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环境中的木烟及其他颗粒物和气态污染物引发ST段抬高型心肌梗死

Triggering of ST-elevation myocardial infarction by ambient wood smoke and other particulate and gaseous pollutants.

作者信息

Evans Kristin A, Hopke Philip K, Utell Mark J, Kane Cathleen, Thurston Sally W, Ling Frederick S, Chalupa David, Rich David Q

机构信息

Department of Public Health Sciences, University of Rochester, School of Medical Center, Rochester, New York, USA.

Institute for a Sustainable Environment, Center for Air Resources Engineering and Science, Clarkson University, Potsdam, New York, USA.

出版信息

J Expo Sci Environ Epidemiol. 2017 Mar;27(2):198-206. doi: 10.1038/jes.2016.15. Epub 2016 Apr 13.

Abstract

We previously observed increased odds of ST-elevation myocardial infarctions (STEMIs) associated with increased ambient fine particulate matter (PM) in the previous hour. However, data are lacking on the effects of specific PM sources. Using data from 362 patients, a case-crossover design, and conditional logistic regression, we estimated the relative odds of STEMI associated with increased Delta-C (wood smoke), black carbon (BC; traffic), PM, and gaseous pollutants in the previous 1-72 h. We did not observe increased odds of STEMIs associated with increased Delta-C or BC. We did observe increased odds associated with each 7.1 μg/m increase in PM (OR (95% CI): 1.17 (0.99, 1.39)) and each 19.9 p.p.b. increase in ozone (O; 1.27 (1.00, 1.63)) in the previous hour, and each 0.22 p.p.m. increase in 48-h carbon monoxide (CO) concentrations (1.32 (1.00, 1.73]). Larger relative odds were associated with PM in May-October, and O and CO in November-April. Increased PM, O, and CO, but not wood smoke or BC, were associated with increased odds of STEMI, and effects may differ by season. Studies using spatially adjusted pollution estimates are needed, as well as studies further examining O and CO effects on the risk of STEMI.

摘要

我们之前观察到,前一小时环境细颗粒物(PM)增加与ST段抬高型心肌梗死(STEMI)的发病几率增加有关。然而,关于特定PM来源的影响的数据尚缺。利用362例患者的数据、病例交叉设计和条件逻辑回归,我们估计了前1至72小时内与δ-C(木烟)、黑碳(BC;交通)、PM和气态污染物增加相关的STEMI相对发病几率。我们未观察到与δ-C或BC增加相关的STEMI发病几率增加。我们确实观察到,前一小时内PM每增加7.1μg/m³(比值比(95%置信区间):1.17(0.99,1.39))以及臭氧(O₃)每增加19.9 p.p.b.(1.27(1.00,1.63)),STEMI发病几率增加;48小时内一氧化碳(CO)浓度每增加0.22 p.p.m.(1.32(1.00,1.73)),STEMI发病几率也增加。5月至10月期间与PM相关的相对发病几率更大,11月至次年4月期间与O₃和CO相关的相对发病几率更大。PM、O₃和CO增加与STEMI发病几率增加相关,而木烟或BC则不然,且影响可能因季节而异。需要开展使用空间调整污染估计值的研究,以及进一步研究O₃和CO对STEMI风险影响的研究。

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