School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan 430071, China.
Department of Family & Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Int J Environ Res Public Health. 2018 Nov 20;15(11):2593. doi: 10.3390/ijerph15112593.
In this article, we review the available evidence and explore the association between air pollution and insulin resistance (IR) using meta-analytic techniques. Cohort studies published before January 2018 were selected through English-language literature searches in nine databases. Six cohort studies were included in our sample, which assessed air pollutants including PM (particulate matter with an aerodynamic diameter less than or equal to 2.5 μm), NO₂(nitrogen dioxide), and PM (particulate matter with an aerodynamic diameter less than 10 μm). Percentage change in insulin or insulin resistance associated with air pollutants with corresponding 95% confidence interval (CI) was used to evaluate the risk. A pooled effect (percentage change) was observed, with a 1 μg/m³ increase in NO₂ associated with a significant 1.25% change (95% CI: 0.67, 1.84; I² = 0.00%, = 0.07) in the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and a 0.60% change (95% CI: 0.17, 1.03; I² = 30.94%, = 0.27) in insulin. Similar to the analysis of NO₂, a 1 μg/m³ increase in PM was associated with a significant 2.77% change (95% CI: 0.67, 4.87; I² = 94.98%, < 0.0001) in HOMA-IR and a 2.75% change in insulin (95% CI: 0.45, 5.04; I² = 58.66%, = 0.057). No significant associations were found between PM and insulin resistance biomarkers. We conclude that increased exposure to air pollution can lead to insulin resistance, further leading to diabetes and cardiometabolic diseases. Clinicians should consider the environmental exposure of patients when making screening and treatment decisions for them.
在本文中，我们使用荟萃分析技术回顾了现有证据，并探讨了空气污染与胰岛素抵抗（IR）之间的关联。通过在九个数据库中进行英语文献检索，选择了 2018 年 1 月之前发表的队列研究。我们的样本中包括了六项评估空气污染的队列研究，其中包括 PM（空气动力学直径小于或等于 2.5μm 的颗粒物）、NO₂（二氧化氮）和 PM（空气动力学直径小于 10μm 的颗粒物）等污染物。使用与空气污染物相关的胰岛素或胰岛素抵抗的百分比变化（相应的 95%置信区间（CI））来评估风险。观察到一个聚集效应（百分比变化），NO₂每增加 1μg/m³，与 Homeostasis Model Assessment of Insulin Resistance（HOMA-IR）显著增加 1.25%（95%CI：0.67，1.84；I² = 0.00%， = 0.07）有关，胰岛素也有 0.60%的变化（95%CI：0.17，1.03；I² = 30.94%， = 0.27）。与 NO₂的分析类似，PM 每增加 1μg/m³，与 HOMA-IR 显著增加 2.77%（95%CI：0.67，4.87；I² = 94.98%， < 0.0001）和胰岛素增加 2.75%（95%CI：0.45，5.04；I² = 58.66%， = 0.057）有关。PM 与胰岛素抵抗生物标志物之间没有显著关联。我们得出结论，增加空气污染暴露会导致胰岛素抵抗，进而导致糖尿病和代谢性心血管疾病。临床医生在为患者进行筛查和治疗决策时应考虑患者的环境暴露情况。
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