季风气候地区空气污染物短期暴露与急性心力衰竭患者就诊的相关性分析^*

Analysis of correlation between short-term exposure of air pollutants and treatment of patients with acute heart failure in monsoon climate area

摘要

目的 探讨季风气候地区空气污染物短期暴露与急性心力衰竭患者就诊的相关性分析。方法 连续纳入2018年1月—2022年12月北京安贞医院就诊的急性心力衰竭患者信息以及同期的空气污染物和气象等数据,包括一氧化碳(CO)、二氧化氮(NO₂)、臭氧(O₃)、二氧化硫(SO₂)、细颗粒物(PM_2.5)和可吸入颗粒物(PM₁₀)、日平均温度和相对湿度。运用广义线性回归模型分析不同空气污染物与急性心力衰竭患者就诊量的关联。结果 CO、NO₂和SO₂与急性心力衰竭急诊就诊风险呈正相关。以SO₂为例,浓度每升高10 μg/m³,单日滞后效应(Lag 0)的RR值为1.085(95%CI:1.026～1.147);多日累积效应(Lag 01～Lag 04)的RR值依次为1.104、1.133、1.163和1.192,且差异均有统计学意义(P＜0.05),呈现随累积天数增加而上升的趋势。以SO₂为例,其单日滞后(Lag 0)与多日累积效应(Lag 01～Lag 04)在男性中均显著,RR值由1.127上升至1.263,呈现累积增强趋势。≥65岁老年人群对NO₂、SO₂等污染物更为敏感,多数滞后时段(Lag 01～Lag 04)均显示风险升高。结论 气态污染物CO、NO₂、SO₂的短期暴露与心力衰竭患者的急诊就诊量显著相关,其中男性、≥65岁患者和复诊急性心力衰竭患者对其更加易感。

Abstract

Objective To explore the correlation analysis between short-term exposure of air pollutants and patients with acute heart failure in monsoon climate area. Methods The information of patients with acute heart failure in anzhen hospital from January 2018 to December 2022, and the data of air pollutants and meteorology in the same period were continuously included, including carbon monoxide (CO), nitrogen dioxide (NO₂), ozone (O₃), sulfur dioxide (SO₂), fine particles (PM_2.5) and inhalable particles (PM₁₀), daily average temperature and relative humidity. The generalized linear regression model was used to analyze the relationship between different air pollutants and patients with acute heart failure. Results In this study,CO、NO₂ and SO₂ were found to be positively associated with the risk of acute heart failure (AHF) emergency visits. In the case of SO₂, a significant association was observed between each 10 μg/m³ increase in concentration and a single-day lag effect (Lag 0), with a RR of 1.085 (95% CI: 1.026 to 1.147).The RR values of multi-day cumulative effect (Lag 01 to Lag 04) were 1.104, 1.133, 1.163 and 1.192, all of which were statistically significant and which exhibited an upward trend with the cumulative days increase. Statistically significant multi-day cumulative effects (Lag 01 to Lag 04) were also identified(P＜0.05), and RR values were 1.104, 1.133, 1.163 and 1.192 in turn, indicating a rising trend with longer cumulative exposure days. In gender-stratified analyses, significant associations were found in males for both the single-day Lag (Lag 0) and multi-day cumulative effects (Lag 01 to Lag 04) of SO₂, where the RR increased from 1.127 to 1.263, demonstrating a cumulative exposure-response pattern. In age-stratified analyses, individuals aged 65 years and older were more susceptible to pollutants such as NO₂ and SO₂, with most Lag periods (Lag 01 to ag04) showing significantly elevated risks. Conclusion Short-term exposure of gaseous pollutants CO, NO₂ and SO₂ is significantly related to the number of emergency visits of patients with heart failure, among which males, patients ≥65 and patients with recurrent acute heart failure are more susceptible.

关键词

急性心力衰竭 / 空气污染物 / 一氧化碳 / 二氧化氮 / 臭氧 / 二氧化硫 / 细颗粒物 / 可吸入颗粒物

Key words

Acute heart failure / Air pollutant / CO / NO₂ / O₃ / SO₂ / PM_2.5 / PM₁₀

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基金资助

^*国家自然科学基金面上项目(62272327);中华医学会心血管病学分会临床研究专项基金项目(CSCF2024B03);北京市医院管理中心临床医学发展专项“杨帆3.0”医工结合培育项目(YGLX202)