大气污染、肺功能与 COPD：来自世卫组织老龄化与成人健康研究第一波的横断面分析。
Ambient air pollution, lung function and COPD: cross-sectional analysis from the WHO Study of AGEing and adult health wave 1.
机构信息
School of Public health, The University of Sydney, Sydney, New South Wales, Australia
Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia.
出版信息
BMJ Open Respir Res. 2020 Dec;7(1). doi: 10.1136/bmjresp-2020-000684.
BACKGROUND
Long-term exposure to ambient air pollution leads to respiratory morbidity and mortality; however, the evidence of the effect on lung function and chronic obstructive pulmonary disease (COPD) in older adult populations is inconsistent.
OBJECTIVE
To address this knowledge gap, we investigated the associations between particulate matter (PM), nitrogen dioxide (NO) exposure and lung function, as well as COPD prevalence, in older Chinese adults.
METHODS
We used data from the WHO Study on global AGEing and adult health (SAGE) China Wave 1, which includes 111 693 participants from 64 townships in China. A cross-sectional analysis explored the association between satellite-based air pollution exposure estimates (PM with an aerodynamic diameter of ≤10 µm [PM], ≤2.5 µm [PM] and NO) and forced expiratory volume in one second (FEV), forced vital capacity (FVC), the FEV/FVC ratio and COPD (defined as post-bronchodilator FEV/FVC <70%). Data on lung function changes were further stratified by COPD status.
RESULTS
Higher exposure to each pollutant was associated with lower lung function. An IQR (26.1 µg/m) increase in PM was associated with lower FEV (-71.88 mL, 95% CI -92.13 to -51.64) and FEV/FVC (-2.81 mL, 95% CI -3.37 to -2.25). For NO, an IQR increment of 26.8 µg/m was associated with decreases in FEV (-60.12 mL, 95% CI -84.00 to -36.23) and FVC (-32.33 mL, 95% CI -56.35 to -8.32). A 31.2 µg/m IQR increase in PM was linked to reduced FEV (-8.86 mL, 95% CI -5.40 to 23.11) and FEV/FVC (-1.85 mL, 95% CI -2.24 to -1.46). These associations were stronger for participants with COPD. Also, COPD prevalence was linked to higher levels of PM (POR 1.35, 95% CI 1.26 to 1.43), PM (POR 1.24, 95% CI 1.18 to 1.29) and NO (POR 1.04, 95% CI 0.98 to 1.11).
CONCLUSION
Ambient air pollution was associated with lower lung function, especially in individuals with COPD, and increased COPD prevalence in older Chinese adults.
背景
长期暴露于环境空气中的污染物会导致呼吸道发病率和死亡率；然而，关于其对老年人群肺部功能和慢性阻塞性肺疾病（COPD）的影响，证据并不一致。
目的
为了解决这一知识空白，我们研究了在中国老年人群中，颗粒物（PM）、二氧化氮（NO）暴露与肺部功能以及 COPD 患病率之间的关系。
方法
我们使用了来自世界卫生组织全球老龄化与成人健康研究（SAGE）中国波 1 的数据，该研究包含了来自中国 64 个乡镇的 111693 名参与者。一项横断面分析探讨了卫星空气污染物暴露估计值（PM 空气动力学直径≤10µm [PM]、≤2.5µm [PM]和 NO）与用力呼气量（FEV）、用力肺活量（FVC）、FEV/FVC 比值和 COPD（定义为支气管扩张剂后 FEV/FVC<70%）之间的关联。进一步根据 COPD 状态对肺部功能变化数据进行分层。
结果
每种污染物的暴露水平升高与肺部功能下降相关。PM 暴露每增加一个 IQR（26.1µg/m），FEV 降低（-71.88mL，95%CI-92.13 至-51.64），FEV/FVC 降低（-2.81mL，95%CI-3.37 至-2.25）。对于 NO，每增加一个 IQR（26.8µg/m），FEV 降低（-60.12mL，95%CI-84.00 至-36.23），FVC 降低（-32.33mL，95%CI-56.35 至-8.32）。PM 暴露每增加一个 IQR（31.2µg/m），FEV 降低（-8.86mL，95%CI-5.40 至 23.11），FEV/FVC 降低（-1.85mL，95%CI-2.24 至-1.46）。这些关联在 COPD 患者中更为明显。此外，COPD 患病率与较高的 PM（比值比 [OR] 1.35，95%CI 1.26 至 1.43）、PM（OR 1.24，95%CI 1.18 至 1.29）和 NO（OR 1.04，95%CI 0.98 至 1.11）水平相关。
结论
环境空气污染与肺部功能下降有关，尤其是在 COPD 患者中，并且增加了中国老年人群中 COPD 的患病率。
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