2015,191(6):656-664.
[21] Rice MB,Ljungman PL,Wilker EH,et al.Short-term exposure to air pollution and lung function in the framingham heart study[J].Am J Respirat Crit Care Med,2013,188(11):1351-1357.
[22] 韩建彪.太原市PM2.5对哮喘患者肺功能和生物指标影响的panel研究[D].太原:山西医科大学,2014.(In English:Han JB.A panel study of effects of PM2.5 in Taiyuan on asthma patients pulmonary function and biomarker[D].Taiyuan:Shanxi Medical University,2014.)
[23] 史传见.PM2.5对慢性阻塞性肺疾病患者血清TNF-α、IL-6、IL-8和生活质量影响的panel研究[D].新乡:新乡医学院,2017.(In English:Shi CJ.The effect of PM2.5 on serum levels of TNF-α,IL-6,IL-8 and quality of life in patdents mith chrongc obstructive pulmonary disease by panel study[D].Xinxiang:Xinxiang Medical University,2017.)
[24] Soppa VJ,Schins RP,Hennig F,et al.Respiratory effects of fine and ultrafine particles from indoor sources--a randomized sham-controlled exposure study of healthy volunteers[J].Int J EnvironRes Public Health,2014,11(7):6871-6889.
[25] Hwang BF,Chen YH,Lin YT,et al.Relationship between exposure to fine particulates and ozone and reduced lung function in children[J].Environ Res,2015,137:382-390.
[26] Hogg JC,Macklem PT,Thurlbeck WM.Site and nature of airway obstruction in chronic obstructive lung disease[J].N Engl J Med,1968,278(25):1355-1360.
[27] Singh D.Small airway disease in patients with chronic obstructive pulmonary disease[J].Tubercul Respirat Dis,2017,80(4):317-324.
[28] Churg A,Brauer M.Human lung parenchyma retains PM2.5[J].Am J Respirat Crit Care Med,1997,155(6):2109-2111.
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