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[33例慢性阻塞性肺疾病患者短期暴露于环境二氧化氮对肺功能和呼出一氧化氮分数的影响]

[The effect of short-term exposure to ambient NO(2) on lung function and fractional exhaled nitric oxide in 33 chronic obstructive pulmonary disease patients].

作者信息

Shan J, Ni Y, Dong W, Xu J H, Pan L, Li H Y, Yang X, Wu S W, Chen Y H, Deng F R, Guo X B

机构信息

Department of Occupational and Environmental Health, Peking University School of Public Health, Beijing 100191, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2017 Jun 6;51(6):527-532. doi: 10.3760/cma.j.issn.0253-9624.2017.06.014.

Abstract

To investigate the effect of short-term exposure to ambient NO(2) has influence on lung function and fractional exhaled nitric oxide (FeNO) in chronic obstructive pulmonary disease (COPD) patients. A panel of doctor-diagnosed stable COPD patients (=33) were recruited and repeatedly measured for lung function and FeNO from December 2013 to October 2014. The patients who lived in Beijing for more than one year and aged between 60 and 85 years old were included in the study. We excluded patients with asthma, bronchial tensor, lung cancer and other respiratory disorders other than chronic obstructive pulmonary disease and occupational exposure and chest trauma surgery patients. Because the frequency of each subject visiting to the hospital was different, a total of 170 times of lung function measurements and 215 times of FeNO measurements were conducted. At the same time, the atmospheric NO(2) data of Beijing environmental monitoring station near the residence of each patient during the study period were collected from 1 day to 7 days lag before the measurement. Effects of short-term NO(2) exposure on lung function and FeNO in COPD patients were estimated by linear mixed-effects models. The subjects' forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), peak expiratory flow (PEF), and exhaled NO of subjects were (3.26±0.83) L, (1.66±0.61) L, (4.13±1.77) L/s, and (48.99±14.30) μg/m(3), respectively. The concentration of NO(2) was (70.3±34.2) μg/m(3) and the interquartile range (IQR) was 39.0 μg/m(3). Short-term exposure to NO(2) resulted in a significant decrease in FVC among COPD patients' which was most obvious in 2 days lag. Every quartile range increased in NO(2) (39 μg/m(3), 2 day) would cause a 1.84% (95: -3.20%- -0.48%) reduction in FVC. The effects of exposure to higher concentration of NO(2) (≥58.0 μg/m(3)) on FVC estimate was -2.32% (95: -4.15%- -0.48%)(=0.02). No significant relevance of FeNO and NO(2) was observed in this study. Short term exposure to ambient NO(2) may bring down pulmonary function in COPD patients.

摘要

为研究短期暴露于环境二氧化氮(NO₂)对慢性阻塞性肺疾病(COPD)患者肺功能和呼出一氧化氮分数(FeNO)的影响。招募了一组经医生诊断为稳定期COPD的患者(n = 33),于2013年12月至2014年10月对其肺功能和FeNO进行反复测量。纳入研究的患者为在北京居住一年以上、年龄在60至85岁之间。我们排除了患有哮喘、支气管扩张、肺癌及除慢性阻塞性肺疾病以外的其他呼吸系统疾病的患者以及职业暴露和胸部创伤手术患者。由于每个受试者到医院就诊的频率不同,共进行了170次肺功能测量和215次FeNO测量。同时,收集每位患者居住地附近北京环境监测站在研究期间测量前1天至7天的大气NO₂数据。通过线性混合效应模型评估短期NO₂暴露对COPD患者肺功能和FeNO的影响。受试者的用力肺活量(FVC)、一秒用力呼气容积(FEV₁)、呼气峰值流速(PEF)和呼出NO分别为(3.26±0.83)L、(1.66±0.61)L、(4.13±1.77)L/s和(48.99±14.30)μg/m³。NO₂浓度为(70.3±34.2)μg/m³,四分位间距(IQR)为39.0μg/m³。短期暴露于NO₂导致COPD患者的FVC显著下降,在滞后2天最为明显。NO₂每增加一个四分位间距(39μg/m³,2天),FVC会降低1.84%(95%置信区间:-3.20%至-0.48%)。暴露于较高浓度NO₂(≥58.0μg/m³)对FVC的估计影响为-2.32%(95%置信区间:-4.15%至-0.48%)(P = 0.02)。本研究未观察到FeNO与NO₂之间存在显著相关性。短期暴露于环境NO₂可能会降低COPD患者的肺功能。

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