天津市细颗粒物和臭氧短期暴露对急性心肌梗死每日入院风险的影响研究

Effects of short-term exposure to fine particulate matter and ozone on daily admission risk of acute myocardial infarction in Tianjin

目的了解天津市大气中细颗粒物(PM_(2.5))与臭氧(O_(3-8h))对急性心肌梗死(AMI)入院风险的影响,为AMI的预防提供依据。方法选取2018年1月1日至2021年12月31日在天津市第一中心医院心内科住院并诊断为AMI的患者2530例为研究对象,从病案系统中记录基本情况。同期的空气污染物及气象因素数据资料由天津市气象局提供。应用SPSS 25.0软件进行Spearman相关性分析和t检验。采用时间分层的病例交叉研究,分析PM_(2.5)、O_(3-8h)对AMI人群住院风险的影响。结果2018—2021年天津市内6区PM_(2.5)的日均浓度值为(50.42±39.08)μg/m^(3),O_(3-8h)的浓度值为(98.86±57.30)μg/m^(3)。调整气象因素后,在单污染物模型中PM_(2.5)、O_(3-8h)每增加10μg/m^(3),滞后4 d时(lag4)AMI患者入院风险最高,OR值分别为1.026(95%CI:1.003~1.049)、1.022(95%CI:1.002~1.043),均有统计学意义(P<0.05)。在单污染物模型中,季节、性别和年龄分层分析结果显示,PM_(2.5)暴露在冷季[AMI入院风险在lag0、lag1、lag2、lag4、lag7均增加,其中lag1的OR值最高,为1.039(95%CI:1.016~1.062)]、≥65岁人群[AMI入院风险仅在lag4时增加,OR值为1.032(95%CI:1.001~1.063)]中增加AMI入院风险(P<0.05);O_(3-8h)暴露仅在冷季增加AMI入院风险[AMI入院风险在lag4增加,OR值为1.077(95%CI:1.025~1.131),P<0.05]。在双污染物模型及多污染模型中,PM_(2.5)对AMI患者入院风险的影响均无统计学意义(P>0.05);O_(3-8h)浓度每升高10μg/m^(3),AMI患者入院风险在O_(3-8h)+可吸入颗粒物(PM_(10))、O_(3-8h)+一氧化碳(CO)、O3-8h+二氧化硫(SO_(2))、O_(3-8h)+二氧化氮(NO_(2))、O_(3-8h)+PM_(2.5)的双污染物及O_(3-8h)+PM_(10)+CO+SO_(2)+NO_(2)+PM_(2.5)的多污染模型中均增加,其中多污染物模型中OR值最高,为1.025(95%CI:1.005~1.046),P<0.05。结论天津市PM_(2.5)和O_(3-8h)短期暴露均增大人群AMI入院风险,应采取积极措施治理大气污染。同时应将≥65岁人群作为重点人群加强防护,并重视PM_(2.5)和O_(3-8h)冷暖季节风险的差异。

Objective To investigate the effects of atmospheric fine particulate matter(PM_(2.5))and ozone(O_(3-8h))on the risk of admission to hospital for acute myocardial infarction(AMI)in Tianjin,and provide the evidence for the prevention of AMI.Methods The subjects were 2530 inpatients diagnosed with AMI in the cardiology Department of Tianjin First Central Hospital from January 1,2018 to December 31,2021,and their basic information was recorded from the medical record system.The date of air pollutants and meteorological factors in the same period were provided by Tianjin Meteorological Bureau.Spearman correlation test and t-test were used to analyze the data,the time-stratified case-crossing study was used to analyze the effects of PM_(2.5) and O_(3-8h) on hospitalization risk of AMI residents.The used software was SPSS 25.0.Results The daily average concentrations of PM_(2.5) and O_(3-8h) in 6 districts of Tianjin from 2018 to 2021 were(50.42±39.08)and(98.86±57.30)μg/m^(3).After adjusting the meteorological factors,in the single pollutant model,the admission risk of AMI patients was the highest when the PM_(2.5) and O_(3-8h) increased by 10μg/m^(3),and the lag time was 4 days(lag4),OR values were 1.026(95%CI:1.003-1.049)and 1.022(95%CI:1.002-1.043),respectively(P<0.05).In the single-pollutant model,the seasonal,gender and age stratified analysis showed that PM_(2.5) increased the risk of AMI admission in lag0,lag1,lag2,lag4 and lag7,and the OR value of lag1 was the highest,which was 1.039(95%CI:1.016-1.062)in the cold season;PM_(2.5) increased the risk of AMI admission in≥65 years old group only in lag4(OR=1.032,95%CI:1.001-1.063),P<0.05;O_(3-8h) exposure increased AMI admission risk in lag4 during the cold season(OR=1.077,95%CI:1.025-1.131),P<0.05.In two-pollutant model and the multi-pollution model,there was no significant effect of PM_(2.5) concentration on AMI admission risk(P>0.05);O_(3-8h) concentration increased by 10μg/m^(3),the risk of admission of AMI patients increased in both the double pollutant model(O_(3-8h)+PM_(10),O_(3-8h)+CO,O_(3-8h)+SO_(2),O_(3-8h)+NO_(2),O_(3-8h)+PM_(2.5))and multi-pollution(O_(3-8h)+PM_(10)+CO+SO_(2)+NO_(2)+PM_(2.5))model,and the OR value was the highest in the multi-pollutant model(OR=1.025,95%CI:1.005-1.046),P<0.05.Conclusion In Tianjin,short-term exposure to PM_(2.5) and O_(3-8h) both increased the risk of AMI admission,and active measures should be taken to control air pollution.At the same time,the protection of residents(≥65 years old)should be strengthened,and it should pay attention to the difference of admission risk between PM_(2.5) and O_(3-8h) during cold and warm seasons.