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Lancet:空气污染加快了冠状动脉钙化的进展

2016-05-25 MedSci MedSci原创

长期暴露于小于2.5微米直径(PM2.5)的细颗粒物和交通相关的空气污染物与心血管风险有关。这些联系背后的疾病过程仍然不明朗。该研究的目的是评估长期暴露于大气污染和冠状动脉钙化和颈总动脉内膜中层厚度进展之间的关联。原始出处:Joel D Kaufman,Sara D Adar,R Graham Barr,et al.Association between air pollution and cor

长期暴露于小于2.5微米直径(PM2.5)的细颗粒物和交通相关的空气污染物与心血管风险有关。这些联系背后的疾病过程仍然不明朗。该研究的目的是评估长期暴露于大气污染和冠状动脉钙化和颈总动脉内膜中层厚度进展之间的关联。

在这个前瞻性10年的队列研究中,研究人员通过CT重复测量了6795名参与者的冠状动脉钙化,这些参与者年龄45-84岁,在动脉粥样硬化和空气污染的多种族研究(MESA Air)中被招募,他们来自于美国6个大都会地区。在2002年和2005年间几乎所有的参与者都完成了重复扫描,在2005年至2007年间一个亚组的患者完成了重复扫描,并于2010年和2012年一半的患者完成了重复扫描。颈总动脉内膜中层厚度的测量,在基线时所有的参与者完成了测量,在2010-12年时3459名参与者完成了测量。在1999年和2012年之间,住宅特定时空污染物浓度模型,包含了社区的具体测量,机构的监测数据和地理预测,PM2.5的估计浓度和氮氧化物(NOX)。主要目的是检查在6个大都会地区的冠状动脉钙化进展和平均颈动脉内膜中层厚度与长期暴露于环境空气污染物(PM2.5,NOX,和黑碳)之间的联系,并对基线年龄,性别,种族,社会经济特征,心血管危险因素,地点和CT扫描技术进行了调整。

在这一人群中,在调整风险因素或空气污染物暴露之前,冠状动脉钙化平均每年增加24盖斯顿单位(SD 58),内膜中层厚度每年增加12μm(10)。参与者特定污染物浓度在2000-10年间为9.2-22.6μg PM2.5/m3和7.2-139.2(ppb)NOX。每增加5μg的PM2.5/m3,冠状动脉钙化进展为每年4.1盖斯顿单位(95%CI 1.4-6.8),每增加40 ppb的NOX,冠状动脉钙化进展为每年4.8盖斯顿单位(0.9-8.7)。污染物暴露与内膜厚度的变化无关。对于长期暴露于PM2.5高5μg/m3的环境中,内膜中层厚度为每年变化-0.9μm(95%CI -3.0至1.3)。暴露于高40 ppb的NOX环境中,估计为每年变化0.2μm(-1.9至2.4)。

在大都会市区,PM2.5和交通相关的空气污染浓度的增加,在全球范围内比较常见,与冠状动脉钙化进展有关,与动脉粥样硬化的加速一致。这项研究支持在预防心血管疾病方面需要进行全球努力。

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    2016-06-24 howi
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