我国中老年人大气PM_(2.5)长期暴露与肝脏疾病发病关系的前瞻性队列研究  

Association between long-term PM_(2.5) and liver diseases incidence among middle-aged and elderly Chinese:a prospective cohort study

作　　者：陈雨萌 曹淦翔 冯浩[3] 容祖华 刘涛 CHEN Yu-meng;CAO Gan-xiang;Feng Hao;RONG Zu-hua;LIU Tao(School of Public Health,Guangdong Pharmaceutical University,Guangzhou 510310,China;Guangdong Provincial Institute of Public Health,Guangdong Provincial Center for Disease Control and Prevention;Department of Public Health and Preventive Medicine,School of Medicine,Jinan University)

机构地区：[1]广东药科大学公共卫生学院,广州510310 [2]广东省疾病预防控制中心广东省公共卫生研究院 [3]暨南大学基础医学与公共卫生学院公共卫生与预防医学系

出　　处：《环境卫生学杂志》2023年第3期162-169,共8页JOURNAL OF ENVIRONMENTAL HYGIENE

基　　金：国家自然科学基金(42175181;81874276);广东省自然科学基金(2019A1515011264)。

摘　　要：目的在全国多省市中老年人群中探索大气细颗粒物(PM_(2.5))长期暴露与肝脏疾病发病风险的关系。方法本研究数据来自北京大学国家发展研究院主持的中国健康与养老追踪调查(CHARLS),采用前瞻性队列研究设计,于2011年开展基线调查,并于2013、2015和2018年进行了追踪随访,主要健康结局为慢性肝脏疾病(除脂肪肝、肿瘤或癌症外)发病。根据圣路易斯华盛顿大学大气成分分析组建立的全球大气年均PM_(2.5)数据集数据评估研究对象PM_(2.5)长期暴露水平,采用Cox比例风险回归模型控制混杂因素后分析大气PM_(2.5)长期暴露与肝脏疾病发病率的暴露反应关系,并分析吸烟、饮酒等因素的修饰效应。结果共纳入12301人,平均随访6.34年,共随访78063人年,肝脏疾病发病409人,发病率为3.3%。经Cox回归分析显示,大气PM_(2.5)暴露浓度每增加10μg/m^(3),肝脏疾病的发病风险HR为1.33(95%CI:1.24~1.43),对应的人群归因分数(PAF)为12.72%(95%CI:9.58~15.76)。若把PM_(2.5)浓度根据四分位数进行分组,以最低组(Q1)为参考,最高组(Q4)发生肝脏疾病的HR为2.11(95%CI:1.59~2.81)。分层分析发现,人群PM_(2.5)每增加10μg/m^(3),吸烟者和不吸烟者引起肝脏疾病的HR分别为1.40(95%CI:1.22~1.60)和1.29(95%CI:1.18~1.41);饮酒人群和不饮酒人群引起肝脏疾病的HR分别为1.38(95%CI:1.20~1.57)和1.32(95%CI:1.21~1.44)。结论长期暴露于高浓度的大气PM_(2.5)可增加我国中老年人群肝脏疾病的发病风险,并且在吸烟者和饮酒人群中的风险更高。Objective To investigate the association between long-term exposure to ambient fine particulate matter(PM_(2.5))and the risk of liver diseases among middle-aged and elderly people in multiple provinces and cities in China.Methods The data of this study were collected from China Health and Retirement Longitudinal Study(CHARLS)conducted by National School of Development at Peking University.With the design of prospective cohort study,a baseline survey was performed in 2011 and follow-up surveys were performed in 2013,2015,and 2018,with the onset of chronic liver diseases(except fatty liver disease,tumor,and cancer)as the primary health outcome.The level of long-term PM_(2.5)exposure was assessed according to the mean annual global atmospheric PM_(2.5)dataset established by Atmospheric Composition Analysis Group of Washington University in St.Louis.The Cox proportional-hazards regression model was used to investigate the association between long-term PM_(2.5)exposure and the incidence rate of liver disease after adjustment for confounding factors,and the modification effect of smoking,drinking and other factors was also analyzed.Results A total of 12301 patients were included,with a mean follow-up time of 6.34 years and a total of 78063 person-years of follow-up,and 409 patients developed liver diseases,resultsing in an incidence rate of 3.3%.The Cox regression analysis showed that for every 10μg/m^(3) increase in PM_(2.5)exposure,the hazard ratio(HR)for the risk of liver disease was 1.33(95%confidence interval[CI]:1.24-1.43),and the corresponding population attributable fraction was 12.72%(95%CI:9.58-15.76).If the patients were divided into four groups according to the quartile of PM_(2.5)exposure,with the lowest group(Q1)as reference,the highest group(Q4)had an HR of 2.11(95%CI:1.59-2.81)for the risk of liver disease.Stratified analysis showed that for every 10μg/m^(3) increase in PM_(2.5)exposure in the population,the HR for liver disease was 1.40(95%CI:1.22-1.60)in smokers and 1.29(95%CI:1.18-1.41)in non-smoke

关 键 词：肝脏疾病 细颗粒物 发病率 比例风险回归模型 空气污染 

分 类 号：R122.2[医药卫生—环境卫生学]