大气细颗粒物和臭氧短期暴露与肺炎患者外周血炎性指标的相关性

Association between short-term exposure to atmospheric fine particulate matter and ozone and inflammatory indicators in peripheral blood of patients with pneumonia

  • 摘要:
    目的 探讨大气细颗粒物(PM2.5)和臭氧(O3)短期暴露与肺炎患者炎症指标的关联,以识别易感人群和易感因素。
    方法 收集2018年 9月—2020年4月在山西省太原市某三甲医院因肺炎就诊入院的患者1 480人,运用广义相加模型(GAMs)分别探讨PM2.5、O3与肺炎患者炎性指标的关联,并通过分层分析探讨PM2.5和O3暴露的易感因素和易感人群。
    结果 大气PM2.5短期暴露与肺炎患者的外周血C‑反应蛋白(CRP)、红细胞沉降率(ESR)、嗜酸性粒细胞(EOS)计数、中性粒细胞(NEU)计数、中性粒细胞与淋巴细胞比值(NLR)的变化存在关联,并且存在不同程度的滞后效应,分别在滞后3 d(lag03)、lag03、滞后0 d(lag0)、lag03、lag03达到最大,即PM2.5每升高10 μg·m-3,分别升高4.13%(95%CI:0.43%~7.84%)、3.10%(95%CI:0.24%~5.97%)、5.27%(95%CI:3.12%~7.42%)、1.85%(95%CI:0.36%~3.34%)、2.53%(95%CI:0.53%~4.74%)。O3浓度变化与肺炎患者的外周血降钙素原(PCT)、ESR的升高存在关联,其效应值均在lag01达到最大,即O3每升高1 μg·m-3分别升高0.38%(95%CI:0.04%~0.73%)、0.47%(95%CI:0.19%~0.76%)。分层分析显示,PM2.5与肺炎患者外周血中的CRP、ESR、NEU、NLR的关联均在男性、老年人群中以及冷季发病的人群中更为显著。O3与肺炎患者PCT、ESR的关联均在老年人群及暖季发病人群中更显著,女性肺炎患者外周血CRP、PCT对O3的变化更为易感。
    结论 大气短期PM2.5及O3短期暴露与肺炎患者的炎症指标的变化呈正相关,且PM2.5对肺炎患者的影响比O3更广泛,短期滞后效应延长。老年肺炎患者对大气污染更敏感,男性肺炎患者对PM2.5更敏感,女性肺炎患者对O3更敏感,冷、暖季可分别加重PM2.5、O3对肺炎患者炎症指标的影响,必须做好防护。

     

    Abstract:
    Objective To explore the association between short-term exposure to atmospheric fine particulate matter (PM2.5) and ozone (O3) and systemic inflammatory indicators in patients with pneumonia, and to identify the susceptible populations.
    Methods From September 2018 to April 2020, data of 1 480 patients admitted for pneumonia was collected from a tertiary hospital in Taiyuan City. Generalized additive models (GAMs) were used to explore the associations between PM2.5 and O3 exposure and inflammatory indicators of patients with pneumonia; and to explore the susceptibility factors and susceptible populations to PM2.5 and O3 exposures through stratified analyses.
    Results The short-term exposure to PM2.5 was associated with changes in peripheral blood C-reation protein (CRP), erythrocyte sedimentation (ESR), easinophil (EOS), neutrophil (NEU) and neutrophil-lymphocyte ratio (NLR) in patients with pneumonia, and there were different degrees of hysteresis effects, with the effect values reaching a maximum at lag03, lag03, lag0, lag03, lag03, respectively, which were 4.13% (95%CI: 0.43%‒7.84%), 3.10% (95%CI: 0.24%‒5.97%), 5.27% (95%CI: 3.12%‒7.42%), 1.85% (95%CI: 0.36%‒3.34%), and 2.53% (95%CI: 0.53%‒4.74%) for every 10 μg·m-3 of PM2.5. The changes in O3 concentration were associated with the elevation of peripheral blood PCT and ESR in patients with pneumonia, and their effect values all reached the maximum at lag01 d, every 1 μg·m-3 of O3 elevation increased by 0.38% (95%CI: 0.04%‒0.73%) and 0.47% (95%CI: 0.19%‒0.76%), respectively. Stratified analyses showed that the associations of PM2.5 with peripheral blood CRP, ESR, NEU, and NLR in pneumonia patients were more significant in males, the elderly, and those with onset in the cold season; the associations of O3 with peripheral blood PCT and ESR in pneumonia patients were more significant in the elderly and those with onset in the warm season, and the peripheral blood CRP and PCT in female patients with pneumonia were more susceptible to the changes of O3.
    Conclusion Short-term exposure to atmospheric PM2.5 and O3 are positively associated with changes in inflammatory indicators in patients with pneumonia, and the effects of PM2.5 on patients with pneumonia are more extensive than those of O3, with a longer lag effect. In addition, elderly patients with pneumonia are more sensitive to air pollution, male patients with pneumonia are more sensitive to PM2.5, and female patients with pneumonia are more sensitive to O3. Cold and warm seasons can exacerbate the effects of PM2.5 and O3 on inflammatory indicators in patients with pneumonia, respectively, and the patients must be protected well.

     

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