空气污染物与急性冠脉综合征患者外周血细胞、心肌酶谱和炎症反应的关系

Relationship of Air Pollutants with Peripheral Blood Cells, Myocardial Enzymes, and Inflammatory Response of Patients with Acute Coronary Syndrome

[目的]研究空气污染物与急性冠状动脉综合征患者(ACS)外周血细胞、心肌酶谱和炎症反应的关系,并进行ACS的危险因素分析。[方法]以上海市某三甲医院2008—2009年因ACS通过"心脏介入绿色通道"途径入院的238名患者为研究对象,检测患者的一般生化指标:胆固醇、三酰甘油及低密度脂蛋白胆固醇等;外周血细胞和炎症指标:白细胞计数、淋巴细胞百分比、高敏C反应蛋白等;心肌损伤标志物:肌酸激酶、肌钙蛋白、人羟脯氨酸糖蛋白等;同时收集大气污染物资料:粗颗粒物(PM10)、二氧化硫、二氧化氮和气象资料,采用Spearman相关分析,分析大气污染物对ACS患者的血液细胞和生化指标的影响。[结果]经Spearman相关分析,PM10与ACS患者的淋巴细胞百分比具有相关关系(r=0.235,P<0.05)。采用多元逐步回归分析方法,以ACS患者的淋巴细胞百分比为应变量,共有自变量PM10(P=0.011)和性别(P=0.020)纳入模型。[结论]大气PM10高浓度暴露可导致患者淋巴细胞百分比发生变化,影响免疫系统功能,提示PM10可能是ACS患者的一个危险因素。

[Objective] To examine the effects of exposure to air pollutants on the peripheral blood cells, myocardial enzymes, and inflammatory response of patients with acute coronary syndrome（ACS）, and to identify ACS risk factors. [Methods] Subjects included patients with ACS in Shanghai, China, who were admitted to a grade-three hospital through Cardiac Intervention Green Channel in 2008-2009. They were tested for the following biochemical indicators： general biochemical indicators, such as cholesterol, triglycerides, and low-density lipoprotein cholesterol; peripheral blood cells and inflammatory indicators, such as white blood cell count, lymphocyte percentage, and high-sensitivity C-reactive protein; myocardial injury markers： creatine kinase, troponin, and hydroxyproline glycoprotein. Atmospheric pollutants [coarse particulate（PM10）, sulfur dioxide, and nitrogen dioxide] data and meteorological data were also collected. The associations between air pollutants and related risk factors of ACS were analyzed by Spearman correlation analysis. [Results] The lymphocyte percentage was closely associated with the recorded PM10 in the Spearman correlation analysis（r=0.235, P 0.05）. The results of multiple stepwise regression analysis showed when using lymphocyte percentages in ACS patients as a dependent variable, PM10（P=0.011） and gender（P=0.020） were incorporated in the model. [Conclusion] Exposure to high concentrations of PM10 can lead to changes in patients＇ lymphocyte percentages and affect their immune system function. These findings indicate that PM10 is likely to be a risk factor for ACS.