Chung Jong-Won, Bang Oh Young, Ahn Kangmo, Park Sang-Soon, Park Tai Hwan, Kim Jae Guk, Ko Youngchai, Lee SooJoo, Lee Kyung Bok, Lee Jun, Kang Kyusik, Park Jong-Moo, Cho Yong-Jin, Hong Keun-Sik, Nah Hyun-Wook, Kim Dae-Hyun, Cha Jae-Kwan, Ryu Wi-Sun, Kim Dong-Eog, Kim Joon-Tae, Choi Jay Chol, Oh Mi-Sun, Yu Kyung-Ho, Lee Byung-Chul, Lee Ji Sung, Lee Juneyoung, Park Hong-Kyun, Kim Beom Joon, Han Moon-Ku, Bae Hee-Joon
From the Department of Neurology (J.-W.C., O.Y.B.), Department of Pediatrics, Environmental Health Center for Atopic Diseases (K.A.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea (S.-S.P., T.H.P.); Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea (J.G.K., Y.K., S.L.); Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Republic of Korea (K.B.L.); Department of Neurology, Yeungnam University Hospital, Daegu, Republic of Korea (Jun Lee); Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Republic of Korea (K.K., J.-M.P.); Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea (Y.-J.C., K.-S.H.); Department of Neurology, Dong-A University Hospital, Pusan, Republic of Korea (H.-W.N., D.-H.K., J.-K.C.); Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea (W.-S.R., D.-E.K.); Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (J.-T.K.); Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea (J.C.C.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (M.-S.O., K.-H.Y., B.-C.L.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea (Juneyoung Lee); and Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea (H.-K.P., B.J.K., M.-K.H., H.-J.B.).
Stroke. 2017 Jan;48(1):17-23. doi: 10.1161/STROKEAHA.116.015428. Epub 2016 Nov 29.
The aim of the study was to assessed the impact of short-term exposure to air pollution on ischemic stroke subtype, while focusing on stroke caused via cardioembolism.
From a nationwide, multicenter, prospective, stroke registry database, 13 535 patients with acute ischemic stroke hospitalized to 12 participating centers were enrolled in this study. Data on the hourly concentrations of particulate matter <10 μm, nitrogen dioxide (NO), sulfur dioxide (SO), ozone (O), and carbon monoxide (CO) were collected from 181 nationwide air pollution surveillance stations. The average values of these air pollutants over the 7 days before stroke onset from nearest air quality monitoring station in each patient were used to determine association with stroke subtype. The primary outcome was stroke subtype, including large artery atherosclerosis, small-vessel occlusion, cardioembolism, and stroke of other or undetermined cause.
Particulate matter <10 μm and SO concentrations were independently associated with an increased risk of cardioembolic stroke, as compared with large artery atherosclerosis and noncardioembolic stroke. In stratified analyses, the proportion of cases of cardioembolic stroke was positively correlated with the particulate matter <10 μm, NO, and SO quintiles. Moreover, seasonal and geographic factors were related to an increased proportion of cardioembolic stroke, which may be attributed to the high levels of air pollution.
Our findings suggest that the short-term exposure to air pollutants is associated with cardioembolic stroke, and greater care should be taken for those susceptible to cerebral embolism during peak pollution periods. Public and environmental health policies to reduce air pollution could help slow down global increasing trends of cardioembolic stroke.
本研究旨在评估短期暴露于空气污染对缺血性卒中亚型的影响，重点关注心源性栓塞所致的卒中。
从一个全国性、多中心、前瞻性的卒中登记数据库中，选取了12个参与中心收治的13535例急性缺血性卒中患者纳入本研究。从181个全国空气污染监测站收集了小于10μm颗粒物、二氧化氮（NO）、二氧化硫（SO）、臭氧（O）和一氧化碳（CO）的每小时浓度数据。每位患者最近空气质量监测站中风发作前7天这些空气污染物的平均值用于确定与卒中亚型的关联。主要结局是卒中亚型，包括大动脉粥样硬化、小血管闭塞、心源性栓塞以及其他或不明原因的卒中。
与大动脉粥样硬化和非心源性栓塞性卒中相比，小于10μm颗粒物和SO浓度与心源性栓塞性卒中风险增加独立相关。在分层分析中，心源性栓塞性卒中病例的比例与小于10μm颗粒物、NO和SO五分位数呈正相关。此外，季节和地理因素与心源性栓塞性卒中比例增加有关，这可能归因于高水平的空气污染。
我们的研究结果表明，短期暴露于空气污染物与心源性栓塞性卒中有关，在污染高峰期，对于易发生脑栓塞的人群应给予更多关注。减少空气污染的公共和环境卫生政策可能有助于减缓全球心源性栓塞性卒中的上升趋势。
