短期环境臭氧暴露对急性缺血性卒中住院的影响:中国武汉的时间序列分析

Effect of short-term environmental ozone exposure on hospitalization of ischemic stroke: a time series analysis of Wuhan, China

目的探讨短期环境臭氧(ozone, O3)暴露对急性缺血性卒中(acute ischemic stroke, AIS)及其亚型住院风险的影响。方法收集武汉大学中南医院2016年1月1日至2017年12月31日AIS患者的住院资料、中国空气质量在线监测分析平台公布的空气污染物资料以及中国气象数据网公布的气象资料。根据TOAST病因学分型标准将AIS患者分为大动脉粥样硬化(large artery atherosclerosis, LAA)、小血管闭塞(small vessel occlusive, SVO)、心源性栓塞(cardioembolism, CE)和其他原因(stroke of other etiology, SOE)4种亚型。运用时间序列分析法的分布滞后非线性模型,回顾性分析短期O3暴露对AIS及其亚型住院风险的影响。结果共纳入1 413例AIS患者,男性910例(64.4%),年龄(67.7±12.8)岁(范围18~99岁)。短期O3暴露可增高AIS的总体住院风险[相对危险度(relative risk, RR)1.06,95%可信区间(confidence interval, CI)0.99~1.13],其原因与增高LAA(RR 1.17,95% CI 1.02~1.34;滞后5 d)和SVO(RR 1.24,95% CI 1.06~1.45;滞后3 d)住院风险有关。引入双污染物(O3+其他污染物)模型后,其RR均未发生明显改变。根据人口统计学特征及血管危险因素进行的分层分析显示,不同人群对O3的急性危害效应的敏感性不同。结论短期O3暴露可显著增高LAA和SVO住院风险。

Objective To investigate the effect of short-term environmental ozone (O3) exposure on hospitalization risk of acute ischemic stroke (AIS) and its subtypes. Methods From January 1, 2016 to December 31, 2017, the hospitalization data of patients with AIS from Zhongnan Hospital of Wuhan University, air pollutant data published by China Air Quality Online Monitoring and Analysis Platform, and the meteorological data published by China Meteorological Data Network were collected. According to TOAST etiological classification criteria, the patients with AIS were divided into large-artery atherosclerosis (LAA), small-artery occlusion (SVO), cardioembolism (CE), and stroke of other etiology (SOE). The effect of short-term O3 exposure on the hospitalization risk of AIS and its subtypes was analyzed retrospectively using a distributed lag non-linear model of time series analysis. Results A total of 1 413 patients with AIS were enrolled, including 910 males (64.4%), aged 67.7±12.8 years (range, 18-99 years). Short-term O3 exposure increased the overall hospitalization risk of AIS [relative risk (RR) 1.06, 95% confidence interval (CI) 0.99-1.13], mainly caused by increased hospitalization risks of LAA (RR 1.17, 95% CI 1.02-1.34;lag 5 d) and SVO (RR 1.24, 95% CI 1.06-1.45;lag 3 d). After introducing double pollutant (O3+ other pollutants) model, its RR did not have significant changes. A stratified analysis based on demographic characteristics and vascular risk factors showed that the different populations had different sensitivities to the acute hazard effects of O3. Conclusion Short-term exposure to O3 could significantly increase the hospitalization risks of LAA and SVO.