大连市空气污染与急性脑梗死患者发病的相关性
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摘要
[目的]探讨大连市急性脑梗死患者发病与空气污染的相关性。[方法]回顾收集大连市3家三级甲等医院2015年1月1日—12月31日收治的3 578例急性脑梗死患者的住院病历资料,同时收集大连市同期空气污染资料。采用Spearman相关分析评估发病当日PM_(2.5)、PM_(10)、NO_2、SO_2、CO、O_3浓度与急性脑梗死患者发病的相关性。采用1∶1配对的病例交叉研究设计,分析发病前0～3日PM_(2.5)浓度与急性脑梗死患者发病的相关性。[结果]急性脑梗死患者的发病数与PM_(2.5)、PM_(10)、NO_2、SO_2、CO、O_3均呈正相关,相关系数分别为0.209、0.122、0.237、0.381、0.272、0.377(均P<0.05)。大动脉粥样硬化型、心源性栓塞型、小动脉闭塞型脑梗死患者发病数均与各空气污染指标呈正相关(均P<0.05)。PM_(2.5)、PM_(10)、NO_2、SO_2与小动脉闭塞型相关性最高,相关系数分别为0.284、0.235、0.280、0.685(均P<0.05);CO与心源性栓塞型相关性最高,相关系数为0.210(P<0.05);O_3与大动脉粥样硬化型的相关系数最高,相关系数为0.684(P<0.05)。滞后效应分析中PM_(2.5)每升高10μg/m~3时,滞后0日(当天)急性脑梗死患者发病的OR(95%CI)最高,为1.098(1.034～1.166)(P<0.05)。[结论]大连市急性脑梗死患者的发病与空气污染物的浓度呈正相关,其中PM_(2.5)对急性脑梗死患者的发病无明显滞后效应。
[Objective]To evaluate the association between acute ischemic stroke(AIS)occurrence of patients and air pollution in Dalian.[Methods]Our study collected hospital records of 3 578 AIS patients from three tertiary Grade A hospitals in Dalian from January 1 to December 31,2015 and obtained air pollution data of the same period.Spearman correlation analysis was used to evaluate the associations of PM_(2.5),PM_(10),NO_2,SO_2,CO,and O_3 concentration on the same day with the AIS recorded.The 1∶1 matched case-crossover study design was applied to determine the risk of AIS in relation to the PM_(2.5) concentraions of previous three days.[Results]The incidence of AIS was positively associated with PM_(2.5),PM_(10),NO_2,SO_2,CO,and O_3,and the coefficients of correlation(r)were 0.209,0.122,0.237,0.381,0.272,and 0.377,respectively(Ps<0.05).Strokes due to large artery atherosclerosis,cardiac embolism,and small artery occlusion were positively associated with all the studied air pollutants(P<0.05).To be specific,strokes due to small artery occlusion had higher correlation coefficients with PM_(2.5)(r=0.284),PM_(10)(r=0.235),NO_2(r=0.280),and SO_2(r=0.685)(Ps<0.05);strokes due to cardiac embolism had a higher correlation coefficient with CO(r=0.210)(P<0.05);strokes due to large artery atherosclerosis had a higher correlation coefficient with O_3(r=0.684)(P<0.05).Each 10μg/m~3 increase in PM_(2.5)was most associated with AIS at lag 0 day(current day)(OR=1.098,95%CI:1.034-1.166)(P<0.05).[Conclusion]The concentrations of air pollutants are positively associated with reported AIS occurrence of patients in Dalian,and PM_(2.5) has no significant lag effect on the AIS occurrence.
[Objective]To evaluate the association between acute ischemic stroke(AIS)occurrence of patients and air pollution in Dalian.[Methods]Our study collected hospital records of 3 578 AIS patients from three tertiary Grade A hospitals in Dalian from January 1 to December 31,2015 and obtained air pollution data of the same period.Spearman correlation analysis was used to evaluate the associations of PM_(2.5),PM_(10),NO_2,SO_2,CO,and O_3 concentration on the same day with the AIS recorded.The 1∶1 matched case-crossover study design was applied to determine the risk of AIS in relation to the PM_(2.5) concentraions of previous three days.[Results]The incidence of AIS was positively associated with PM_(2.5),PM_(10),NO_2,SO_2,CO,and O_3,and the coefficients of correlation(r)were 0.209,0.122,0.237,0.381,0.272,and 0.377,respectively(Ps<0.05).Strokes due to large artery atherosclerosis,cardiac embolism,and small artery occlusion were positively associated with all the studied air pollutants(P<0.05).To be specific,strokes due to small artery occlusion had higher correlation coefficients with PM_(2.5)(r=0.284),PM_(10)(r=0.235),NO_2(r=0.280),and SO_2(r=0.685)(Ps<0.05);strokes due to cardiac embolism had a higher correlation coefficient with CO(r=0.210)(P<0.05);strokes due to large artery atherosclerosis had a higher correlation coefficient with O_3(r=0.684)(P<0.05).Each 10μg/m~3 increase in PM_(2.5)was most associated with AIS at lag 0 day(current day)(OR=1.098,95%CI:1.034-1.166)(P<0.05).[Conclusion]The concentrations of air pollutants are positively associated with reported AIS occurrence of patients in Dalian,and PM_(2.5) has no significant lag effect on the AIS occurrence.
引文
[1]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑血管病一级预防指南2015[J].中华神经科杂志,2015,48(8):629-643.
[2]LIU L,YANG X,LIU H,et al. Spatial-temporal analysis of air pollution,climate change and total mortality in 120 Cities of China,2012-2013[J]. Front Public Health,2016,4:143.
[3]SCHEERS H,JACOBS L,CASAS L,et al. Long-term exposure to particulate matter air pollution is a risk factor for stroke[J]. Stroke,2015,46(11):3058-3066.
[4]FEIGIN V L,ROTH G A,NAGHAVI M,et al. Global burden of stroke and risk factors in 188 countries,during 1990-2013:a systematic analysis for the Global Burden of Disease Study2013[J]. Lancet Neurol,2016,15(9):913-924.
[5]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146-153.
[6]ADAMS H P J R,BENDIXEN B H,KAPPELLE L J,et al.Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org10172 in Acute Stroke Treatment[J]. Stroke,1993,24(1):35-41.
[7]阎守政,纪德钰,李丹,等.大连市区空气中颗粒物(PM10和PM2.5)污染原因分析[J].中国环境管理干部学院学报,2015,25(4):53-55,81.
[8]韩立达,王晓雯,纪德钰,等.浅析大连市空气质量污染日特征及成因[J].中国环境管理干部学院学报,2014,24(5):53-55.
[9]O’DONNELL M J,FANG J,MITTLEMAN M A,et al. Fine particulate air pollution(PM2.5)and the risk of acute ischemic stroke[J]. Epidemiology,2011,22(3):422-431.
[10]MACLURE M. The case-crossover design:a method for studying transient effects on the risk of acute events[J]. Am J Epidemiol,1991,133(2):144-153.
[11]TURIN T C,KITA Y,MURAKAMI Y,et al. Increase of stroke incidence after weekend regardless of traditional risk factors:Takashima Stroke Registry,Japan;1988-2003[J].Cerebrovasc Dis,2007,24(4):328-337.
[12]OUDIN A,STR?MBERG U,JAKOBSSON K,et al. Estimation of short-term effects of air pollution on stroke hospital admissions in southern Sweden[J]. Neuroepidemiology,2010,34(3):131-142.
[13]FOLYOVICH A,BICZO D,FULOP A,et al. Effect of shortterm changes of air pollution on the development of acute ischemic stroke[J]. J Neurol Sci,2013,333(S1):e196.
[14]SHAH A S,LEE K K,MCALLISTER D A,et al. Short term exposure to air pollution and stroke:systematic review and meta-analysis[J]. BMJ,2015,350:h1259.
[15]NEWBY D E,MANNUCCI P M,TELL G S,et al. Expert position paper on air pollution and cardiovascular disease[J].Eur Heart J,2015,36(2):83-93.
[16]BROOK R D,RAJAGOPALAN S,POPE C A III,et al.Particulate matter air pollution and cardiovascular disease:an update to the scientific statement from the American Heart Association[J]. Circulation,2010,121(21):2331-2378.
[17]EMMERECHTS J,HOYLAERTS M F. The effect of air pollution on haemostasis[J]. Hamostaseologie,2012,32:5-13.
[18]JACOBS L,EMMERECHTS J,HOYLAERTS M F,et al.Traffic air pollution and oxidized LDL[J]. PLoS One,2011,6(1):e16200.
[19]SUN Q,WANG A,JIN X,et al. Long-term air pollution exposure and acceleration of atherosclerosis and vascular inflammation in an animal model[J]. JAMA,2005,294(23):3003-3010.
[20]CHUNG J W,BANG O Y,AHN K,et al. Air pollution is associated with ischemic stroke via cardiogenic embolism[J].Stroke,2017,48(1):17-23.
[21]HUANG F,LUO Y,GUO Y,et al. Particulate matter and hospital admissions for stroke in Beijing,China:Modification effects by ambient temperature[J]. J Am Heart Assoc,2016,5(7):e003437.
[22]LISABETH L D,ESCOBAR J D,DVONCH J T,et al.Ambient air pollution and risk for ischemic stroke and transient ischemic attack[J]. Ann Neurol,2008,64(1):53-59.
[23]MATSUO R,MICHIKAWA T,UEDA K,et al. Short-term exposure to fine particulate matter and risk of ischemic stroke[J]. Stroke,2016,47(12):3032-3034.
[2]LIU L,YANG X,LIU H,et al. Spatial-temporal analysis of air pollution,climate change and total mortality in 120 Cities of China,2012-2013[J]. Front Public Health,2016,4:143.
[3]SCHEERS H,JACOBS L,CASAS L,et al. Long-term exposure to particulate matter air pollution is a risk factor for stroke[J]. Stroke,2015,46(11):3058-3066.
[4]FEIGIN V L,ROTH G A,NAGHAVI M,et al. Global burden of stroke and risk factors in 188 countries,during 1990-2013:a systematic analysis for the Global Burden of Disease Study2013[J]. Lancet Neurol,2016,15(9):913-924.
[5]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146-153.
[6]ADAMS H P J R,BENDIXEN B H,KAPPELLE L J,et al.Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org10172 in Acute Stroke Treatment[J]. Stroke,1993,24(1):35-41.
[7]阎守政,纪德钰,李丹,等.大连市区空气中颗粒物(PM10和PM2.5)污染原因分析[J].中国环境管理干部学院学报,2015,25(4):53-55,81.
[8]韩立达,王晓雯,纪德钰,等.浅析大连市空气质量污染日特征及成因[J].中国环境管理干部学院学报,2014,24(5):53-55.
[9]O’DONNELL M J,FANG J,MITTLEMAN M A,et al. Fine particulate air pollution(PM2.5)and the risk of acute ischemic stroke[J]. Epidemiology,2011,22(3):422-431.
[10]MACLURE M. The case-crossover design:a method for studying transient effects on the risk of acute events[J]. Am J Epidemiol,1991,133(2):144-153.
[11]TURIN T C,KITA Y,MURAKAMI Y,et al. Increase of stroke incidence after weekend regardless of traditional risk factors:Takashima Stroke Registry,Japan;1988-2003[J].Cerebrovasc Dis,2007,24(4):328-337.
[12]OUDIN A,STR?MBERG U,JAKOBSSON K,et al. Estimation of short-term effects of air pollution on stroke hospital admissions in southern Sweden[J]. Neuroepidemiology,2010,34(3):131-142.
[13]FOLYOVICH A,BICZO D,FULOP A,et al. Effect of shortterm changes of air pollution on the development of acute ischemic stroke[J]. J Neurol Sci,2013,333(S1):e196.
[14]SHAH A S,LEE K K,MCALLISTER D A,et al. Short term exposure to air pollution and stroke:systematic review and meta-analysis[J]. BMJ,2015,350:h1259.
[15]NEWBY D E,MANNUCCI P M,TELL G S,et al. Expert position paper on air pollution and cardiovascular disease[J].Eur Heart J,2015,36(2):83-93.
[16]BROOK R D,RAJAGOPALAN S,POPE C A III,et al.Particulate matter air pollution and cardiovascular disease:an update to the scientific statement from the American Heart Association[J]. Circulation,2010,121(21):2331-2378.
[17]EMMERECHTS J,HOYLAERTS M F. The effect of air pollution on haemostasis[J]. Hamostaseologie,2012,32:5-13.
[18]JACOBS L,EMMERECHTS J,HOYLAERTS M F,et al.Traffic air pollution and oxidized LDL[J]. PLoS One,2011,6(1):e16200.
[19]SUN Q,WANG A,JIN X,et al. Long-term air pollution exposure and acceleration of atherosclerosis and vascular inflammation in an animal model[J]. JAMA,2005,294(23):3003-3010.
[20]CHUNG J W,BANG O Y,AHN K,et al. Air pollution is associated with ischemic stroke via cardiogenic embolism[J].Stroke,2017,48(1):17-23.
[21]HUANG F,LUO Y,GUO Y,et al. Particulate matter and hospital admissions for stroke in Beijing,China:Modification effects by ambient temperature[J]. J Am Heart Assoc,2016,5(7):e003437.
[22]LISABETH L D,ESCOBAR J D,DVONCH J T,et al.Ambient air pollution and risk for ischemic stroke and transient ischemic attack[J]. Ann Neurol,2008,64(1):53-59.
[23]MATSUO R,MICHIKAWA T,UEDA K,et al. Short-term exposure to fine particulate matter and risk of ischemic stroke[J]. Stroke,2016,47(12):3032-3034.