空气中粒径小于等于10微米颗粒物对成人哮喘患者肺功能的影响

Effect of Exposure in Particulate Matter Equal or Less than 10 μm in Aerodynamic Diameter on Lung Function of Adult Patients with Asthma

目的研究空气中粒径≤10μm细颗粒物(particulate matter≤10μm in aerodynamic diameter,PM10)暴露对成人哮喘患者肺功能的影响。方法于2016年1至10月在北京地区常住居民中招募17例成年哮喘患者,在9个月时间内,每3个月完成一次肺量仪通气功能检查,至少需要完成2次检查,共获得26组有前后肺功能对比的数据。分析受试者每3个月间隔时间内肺功能的变化值与该时段内PM10暴露平均值之间的关系。肺功能分析值选取舒张试验前第1秒用力呼气容积占预计值的百分比(pre-bronchodilator forced expiratory volume in 1 second expressed as percent predicted,Pre FEV_1%)、舒张试验前用力肺活量占预计值的百分比(pre-bronchodilator forced vital capacity expressed as percent predicted,Pre FVC%)、舒张试验前1秒率(pre-bronchodilator FEV_1/FVC,Pre FEV_1/FVC)、舒张试验后第1秒用力呼气容积占预计值的百分比(post-bronchodilator forced expiratory volume in 1 second expressed as percent predicted,Post FEV_1%)、舒张试验后用力肺活量占预计值的百分比(post-bronchodilator forced vital capacity expressed as percent predicted,Post FVC%)、舒张试验后1秒率(post-bronchodilator FEV_1/FVC,Post FEV_1/FVC)等6个指标。6项指标的变化值分别设定为ΔPre FEV_1%、ΔPre FVC%、ΔPre FEV_1/FVC、ΔPost FEV_1%、ΔPost FVC%和ΔPost FEV_1/FVC。肺功能指标的变化以及PM10暴露的差异采用两独立样本t检验或非参数秩和检验。结果在3个月时间段内,以PM10中位数划分为相对较高PM10暴露组[(98.00±10.99)g/m^3,n=13]与相对较低PM10暴露组[(79.23±6.30)g/m^3,n=13]。ΔPre FEV_1%、ΔPre FEV_1/FVC、ΔPost FEV_1%和ΔPost FEV_1/FVC在PM10相对较高暴露组[4个指标变化分别为(-6.96±10.49)%、(-3.79±7.92)%、(-4.07±5.72)%和(-2.85±5.14)%]与相对较低暴露组[4个指标变化分别为(4.32±12.02)%、(2.22±5.38)%、(7.61±12.66)%和(7.79±7.93)%]比较均有显著降低(P值分别为0.005、0.016、0.004、0.020)。ΔPre FVC%[两组变化值分别为(-4.62±8.83)%、(2.63±13.49)%]、ΔPost FVC%[两组变化值分别为(-2.65±6.74)%、(0.28±13.58)%]在相对较高PM10暴露组虽有下降趋势,但两组间差异无统计学意义。结论 PM10的长期暴露对成人哮喘患者肺通气功能会产生负面健康效应,需要引起重视。

Objective To investigate whether the exposure of particulate matter ≤ 10 μm in aerodynamic diameter（PM10） has any impact on lung function in adult patients with asthma. Methods Seventeen asthma adults from inhabitants of Beijing were recruited and followed up for 9 months,they received at least two spirometry tests every three months in the meanwhile. Twenty-six corresponding data of spirometry test at the beginning and the end of 3 months period were collected. The association between the variation of lung function in three months and the average exposure of PM10 during the corresponding period was analyzed. The six lung function parameters used in analysis were pre-bronchodilator forced expiratory volume in 1 second expressed as percent predicted（Pre FEV_1%）,pre-bronchodilator forced vital capacity（Pre FVC%） expressed as percent predicted,pre-bronchodilator FEV_1/FVC（Pre FEV_1/FVC）,post-bronchodilator FEV_1 expressed as percent predicted（Post FEV_1%）,post-bronchodilator FVC expressed as percent predicted（Post FVC%）,and post-bronchodilator FEV_1/FVC（Post FEV_1/FVC）. The changes of these parameters during the observation period were defined as ΔPre FEV_1%,ΔPre FVC%,ΔPre FEV_1/FVC,ΔPost FEV_1%,ΔPost FVC%,and ΔPost FEV_1/FVC respectively. The discrepancy between lung function and PM10 exposure is analyzed using independent-samples t test or nonparametric rank-sum test. Results The participants were divided into the relatively higher PM10 exposure group [（98. 00 ± 10. 99） g/m-3,n =13]and relatively lower PM10 exposure group [（79. 23 ±6. 30） g/m-3,n = 13] based on the median value within three months of the observation period.The ΔPre FEV_1%,ΔPre FEV_1/FVC,ΔPost FVC% and ΔPost FEV_1/FVC of participants with relatively higher PM10 exposure [the four variations were（-6. 96 ± 10. 49） %,（-3. 79 ± 7. 92） %,（-4. 07 ± 5. 72） %,and（-2. 85 ± 5. 14） %]showed significant reduction（P values were 0. 005,0. 016,0. 004,0. 020）,compared with the relatively lower PM10 exposure participants [the four variations were（4. 32 ± 12. 02） %,（2. 22 ± 5. 38） %,（7. 61 ± 12. 66） %,（7. 79 ± 7. 93） %]. TheΔPre FVC% [the variations were（-4. 62 ± 8. 83） %,（2. 63 ± 13. 49） % respectively],ΔPost FVC% [the variations were（-2. 65 ± 6. 74） %,（0. 28 ± 13. 58） % respectively]presented a downtrend in participants with relatively higher PM10 exposure but there is no significant difference between the two groups statistically. Conclusion The long term PM10 exposure has a negative effect on the pulmonary ventilation function of asthma adults.