中国医学科学院北京协和医学院顾东风院士的研究团队分析了长期暴露于环境细颗粒物和中风发病率之间的相关性。相关论文于2019年12月30日发表在《英国医学杂志》上。

为了研究长期暴露于直径≤2.5μm（PM2.5）的环境细颗粒物对中国成人总中风、缺血性中风和出血性中风的影响，研究组在中国的15个省份进行了一项基于人群的前瞻性队列研究。对中国动脉粥样硬化性心脏病的风险进行预测，共招募了117575名成年男性和女性，入组时他们均没有中风。

2000-2015年，这些参与者居住地的长期平均PM2.5水平为64.9μg/m³，最低31.2μg/m³，最高97.0μg/m³。在900214人年的随访中，研究组共发现3540例中风，其中63.0%为缺血性中风，27.5%为出血性中风。与第一季度暴露于PM2.5（<54.5μg/m³）相比，暴露于最高季度（>78.2μg/m³）的参与者发生中风的风险较大，风险比为1.53，其中缺血性中风的风险比为1.82，出血性中风为1.50。

PM2.5浓度每升高10μg/m³，发生中风、缺血性中风和出血性中风的风险分别增加13%、20%和12%。通过对中风及其亚型进行观察，长期暴露于PM2.5与中风事件之间呈几乎线性的暴露-反应关系。

研究结果表明，在中国，长期暴露于较高浓度的PM2.5与中风及其主要亚型呈正相关。该发现不仅对中国，还对其他中低收入国家制定与空气污染和预防中风相关的环境和卫生政策有重要意义。

附：英文原文

Title: Long term exposure to ambient fine particulate matter and incidence of stroke: prospective cohort study from the China-PAR project

Author: Keyong Huang, Fengchao Liang, Xueli Yang, Fangchao Liu, Jianxin Li, Qingyang Xiao, Jichun Chen, Xiaoqing Liu, Jie Cao, Chong Shen, Ling Yu, Fanghong Lu, Xianping Wu, Liancheng Zhao, Xigui Wu, Ying Li, Dongsheng Hu, Jianfeng Huang, Yang Liu, Xiangfeng Lu, Dongfeng Gu

Issue&Volume: 2019/12/30

Abstract: Objective To study the effect of long term exposure to ambient fine particulate matter of diameter ≤2.5 μm (PM2.5) on the incidence of total, ischemic, and hemorrhagic stroke among Chinese adults.

Design Population based prospective cohort study.

Setting Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project carried out in 15 provinces across China.

Participants 117 575 Chinese men and women without stroke at baseline in the China-PAR project.

Main outcome measures Incidence of total, ischemic, and hemorrhagic stroke.

Results The long term average PM2.5 level from 2000 to 2015 at participants’ residential addresses was 64.9 μg/m3, ranging from 31.2 μg/m3 to 97.0 μg/m3. During 900 214 person years of follow-up, 3540 cases of incident stroke were identified, of which 63.0% (n=2230) were ischemic and 27.5% (n=973) were hemorrhagic. Compared with the first quarter of exposure to PM2.5 (<54.5 μg/m3), participants in the highest quarter (>78.2 μg/m3) had an increased risk of incident stroke (hazard ratio 1.53, 95% confidence interval 1.34 to 1.74), ischemic stroke (1.82, 1.55 to 2.14), and hemorrhagic stroke (1.50, 1.16 to 1.93). For each increase of 10 μg/m3 in PM2.5 concentration, the increased risks of incident stroke, ischemic stroke, and hemorrhagic stroke were 13% (1.13, 1.09 to 1.17), 20% (1.20, 1.15 to 1.25), and 12% (1.12, 1.05 to 1.20), respectively. Almost linear exposure-response relations between long term exposure to PM2.5 and incident stroke, overall and by its subtypes, were observed.

Conclusions This study provides evidence from China that long term exposure to ambient PM2.5 at relatively high concentrations is positively associated with incident stroke and its major subtypes. These findings are meaningful for both environmental and health policy development related to air pollution and stroke prevention, not only in China, but also in other low and middle income countries.

DOI: 10.1136/bmj.l6720

Source: https://www.bmj.com/content/367/bmj.l6720