Henrotin J B, Besancenot J P, Bejot Y, Giroud M
Stroke Register of Dijon, Neurology Department, University Hospital of Dijon, Dijon, France.
Occup Environ Med. 2007 Jul;64(7):439-45. doi: 10.1136/oem.2006.029306. Epub 2007 Apr 4.
To evaluate the association between air pollutants and the occurrence of acute stroke from 10-year population-based study.
The daily stroke count was obtained from Dijon Stroke Register between March 1994 and December 2004. The register recorded all first-ever strokes among residents of Dijon (150,000 inhabitants) in France, using standard diagnostic criteria. Pollutant concentrations (SO2, CO, NO2, O3 and PM10) were measured hourly. A bi-directional case-crossover design was used to examine the association between air pollutant and stroke onset. The conditional logistic regression model included the meteorological parameters (temperature, relative humidity), influenza epidemics and holidays.
The authors collected 493 large artery infarcts, 397 small artery infarcts, 530 cardio-embolic infarcts, 67 undeterminate infarcts, 371 transient ischaemic attacks and 220 haemorrhagic strokes. For single-pollutant model and for a 10 mg/m(3) increase of O3 exposure, a positive association was observed only in men, over 40 years of age, between ischaemic stroke occurrence and O3 levels with 1-day lag, (OR 1.133, 95% CI 1.052 to 1.220) and 0-day lag (OR 1.058, 95% CI 0.987 to 1.134). No significant associations were found for haemorrhagic stroke. In two-pollutant models, the effects of O3 remained significant after each of the other pollutants were included in the model, in particular with PM10. A significant association was observed for ischaemic strokes of large arteries (p = 0.02) and for transient ischaemic attacks (p = 0.01). Moreover, the authors found an exposure-response relations between O3 exposure and ischaemic stroke (test for trend, p = 0.01). An increase in association in men with several cardiovascular risk factors (smoker, dyslipidemia and hypertension) was also observed.
These observational data argue for an association between ischaemic stroke occurrence and O3 pollution levels; these results still need to be confirmed by other studies.
通过一项为期10年的基于人群的研究，评估空气污染物与急性中风发生之间的关联。
1994年3月至2004年12月期间，从第戎中风登记处获取每日中风病例数。该登记处使用标准诊断标准，记录了法国第戎市（15万居民）所有首次发生的中风病例。每小时测量一次污染物浓度（二氧化硫、一氧化碳、二氧化氮、臭氧和可吸入颗粒物）。采用双向病例交叉设计来研究空气污染物与中风发病之间的关联。条件逻辑回归模型纳入了气象参数（温度、相对湿度）、流感流行情况和节假日因素。
作者收集了493例大动脉梗死、397例小动脉梗死、530例心源性栓塞性梗死、67例不明梗死、371例短暂性脑缺血发作和220例出血性中风病例。在单污染物模型中，对于臭氧暴露每增加10毫克/立方米，仅在40岁以上男性中观察到缺血性中风发生与臭氧水平之间存在正相关，滞后1天（比值比1.133，95%可信区间1.052至1.220）和滞后0天（比值比1.058，95%可信区间0.987至1.134）。出血性中风未发现显著关联。在双污染物模型中，将其他每种污染物纳入模型后，臭氧的影响仍然显著，尤其是与可吸入颗粒物相关。观察到大动脉缺血性中风（p = 0.02）和短暂性脑缺血发作（p = 0.01）存在显著关联。此外，作者发现臭氧暴露与缺血性中风之间存在暴露-反应关系（趋势检验，p = 0.01）。在患有多种心血管危险因素（吸烟者、血脂异常和高血压患者）的男性中，关联也有所增加。
这些观察数据表明缺血性中风发生与臭氧污染水平之间存在关联；这些结果仍需其他研究予以证实。
