2020—2022年扬州市二氧化氮对居民冠心病发病的急性效应研究-东南大学学报医学版

2020—2022年扬州市二氧化氮对居民冠心病发病的急性效应研究

作者：时巧梅¹ 解晔¹ 李秋梅¹ 李小琴¹ 赵培¹ 蒋萌¹ 王猛猛¹ 胡乃元¹ 王琦玮¹ 王元霞² 杨辰² 朱立文²

单位：1. 扬州市疾病预防控制中心, 江苏扬州 225100;
2. 扬州宝应县疾病预防控制中心, 江苏扬州 225800

分类号：R122.26;R543.3

出版年·卷·期（页码）：2025·44·第三期（395-403）

摘要：

目的: 分析扬州市二氧化氮(NO₂)暴露对居民冠心病发病的急性效应,为冠心病综合防控政策的制定提供理论依据。方法: 收集2020年1月1日至2022年12月31日扬州市居民冠心病发病数据以及同期扬州市大气污染物[NO₂、细颗粒物(PM_2.5)、可吸入颗粒物(PM₁₀)、二氧化硫(SO₂)、一氧化碳(CO)、O₃日最大8 h平均值(O₃-8 h)]浓度和气象数据(日均气温、相对湿度),采用时间序列分析方法研究NO₂对冠心病发病的影响。结果: 研究期间NO₂日均浓度为(27.91±14.04)μg·m^-3。单污染物模型中,NO₂浓度(lag0 d)每升高1个IQR,冠心病急性发病人数增加4.73%(1.03%,8.57 %);双污染物及三污染物模型显示,在控制其他污染物的混杂影响后,NO₂与冠心病急性发病之间仍正相关联。分层分析显示,NO₂浓度(lag0 d)每升高1个IQR,心绞痛发病风险增加4.16%(0.25%,8.23%);女性发病风险增加5.77%(0.18%,11.66%);≥65岁居民发病风险增加5.50%(1.32%,9.85%);城市居民发病风险增加6.35%(1.36%,11.58%);未婚/离异/丧偶/独居居民发病风险增加11.42%(2.77%,20.81%);对不同季节冠心病发病风险影响无统计学意义。结论: NO₂暴露可能会增加冠心病急性发病的概率,尤其是心绞痛。女性、≥65岁、城市、未婚/离异/丧偶/独居群体对NO₂浓度上升更易感。

Objective: To analyze the acute effect of nitrogen dioxide(NO₂) exposure on the incidence of coronary heart disease in residents of Yangzhou city, and to provide theoretical basis for the formulation of comprehensive prevention and control policies of coronary heart disease. Methods: Data on the incidence of coronary heart disease in Yangzhou residents were collected from January 1, 2020 to December 31, 2022, and the atmospheric pollutants in Yangzhou during the same period[NO₂, fine particulate matter(PM_2.5), inhalable particulate matter(PM₁₀), sulfur dioxide(SO₂), carbon monoxide(CO) and the daily maximum 8-hour average values of O₃(O₃-8) h)] concentration and meteorological data(average daily temperature, relative humidity), the effect of NO₂ on the incidence of coronary heart disease was studied by using time series analysis method. Results: The average dail concentration of NO₂ during the study period was (27.91±14.04) μg·m^-3. In the single-pollutant model, the number of acute cases of coronary heart disease increased by 4.73%(1.03%, 8.57%) for each IQR increase of NO₂concentration(lag0 d). Two-and three-pollutant models showed that NO₂ was still positively associated with acute coronary heart disease after controlling for the confounding effects of other pollutants. Stratification analysis showed that the risk of angina pectoris increased by 4.16%(0.25%, 8.23%) for each IQR increase of NO₂ concentration(lag0 d). The risk increased by 5.77%(0.18%, 11.66%) in women; The risk was increased by 5.50%(1.32%, 9.85%) in residents aged≥65 years. The risk of urban residents was increased by 6.35%(1.36%, 11.58%). The incidence of unmarried/divorced/widowed/living alone residents increased by 11.42%(2.77%, 20.81%); There was no significant effect on the risk of coronary heart disease in different seasons. Conclusion: NO₂ exposure may increase the probability of acute coronary heart disease, especially angina pectoris. Female, ≥65 years old, urban, unmarried/divorced/widowed/living alone groups are more susceptible to increased NO₂ concentration.

参考文献：

[1] ROTH G A, MENSAH G A, JOHNSON C O, et al.Global burden of cardiovascular diseases and risk factors, 1990-2019:update from the GBD 2019 study[J].J Am Coll Cardiol, 2020, 76(25):2982-3021.
[2] 国家心血管病中心, 中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2023概要[J].中国循环杂志, 2024, 39(7):625-660.
[3] 潘扬, 丁建东.平均血小板体积与冠心病相关性的研究进展[J].东南大学学报(医学版), 2018, 37(3):549-552.
[4] WOLF K, HOFFMANN B, ANDERSEN Z J, et al.Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease:a pooled analysis of six European cohorts within the ELAPSE project[J].Lancet Planet Health, 2021, 5(9):e620-e632.
[5] 时巧梅, 夏俊鹏, 解晔, 等.扬州市大气NO₂与脑卒中急性发病的时间序列研究[J].环境卫生学杂志, 2024, 14(12):969-974, 994.
[6] 孙威, 廖子锐, 关天嘉, 等.我国大气二氧化氮污染防治政策研究[J].中国公共卫生管理, 2024, 40(4):524-527.
[7] 于泓.基于meta分析和数据挖掘的中成药治疗原发性高血压的临床评价研究[D].北京:中国中医科学院, 2019.
[8] FENG Y T, LANG C F, CHEN C, et al.Association between air pollution exposure and coronary heart disease hospitalization in a humid sub-tropical region of China:a time-series study[J].Front Public Health, 2023, 10:1090443.
[9] FU Z, MA Y, YANG C, et al.Association of air pollution exposure and increased coronary artery disease risk:the modifying effect of genetic susceptibility[J].Environ Health, 2023, 22(1):85.
[10] KLOMPMAKER J O, HART J E, JAMES P, et al.Air pollution and cardiovascular disease hospitalization-Are associations modified by greenness, temperature and humidity?[J].Environ Int, 2021, 156:106715.
[11] 蒋欣芸, 张斌, 任东, 等.兰州市西固区大气污染和气象因素对冠心病糖尿病及脑梗死就诊人数的影响[J].环境与健康杂志, 2024, 41(8):715-721.
[12] 刘婷婷.赣州市大气污染物和气象因素对冠心病日住院的影响[D].赣州:赣南医学院, 2023.
[13] 李妹, 张经纬, 杜娟.2019年天津市河北区气态污染物对冠心病住院人次影响的时间序列分析[J].职业与健康, 2023, 39(2):243-246.
[14] 尹春苗, 张莹, 杨涵.2014—2016年成都市多种污染物对心脑血管疾病死亡人数的影响研究[J].成都信息工程大学学报, 2024, 39(5):618-625.
[15] 谢昀霏, 宋晓明, 方嘉堃, 等.广州市氧化性污染物与气温对居民心脑血管疾病死亡风险的交互作用[J].环境与职业医学, 2021, 38(11):1199-1206.
[16] 张钊源, 何胜虎, 刘佳, 等.扬州地区冠心病经皮冠状动脉介入治疗患者CYP2C19基因多态性分析[J]实用临床医药杂志, 2023, 27(23):17-21.
[17] 贾仓仓.推动老年长期照护服务体系高质量发展的对策[J].健康教育与健康促进, 2024, 19(3):318-321.
[18] 张钊铭, 刘玟彤, 周丽婷, 等.长春市大气污染与冠心病住院人次的关联性[J].中国老年学杂志, 2020, 40(7):1345-1349.
[19] 王兆成.社交媒体背景下的精酿啤酒与扬州美食整合营销探析[J].酿酒, 2022, 49(4):42-45.
[20] 宁日.长三角城市群新型城镇化与城市生态韧性耦合协调机制研究[D].合肥:安徽建筑大学, 2024.
[21] 朱晓娟.基于机器学习的健康风险评估与预测[D].成都:电子科技大学, 2020.
[22] 李欢, 岳宣志, 杨升美, 等.2018—2021年呼和浩特市大气污染物对儿科呼吸系统疾病门诊量的影响[J].环境卫生学杂志, 2023, 13(12):901-908, 927.
[23] 秦叙, 温馥源, 李冰潇, 等.北京市密云区大气污染物短期暴露与呼吸系统疾病住院人数的关联性研究[J].环境卫生学杂志, 2023, 13(5):371-377.
[24] KHAN M A, HASHIM M J, MUSTAFA H, et al.Global epidemiology of ischemic heart disease:results from the global burden of disease study[J].Cureus, 2020, 12(7):e9349.
[25] FIORITO G, VLAANDEREN J, POLIDORO S, et al.Oxidative stress and inflammation mediate the effect of air pollution on cardio-and cerebrovascular disease:a prospective study in nonsmokers[J].Environ Mol Mutagen, 2018, 59(3):234-246.
[26] 黄慧敏, 何慧慧, 林珊珊, 等.2013—2019年郑州市大气污染物对循环系统疾病就诊量影响的时间序列研究[J].环境与健康杂志, 2024, 41(4):283-290.
[27] 王雪.内蒙古通辽地区气象因素与大气污染物对心脑血管相关疾病联合作用特征分析及其预测模型的构建[D].沈阳:中国医科大学, 2021.
[28] 刘城城, 李玉, 梁艳, 等.室外空气污染影响心血管疾病的机制研究进展[J].中国实验方剂学杂志, 2024, 30(23):318-326.
[29] CHEN Z, WANG B, HU Y, et al.Short-term effects of low-level ambient air NO₂ on the risk of incident stroke in Enshi City, China[J].Int J Environ Res Public Health, 2022, 19(11):6683.
[30] 王玉雯, 张经纬, 冯利红, 等.天津市大气中二氧化氮短期暴露对心血管疾病急救人次的影响[J].环境卫生学杂志, 2024, 14(8):641-646.
[31] 颜建强, 张霖, 高原, 等.城市交通拥堵预测研究:以西安市为例[J].计算机工程与应用, 2025, 61(1):330-340.
[32] 张宇格, 韩红亚, 马涵英, 等.冠心病合并焦虑的影响因素及干预疗法的研究进展[J].中国医药, 2023, 18(6):922-926.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录