不同粒径和大气颗粒物对成年人心律失常的影响  

Impacts of ambient particles of differential sizes and sourceson arrhythmias in adults

作　　者：徐洪兵[1] 刘凌燕 王洋 何兴侯 易铁慈[3] 朱雨桐 刘胜聪 陈婕[1] 关新朋 王童[1] 张怡[1] 吴荣山 赵茜[1] 宋晓明[1] 李建平[3] 黄薇[1] XU Hong-bing;LIU Ling-yan;WANG Yang;HE Xing-hou;YI Tie-ci;ZHU Yu-tong;LIU Sheng-cong;CHEN Jie;GUAN Xin-peng;WANG Tong;ZHANG Yi;WU Rong-shan;ZHAO Qian;SONG Xiao-ming;LI Jian-ping;HUANG Wei(Department of Occupational and Environmental Health,Peking University School of Public Health,Beijing 100191,China;Department of Prevention and Health Care,Hospital of Health Science Center,Peking University,Beijing 100191,China;Division of Cardiology,Peking University First Hospital,Beijing 100034,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]北京大学医学部校医院预防保健科,北京100191 [3]北京大学第一医院心内科,北京100034

出　　处：《中华疾病控制杂志》2023年第1期41-46,共6页Chinese Journal of Disease Control & Prevention

基　　金：中国博士后科学基金(2021M690249);北京大学医学部-密歇根大学转化医学联合研究所项目基金(BMU20140467)。

摘　　要：目的 评估不同粒径和大气颗粒物对成年人心律失常的影响。方法 对73名健康成年人于2014年11月―2016年1月进行4次临床调查,采用24 h动态心电图监测仪记录心律失常逐时发生次数;测定血清中炎性标志物可溶性白介素-1受体拮抗剂(soluble IL-1 receptor antagonist, sIL-1RA)和巨噬细胞炎性蛋白-1β(macrophage inflammatory protein-1β, MIP-1β)水平;监测同期细颗粒物(fine particles matter, PM_(2.5))、空气动力学直径5.6~560.0 nm不同粒径段颗粒物浓度,以及开展不同粒径尺度颗粒物的源解析。利用广义估计方程模型分析大气颗粒物对心律失常的影响。结果 累积暴露1 d的超细颗粒物与室性期前收缩(premature ventricular contraction, PVC)、成对室性早搏(ventricular couplets, VC)、室上性期前收缩(supraventricular premature beat, SVPB)、室性心动过速(ventricular tachycardia, VT)的发生存在统计学意义(均有P<0.05);超细颗粒物每升高IQR浓度的RR值分别为1.89(95%CI:1.27~2.51)、2.23(95%CI:1.45~3.00)、1.44(95%CI:1.12~1.77)和2.63(95%CI:1.42~3.83)。汽油车排放、老化机动车来源的颗粒物与心律失常发生也呈正相关。分层分析显示,颗粒物致心律失常效应在可溶性白介素-1受体拮抗剂和巨噬细胞炎性蛋白-1β水平高的研究对象中更强。结论 大气颗粒物特别是其中的交通相关来源的颗粒物可增加成年人发生心律失常的风险,且在全身炎症水平较高者中效应更明显。Objective To assess the impacts of ambient particles of differential sizes and sources on arrhythmias in adults. Methods A total of 73 healthy adults underwent 4 repeated clinical visits between November 2014 and January 2016. At each visit, 24h-ambulatory electrocardiograms were performed to record hourly arrhythmia episodes;And serum inflammatory biomarkers, including soluble IL-1 receptor antagonist and macrophage inflammatory protein-1β were also measured. Concentrations of ambient fine particles and particles in size fractions of 5.6-560.0 nm were monitored throughout the study period. Generalized estimating equation models were conducted to evaluate the impacts of ambient particles on arrhythmias. Results Episodes of premature ventricular contraction, ventricular couplets, supraventricular premature beat, and ventricular tachycardia were positively associated with interquartile range increases in ultrafine particles at prior 1-day moving average of exposure(P<0.05), with relative risks of 1.89(95% CI: 1.27-2.51), 2.23(95% CI: 1.45-3.00), 1.44(95% CI: 1.12-1.77), and 2.63(95% CI:1.42-3.83), respectively. Particles originated from secondary aerosols and aged vehicle emissions were also associated with arrhythmia episodes. Stratified analyses showed stronger associations in participants with higher levels of soluble IL-1 receptor antagonist and macrophage inflammatory protein-1β. Conclusions Ambient particles, especially particles from traffic emission were capable of increasing risks of arrhythmia episodes in adults, and participants with higher levels of systemic inflammation were prone to the proarrhythmic effects of particles.

关 键 词：大气颗粒物 超细颗粒物 心律失常 源解析 

分 类 号：R122.2[医药卫生—环境卫生学] R181[医药卫生—公共卫生与预防医学]