植入式心脏复律除颤器患者的主要空气污染物与室性心律失常：一项系统评价和荟萃分析。

Main air pollutants and ventricular arrhythmias in patients with implantable cardioverter-defibrillators: A systematic review and meta-analysis.

作者信息

Yang Hong-Jie, Liu Xin, Qu Chuan, Shi Shao-Bo, Liang Jin-Jun, Yang Bo

机构信息

Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.

Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060, China.

出版信息

Chronic Dis Transl Med. 2017 Oct 25;3(4):242-251. doi: 10.1016/j.cdtm.2017.09.001. eCollection 2017 Dec.

DOI:10.1016/j.cdtm.2017.09.001

PMID:29354807

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5747495/

Abstract

OBJECTIVE

Previous studies of ambient air pollutants and ventricular arrhythmias in patients with implantable cardioverter-defibrillator (ICD) have yielded mixed results, and the association between air pollution and ventricular arrhythmias in these patients remains unclear. This study aimed to assess and quantify the association between exposure to major air pollutants [CO, inhalable particles (PM), SO, fine particulate matter (PM), O, and NO] and the presence of ventricular arrhythmia in patients with ICD.

METHODS

The Medline, PubMed, Web of Science, Global Health Library, Virtual Health Library, Population Information Online (POPLINE), and New York Academy of Medicine Grey Literature Report databases were searched to identify studies analyzing the association between ventricular arrhythmias in patients with ICD and the abovementioned main air pollutants. Pooled estimates were generated using a random-effects model or fixed-effects model, according to the value of heterogeneity. Heterogeneity within studies was assessed using Cochran's and statistics. Funnel plots, Egger's regression test, and Begg's rank correlation method were used to evaluate publication bias. Sensitivity analyses were also conducted to evaluate the potential sources of heterogeneity.

RESULTS

After a detailed screening of 167 studies, seven separate studies were identified. Ventricular arrhythmias in patients with ICD were found to be positively, but not significantly, associated with CO, PM, SO, PM, and NO with a pooled estimate [odds ratio () associated with each 10 μg/m increase in pollutant concentration, except for CO, which was associated with each 1 mg/m increase in concentration] of 1.03 [95% confidence interval (): 0.92-1.17, = 0.59] for CO, 1.01 (95%: 0.97-1.05, = 0.55) for PM, 1.09 (95%: 0.95-1.24, = 0.22) for SO 1.07 (95%: 0.95-1.21, = 0.25) for PM, and 1.06 (95%: 0.98-1.14, = 0.16) for NO. No increased risk of ventricular arrhythmias in patients with ICD was found to be associated with O ( = 1.00; 95%: 0.98-1.01, = 0.56).

CONCLUSIONS

The results of this study provide little evidence that ambient air pollutants affect the risk of ICD discharges for treating ventricular arrhythmias.

摘要

目的

先前关于植入式心脏复律除颤器（ICD）患者的环境空气污染物与室性心律失常的研究结果不一，这些患者中空气污染与室性心律失常之间的关联仍不明确。本研究旨在评估和量化主要空气污染物[一氧化碳（CO）、可吸入颗粒物（PM）、二氧化硫（SO）、细颗粒物（PM）、臭氧（O）和一氧化氮（NO）]暴露与ICD患者室性心律失常存在之间的关联。

方法

检索了医学文献数据库（Medline）、美国国立医学图书馆生物医学数据库（PubMed）、科学引文索引数据库（Web of Science）、全球健康图书馆、虚拟健康图书馆、在线人口信息数据库（POPLINE）以及纽约医学院灰色文献报告数据库，以确定分析ICD患者室性心律失常与上述主要空气污染物之间关联的研究。根据异质性值，使用随机效应模型或固定效应模型生成合并估计值。采用 Cochr an's Q统计量和I²统计量评估研究内的异质性。使用漏斗图、Egger回归检验和Begg秩相关方法评估发表偏倚。还进行了敏感性分析以评估异质性的潜在来源。

结果

在对167项研究进行详细筛选后，确定了7项独立研究。发现ICD患者的室性心律失常与CO、PM、SO、PM和NO呈正相关，但不显著，合并估计值[污染物浓度每增加10μg/m³（CO为每增加1mg/m³）时的比值比（OR）]为：CO为1.03[95%置信区间（CI）：0.92 - 1.17，I² = 0.59]，PM为1.01（95%CI：0.97 - 1.05，I² = 0.55），SO为1.09（95%CI：0.95 - 1.24，I² = 0.22），PM为1.07（95%CI：0.95 - 1.21，I² = 0.25），NO为1.06（95%CI：0.98 - 1.14，I² = 0.16）。未发现ICD患者室性心律失常风险增加与O有关（OR = 1.00；95%CI：0.98 - 1.01，I² = 0.56）。