COPD 患者室内颗粒物与全身炎症相关性的改变。
Modification of associations between indoor particulate matter and systemic inflammation in individuals with COPD.
机构信息
Research and Development Service, VA Boston Healthcare System, Boston, MA, USA.
Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
出版信息
Environ Res. 2022 Jun;209:112802. doi: 10.1016/j.envres.2022.112802. Epub 2022 Jan 29.
RATIONALE
Little is known about personal characteristics and systemic responses to particulate pollution in patients with COPD.
OBJECTIVES
Assess whether diabetes, obesity, statins and non-steroidal anti-inflammatory medications (NSAIDs) modify associations between indoor black carbon (BC) and fine particulate matter ≤2.5 μm in diameter (PM) on systemic inflammation and endothelial activation.
METHODS
144 individuals with COPD without current smoking and without major in-home combustion sources were recruited at Veterans Affairs Boston Healthcare System. PM and BC were measured in each participant's home seasonally for a week (up to 4 times; 482 observations) and plasma biomarkers of systemic inflammation [C-reactive protein (CRP); interleukin-6 (IL-6)] and endothelial activation [soluble vascular adhesion molecule-1 (sVCAM-1)] measured. Linear mixed effects regression with a random intercept was used, and effect modification assessed with multiplicative interaction terms and stratum specific estimates.
RESULTS
Median (25%ile, 75%ile) indoor BC and PM were 0.6 (0.5,0.7) μg/m and 6.8 (4.8,10.4) μg/m, respectively. Although p-values for effect modification were not statistically significant, there were positive associations (%-increase/interquartile range; 95% CI) between CRP and BC greater among non-statin (18.8%; 3.6-36.3) than statin users (11.1%; 2.1-20.9). There were also positive associations greater among non-statin users between PM and CRP. For IL-6, associations with BC and PM were also greater among non-statin users. Associations between CRP and BC were greater (20.3%; 4.5-38.5) in persons with diabetes than without diabetes (10.3%; 0.92-20.6) with similar effects of PM. There were no consistent associations that differed based on obesity. Effect modification was not observed for NSAID use, or with any factor considered with sVCAM-1.
CONCLUSIONS
Associations between indoor BC and PM and CRP were greater in patients with diabetes and those not taking statins, and with IL-6 if not taking statins. These results suggest that these characteristics may modify the systemic response to indoor BC and PM in persons with COPD.
背景
对于慢性阻塞性肺疾病（COPD）患者的个人特征和对颗粒物污染的系统反应知之甚少。
目的
评估糖尿病、肥胖、他汀类药物和非甾体抗炎药（NSAIDs）是否会改变室内黑碳（BC）与直径≤2.5μm 的细颗粒物（PM）之间的关联，从而影响全身炎症和内皮激活。
方法
在退伍军人事务部波士顿医疗保健系统招募了 144 名无当前吸烟且家中无主要燃烧源的 COPD 患者。每例患者在家中季节性测量 PM 和 BC，每周一次（最多 4 次；482 次观测），并测量全身炎症的血浆生物标志物[C 反应蛋白（CRP）；白细胞介素-6（IL-6）]和内皮激活[可溶性血管细胞黏附分子-1（sVCAM-1）]。使用带有随机截距的线性混合效应回归，并使用乘法交互项和分层特定估计值评估效应修饰。
结果
室内 BC 和 PM 的中位数（25%分位数，75%分位数）分别为 0.6（0.5，0.7）μg/m 和 6.8（4.8，10.4）μg/m。尽管效应修饰的 p 值没有统计学意义，但 CRP 与 BC 之间的正相关（%增加/四分位距；95%CI）在非他汀类药物使用者（18.8%；3.6-36.3）中高于他汀类药物使用者（11.1%；2.1-20.9）。在非他汀类药物使用者中，CRP 与 PM 之间也存在正相关。对于 IL-6，BC 和 PM 与非他汀类药物使用者之间的关联也更大。CRP 与 BC 之间的关联在糖尿病患者中（20.3%；4.5-38.5）大于非糖尿病患者（10.3%；0.92-20.6），PM 也有类似的效果。根据肥胖情况，没有观察到基于这些因素的一致关联。非甾体抗炎药使用或任何与 sVCAM-1 相关的因素均未观察到效应修饰。
结论
在糖尿病患者和未服用他汀类药物的患者中，室内 BC 和 PM 与 CRP 之间的关联更大，而在未服用他汀类药物的患者中，IL-6 与 CRP 之间的关联更大。这些结果表明，这些特征可能会改变 COPD 患者对室内 BC 和 PM 的全身反应。
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