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长期暴露于环境空气污染可加重肺气肿
来源:小柯机器人 发布时间:2019/8/14 15:57:42

美国华盛顿大学Meng Wang等研究人员分析了长期暴露于环境空气污染与定量评估的肺气肿和肺功能变化之间的关系。 该研究于2019年8月13日发表于《美国医学会杂志》上。

虽然已证实空气污染物与心血管和呼吸系统疾病有关,但目前尚不清楚现今的空气污染物浓度是否与肺气肿进展有关。研究人员采用一种验证过的时空数据模型来估计受试者居住区的特定空气污染物浓度,这些污染物包括环境臭氧(O3)、细颗粒物(PM2.5)、氮氧化物(NOX)和黑碳。通过心脏CT和肺CT扫描确定肺气肿的百分比。

这项队列研究从美国6个大都会地区中招募7071例45至84岁的成年人作为受试者,其中47.1%为男性。6814例受试者于2000年7月至2002年8月参与,257例受试者于2005年2月至2007年5月参与,所有受试者均随访至2018年11月。

基线时肺气肿的中位数为3%,平均每10年增加0.58个百分点。在随访期间,PM2.5和NOX(O3除外)的平均环境浓度显著降低。基线研究中,O3、PM2.5、NOX和黑碳的环境浓度与每十年间的肺气肿百分比增加显著相关。随访期间,环境O3和NOX(PM2.5除外)与肺气肿百分比增加显著相关。在基线和随访期间,环境O3浓度(其他污染物除外)与一秒用力呼气量(FEV1)的快速下降显著相关。
 

附:英文原文

Title: Association Between Long-term Exposure to Ambient Air Pollution and Change in Quantitatively Assessed Emphysema and Lung Function

Author: Meng Wang; Carrie Pistenmaa Aaron; Jaime Madrigano; Eric A. Hoffman; Elsa Angelini; Jie Yang; Andrew Laine; Thomas M. Vetterli; Patrick L. Kinney; Paul D. Sampson; Lianne E. Sheppard; Adam A. Szpiro; Sara D. Adar; Kipruto Kirwa; Benjamin Smith; David J. Lederer; Ana V. Diez-Roux; Sverre Vedal; Joel D. Kaufman; R. Graham Barr

Issue&Volume: Vol.322 No.6

Abstract:

Importance  While air pollutants at historical levels have been associated with cardiovascular and respiratory diseases, it is not known whether exposure to contemporary air pollutant concentrations is associated with progression of emphysema.

Objective  To assess the longitudinal association of ambient ozone (O3), fine particulate matter (PM2.5), oxides of nitrogen (NOx), and black carbon exposure with change in percent emphysema assessed via computed tomographic (CT) imaging and lung function.

Design, Setting, and Participants  This cohort study included participants from the Multi-Ethnic Study of Atherosclerosis (MESA) Air and Lung Studies conducted in 6 metropolitan regions of the United States, which included 6814 adults aged 45 to 84 years recruited between July 2000 and August 2002, and an additional 257 participants recruited from February 2005 to May 2007, with follow-up through November 2018.

Exposures  Residence-specific air pollutant concentrations (O3, PM2.5, NOx, and black carbon) were estimated by validated spatiotemporal models incorporating cohort-specific monitoring, determined from 1999 through the end of follow-up.

Main Outcomes and Measures  Percent emphysema, defined as the percent of lung pixels less than −950 Hounsfield units, was assessed up to 5 times per participant via cardiac CT scan (2000-2007) and equivalent regions on lung CT scans (2010-2018). Spirometry was performed up to 3 times per participant (2004-2018).

Results  Among 7071 study participants (mean [range] age at recruitment, 60 [45-84] years; 3330 [47.1%] were men), 5780 were assigned outdoor residential air pollution concentrations in the year of their baseline examination and during the follow-up period and had at least 1 follow-up CT scan, and 2772 had at least 1 follow-up spirometric assessment, over a median of 10 years. Median percent emphysema was 3% at baseline and increased a mean of 0.58 percentage points per 10 years. Mean ambient concentrations of PM2.5 and NOx, but not O3, decreased substantially during follow-up. Ambient concentrations of O3, PM2.5, NOx, and black carbon at study baseline were significantly associated with greater increases in percent emphysema per 10 years (O3: 0.13 per 3 parts per billion [95% CI, 0.03-0.24]; PM2.5: 0.11 per 2 μg/m3 [95% CI, 0.03-0.19]; NOx: 0.06 per 10 parts per billion [95% CI, 0.01-0.12]; black carbon: 0.10 per 0.2 μg/m3 [95% CI, 0.01-0.18]). Ambient O3 and NOx concentrations, but not PM2.5 concentrations, during follow-up were also significantly associated with greater increases in percent emphysema. Ambient O3 concentrations, but not other pollutants, at baseline and during follow-up were significantly associated with a greater decline in forced expiratory volume in 1 second per 10 years (baseline: 13.41 mL per 3 parts per billion [95% CI, 0.7-26.1]; follow-up: 18.15 mL per 3 parts per billion [95% CI, 1.59-34.71]).

Conclusions and Relevance  In this cohort study conducted between 2000 and 2018 in 6 US metropolitan regions, long-term exposure to ambient air pollutants was significantly associated with increasing emphysema assessed quantitatively using CT imaging and lung function.

DOI: 10.1001/jama.2019.10255

Source: https://jamanetwork.com/journals/jama/article-abstract/2747669

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex


本期文章:《美国医学会杂志》:Vol 322 No.6