大气细颗粒物2.5对中老年高血压患者急性心血管效应的影响  

Effect of atmospheric particulate matter 2.5 on acute cardiovascular effect in middle-aged and elderly patients with hypertension

作　　者：张艳格 安珍[1] 姜静 孙贝贝 宋杰 李娟 王贵 王亚 吴卫东[1] ZHANG Yan′ge;AN Zhen;JIANG Jing;SUN Beibei;SONG Jie;LI Juan;WANG Gui;WANG Ya;WU Weidong(School of Public Health,Xinxiang Medical University,Xinxiang 453003,Henan Province,China)

机构地区：[1]新乡医学院公共卫生学院,河南新乡453003

出　　处：《新乡医学院学报》2023年第2期119-124,共6页Journal of Xinxiang Medical University

基　　金：国家自然科学基金面上项目(编号:81573112,81373030,81703182);河南省高等学校青年骨干教师培养计划项目(编号:2019GGJS151)。

摘　　要：目的探讨新乡地区大气细颗粒物2.5(PM_(2.5))暴露对中老年高血压患者心血管效应的影响。方法招募新乡医学院11例患高血压病的退休职工为研究对象,采用定组研究方法,从2018年12月至2019年4月进行5次随访,每次随访时间间隔4周,随访当日测量患者的血压、身高、体质量和静态心电图,记录心率(HR)值;采集患者空腹外周静脉血,采用酶联免疫吸附测定法测定患者血清炎症标志物白细胞介素(IL)-6、IL-8、超敏C-反应蛋白(hs-CRP)及氧化应激标志物8-羟基脱氧鸟苷(8-OHdG)、纤溶功能标志物组织型纤溶酶原激活剂(t-PA)、血浆内皮功能指标内皮素-1(ET-1)水平,并检测血小板-单核细胞聚合体(PMAs)数量,计算PMAs占单核细胞的百分比。收集每次体检前1周内患者居住区的每小时空气污染物PM_(2.5)浓度和气温、相对湿度数据。采用线性混合效应模型评估大气PM_(2.5)浓度与受试者血压、炎症标志物、氧化应激标志物、内皮功能指标及凝血标志物等的关系。结果大气PM_(2.5)浓度每升高10μg·m^(-3),患者的HR升高26.85次·min^(-1)[95%置信区间(CI):1.83~51.88],舒张压升高44.90 mm Hg(95%CI:3.18~86.61),血清IL-8、hs-CRP、8-OHdG水平分别升高26.56%(95%CI:0.76%~52.35%)、84.69%(95%CI:18.32%~151.05%)、68.94%(95%CI:35.77%~102.11%),血浆ET-1水平升高29.01%(95%CI:6.72%~51.30%),PMAs水平升高8.19%(95%CI:2.05%~14.32%),t-PA水平下降408.85%(95%CI:-720.75%~-96.94%),差异有统计学意义(P<0.05)。结论PM_(2.5)暴露可诱发中老年高血压患者出现血压异常、炎症反应、氧化应激、血管内皮损伤和凝血功能障碍等改变。Objective To investigate the effect of atmospheric particulate matter 2.5(PM_(2.5)) exposure on cardiovascular effect in middle-aged and elderly patients with hypertension in Xinxiang area.Methods A total of 11 retired employees suffering from hypertension in Xinxiang Medical University were recruited as the research objects, and a group study method was adopted, the patients were followed up for 5 times from December 2018 to April 2019,with an interval of 4 weeks.On the day of follow-up, the blood pressure, height, body mass and static electrocardiogram, heart rate(HR) of the patients was recorded;the fasting peripheral venous blood of the patients was collected, and the levels of serum inflammatory markers interleukin(IL)-6,IL-8,hypersensitive C-reactive protein(hs-CRP),and oxidative stress marker 8-hydroxy-2′-deoxyguanosine(8-OHdG),fibrinolytic function marker tissue type plasminogen activator(t-PA) and plasma endothelial function indicator endothelin-1(ET-1) were measured by enzyme-linked immunosorbent assay;the amount of platelet-monocyte aggregates(PMAs) was detected and the percentage of PMAs in monocytes was calculated.The hourly air pollutant PM_(2.5)concentration, temperature and relative humidity data in the residential area of the patients within one week before each physical examination were collected.The relationships between atmospheric PM_(2.5)concentration and blood pressure, inflammatory markers, oxidative stress markers, endothelial function indicator and blood coagulation markers were evaluated by Linear mixed effect model.Results For atmospheric PM_(2.5)concentration every increasing of 10 μg·m^(-3),the HR of the subjects increased by 26.85 times·min^(-1)[95% confidence interval(CI):1.83-51.88],diastolic pressure increased by 44.90 mm Hg(95%CI:3.18-86.61),and serum IL-8,hs-CRP,8-OHdG levels increased by 26.56%(95%CI:0.76%-52.35%),84.69%(95%CI:18.32%-151.05%),68.94%(95%CI:35.77%-102.11%),respectively;the plasma ET-1 level increased by 29.01%(95%CI:6.72%-51.30%),the PMAs level increased by

关 键 词：细颗粒物2.5 定组研究 高血压 心血管效应 

分 类 号：R544.1[医药卫生—心血管疾病]