大气细颗粒物浓度与急性冠脉综合征急诊人次的相关性分析

Study of relationship between content of fine particulate matter in atmospheric and the number of emergency room visits with acute coronary syndrome

目的探讨大气细颗粒物（fineparticulatematter，PM2.5）浓度与居民急性冠脉综合征（acutecoronarysyndrome，ACS）急诊人次之间的相关性。方法收集2013年12月1日至2014年11月30日期间北京大学第三医院急诊科每日ACS就诊病例，患者均为北京市海淀区常住居民。收集同期北京市海淀区大气污染物和气象因素的监测数据。采用广义相加模型，在控制时间长期趋势、节假日效应、星期几效应以及气象因素等？昆杂因素的基础上，定量评估大气PM2.5浓度与急性冠脉综合征急诊人次的相关性。结果研究期间北京市PM2.5年平均浓度为85．44μg／m3，北京大学第三医院急诊科共确诊ACS患者619例。大气PM2.5浓度与PM10、SO2、NO2浓度呈正相关，相关系数分别为0．88、0．48和0．67，均有统计学意义（P〈0．05），与日均气温呈负相关，相关系数为-0．04（P〈O．05）。污染模型中，PM2.5浓度与ACS急诊人次呈正相关，PM2.5浓度每上升10μg／m3，ACS急诊相对危险度Rn为1．019（95％CI：1．000～1．038）。此外，大气PM25浓度对ACS急诊人次的影响具有滞后效应，滞后1d（1agl）的PM2.5浓度对急诊人次的相对危险度最大。结论大气PM2.5浓度升高引起ACS急诊人次的增加，并且具有滞后效应。

Objective To explore the relationship between content of fine particulate matter （ PM2.5 ） in atmospheric and the number of emergency room （ER） visits with acute coronary syndrome （ACS） . Methods Daily data of ER visits to Peking University Third Hospital for ACS was collected from December 1st, 2013 to November 30th, 2014. All patients were resident population of Haidian District, Beijing. The daily meteorological data and contents of air pollutants in Beijing were also collected in the same time period. Generalized Additive Model （GAM） was fitted to estimate the association between the ambient PM2.5 and the ER visits for ACS, under controlling for time trends, holiday effect, day of week effect and weather conditions. Results The annual average amount of PM2.5 was 85.44 μg/m3 over the study period. There were 619 cases with ACS as ER visits. PM2.5 was positive related with PM10, NO2 and SO2. The corresponding correlation coefficients were 0. 87, 0.48 and 0.67, respectively （P 〈 0.05 ） . But PM2. 5 was negative related with mean temperature （r = - 0. 04, P 〈 0. 05） . In the polluted model, there was positive association between PM2.5 and ER visits with ACS. When each increament in PM25 with 10 μg/m3, the relative risk strength of ER visits with ACS was 1. 019 （95% CI： 1. 000-1. 038） . PM2.5 concentrations had a delayed effect on the onset of ACS occurred on the next day. This lagged 1 day phenomenon showed the most significant influence of PM2.5 on ER visits for ACS. Conclusions The ambient concentrations of PM2.5 are positively associated with ER visits for ACS. And there is a lag effect.