室内不同粒径颗粒物及其金属组分与慢性阻塞性肺疾病患者自主神经功能的关联  

Association between indoor particulate matter with different sizes and their metal components and autonomic nerve function in patients with chronic obstructive pulmonary disease

作　　者：张文楼 李宏宇[1] 潘璐[1] 张雪芹 许珺辉[1] 杨玄[1] 董伟[1] 单娇[1] 吴少伟 陈亚红[4] 郭新彪[1] 邓芙蓉[1] ZHANG Wenlou;LI Hongyu;PAN Lu;ZHANG Xueqin;XU Junhui;YANG Xuan;DONG Wei;SHAN Jiao;WU Shaowei;CHEN Yahong;GUO Xinbiao;DENG Furong(Department of Occupational and Environmental Health Sciences,School of Public Health,Peking University,Beijing 100191,China;Department of Respiratory and Critical Care Medicine,Beijing Fengtai Hospital,Beijing 100071,China;Department of Occupational and Environmental Health Sciences,School of Public Health,Xi'an Jiaotong University,Xi'an,Shaanxi 710061,China;Department of Respiratory and Critical Care Medicine,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学公共卫生学院劳动卫生与环境卫生学系,北京100191 [2]北京市丰台医院呼吸与危重症医学科,北京100071 [3]西安交通大学公共卫生学院劳动卫生与环境卫生学系,陕西西安710061 [4]北京大学第三医院呼吸与危重症医学科,北京100191

出　　处：《环境与职业医学》2021年第3期203-209,共7页Journal of Environmental and Occupational Medicine

基　　金：国家自然科学基金(22076006,91543112,81571130090)。

摘　　要：[背景]室内不同粒径颗粒物均会对慢性阻塞性肺疾病(简称慢阻肺)患者心脏自主神经功能产生不良影响,但其化学组分与慢阻肺患者自主神经功能的关联目前仍不清楚。[目的]探讨室内细颗粒物(PM_(2.5))和粗颗粒物(PM_(2.5-10))及其金属组分与慢阻肺患者心脏自主神经功能的关联。[方法]采用横断面研究设计,选取43名慢阻肺患者为研究对象,于2015年11月—2016年5月,对每名研究对象进行24 h的动态心电图监测,获得心率变异性(HRV)指标,包括NN间期标准差指数(SDNNI)、低频功率(LF)、高频功率(HF)及LF/HF。在健康测量前连续24 h收集室内PM_(2.5)和PM_(2.5-10),采用电感耦合等离子体质谱法测定颗粒物样品中的20种金属组分,并依据主要的地壳元素浓度估算颗粒物的地壳成分浓度。采用多元线性回归模型评估室内PM_(2.5)和PM_(2.5-10)及其金属组分与慢阻肺患者HRV指标之间的关联。[结果]室内PM_(2.5)和PM_(2.5-10)的质量浓度(后称浓度)分别为(69.24±76.63)μg·m^(-3)和(34.19±24.10)μg·m^(-3)。研究未观察到室内PM_(2.5)和PM_(2.5-10)与慢阻肺患者HRV指标改变之间存在关联,但发现室内PM_(2.5-10)的地壳成分浓度每升高9.67μg·m^(-3),患者LF/HF的改变量为-2.20(95%CI:-4.12~-0.28)。对颗粒物金属组分与HRV指标的关联分析发现:在室内PM_(2.5)中,Cd每升高1个四分位数间距(IQR)浓度(1.59ng·m^(-3)),慢阻肺患者LF的改变量为-21.19%(95%CI:-35.65%~-3.49%);在PM_(2.5-10)中,观察到Mg、Ca和Sr每升高1个IQR浓度(分别为0.27、1.36μg·m^(-3)和5.30ng·m^(-3)),慢阻肺患者HF分别升高36.64%(95%CI:3.51%~80.36%)、69.62%(95%CI:20.15%~139.48%)和49.74%(95%CI:3.54%~116.56%);Na、Mg、Ca、V和Sr每升高1个IQR浓度(分别为0.19、0.27、1.36μg·m^(-3),及0.98、5.30ng·m^(-3)),患者LF/HF的改变量分别为-4.93(95%CI:-8.00~-1.86)、-3.50(95%CI:-5.96~-1.04)、-5.20(95%CI:-8.32~-2.08)、-2.12(95%CI:-4.13~-0.10)和-4.29(95%CI:-7.61~-0.97)[Background]Indoor particulate matter(PM)with different sizes may have adverse effects on cardiac autonomic nerve function in patients with chronic obstructive pulmonary disease(COPD),but the association between their chemical components and autonomic nerve function of COPD patients remains unclear.[Objective]This study aims to investigate the association between indoor fine particulate matter(PM_(2.5))and coarse particulate matter(PM_(2.5-10))and their metal components and cardiac autonomic nerve function of COPD patients.[Methods]A cross-sectional design was adopted in this study and 43 COPD patients were recruited.From November 2015 to May 2016,heart rate variability(HRV)indices of each patient,including standard deviation of normal-to-normal intervals index(SDNNI),lowfrequency power(LF),high-frequency power(HF),and LF/HF,were gained by dynamic electrocardiogram monitoring for 24 h.Indoor PM_(2.5)and PM_(2.5-10)samples were collected for 24 h before health measurement,and 20 metal components were measured by inductively coupled plasma mass spectrometry.The concentration of crustal composition of PM was estimated according to the concentration of main crustal elements.Multiple linear regression model was used to explore the association between indoor PM_(2.5)and PM_(2.5-10)and their metal components and HRV indices in COPD patients.[Results]The average concentrations of indoor PM_(2.5)and PM_(2.5-10)were(69.24±76.63)μg·m^(-3)and(34.19±24.10)μg·m^(-3),respectively.No significant association was observed between indoor PM_(2.5)and PM_(2.5-10)concentrations and changes in HRV indices.However,an interquartile range(IQR,9.67μg·m^(-3))increase in crustal composition of indoor PM_(2.5-10)was associated with a-2.20(95%CI:-4.12﹣-0.28)change in LF/HF of COPD patients.For metal components of indoor PM_(2.5),an IQR(1.59 ng·m^(-3))increase in Cd was associated with a-21.19%(95%CI:-35.65%﹣-3.49%)change in LF.For metal components of indoor PM_(2.5-10),an IQR increase of Mg(0.27μg·m^(-3)),Ca(1.36μg·m^(-3)),and

关 键 词：室内颗粒物 金属组分 心率变异性 慢性阻塞性肺疾病 细颗粒物 粗颗粒物 

分 类 号：R12[医药卫生—环境卫生学]