Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 86 Wujin Road, Shanghai, 200080, People's Republic of China.
Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240, People's Republic of China.
Environ Sci Pollut Res Int. 2022 Nov;29(54):82243-82255. doi: 10.1007/s11356-022-21458-6. Epub 2022 Jun 24.
Atmospheric pollutants increase the risk of acute ischemic stroke (AIS) which has been widely reported. However, little is known about the relationships between air pollution and specific subsets of AIS, such as wake-up stroke (WUS) and non-wake-up stroke (non-WUS). This study aimed to explore the relationship between WUS and non-WUS and atmospheric pollutants. A total of 1432 patients (331 WUS patients and 1101 non-WUS patients) were admitted to a tertiary hospital from 2016 to 2019. A time-stratified case-crossover design and a conditional logistic regression model to study the associations of change in pollutant concentration with WUS and non-WUS events were constructed. Data analysis revealed that WUS-related risks increased 48 to 72 h after the increase in the PM concentration (each 10 μg/m increase, lag 0-72 h) [threshold OR (95% CI):18 μg/m 1.03 (0.94-1.11), 35 μg/m 1.01 (0.92-1.12), 50 μg/m 1.04 (0.91-1.19)]; the non-WUS-related risk increased 1 to 6 h after the increase in the PM concentration (each 10 μg/m increase, lag 0-1 h) [threshold OR (95% CI):18 μg/m 1.01 (0.98-1.03), 35 μg/m 1.00 (0.97-1.04), 50 μg/m 1.01 (0.96-1.05)] (lag 0-6 h) [threshold OR (95% CI): 18 μg/m 1.00 (0.97-1.03), 35 μg/m 1.00 (0.97-1.04), 50 μg/m 1.01 (0.97-1.06)]; O exposure was related to WUS events, and its impact on WUS events was stronger and longer-lasting (1-96 h) than its impact on non-WUS events (1-6 h). Greater than or equal to 65 years of age, overweight (BMI ≥ 25), and diabetes had a significantly greater risk of WUS associated with increased PM concentration in the previous 12-96 h than patients without these conditions. Patients with hypertension and smoking had a significant risk of non-WUS associated with increased PM concentration in the previous 1-6 h. The increase in PM concentration in the cold season increased the risk of both WUS and non-WUS events. Ambient air pollution hysteresis triggers WUS and rapidly triggers non-WUS, even if the degree of pollutant is relatively low. Patients with elderly, overweight, and diabetes appeared particularly susceptible to WUS, and patients with hypertension and smoking history were susceptible to non-WUS. We need to expand the sample for further investigation into mechanisms by which environmental pollutants trigger WUS or non-WUS.
大气污染物增加了急性缺血性脑卒中（AIS）的风险，这已经得到了广泛的报道。然而，人们对空气污染与 AIS 的特定亚组（如觉醒性卒中（WUS）和非觉醒性卒中（non-WUS））之间的关系知之甚少。本研究旨在探讨 WUS 和非 WUS 与大气污染物之间的关系。共有 1432 名患者（331 名 WUS 患者和 1101 名非 WUS 患者）于 2016 年至 2019 年入住一家三级医院。采用时间分层病例交叉设计和条件逻辑回归模型来研究污染物浓度变化与 WUS 和非 WUS 事件的关联。数据分析显示，WUS 相关风险在 PM 浓度增加后的 48 至 72 小时内增加（每增加 10μg/m，滞后 0-72 小时）[阈值 OR（95%CI）：18μg/m 1.03（0.94-1.11），35μg/m 1.01（0.92-1.12），50μg/m 1.04（0.91-1.19）]；非 WUS 相关风险在 PM 浓度增加后的 1 至 6 小时内增加（每增加 10μg/m，滞后 0-1 小时）[阈值 OR（95%CI）：18μg/m 1.01（0.98-1.03），35μg/m 1.00（0.97-1.04），50μg/m 1.01（0.96-1.05）]（滞后 0-6 小时）[阈值 OR（95%CI）：18μg/m 1.00（0.97-1.03），35μg/m 1.00（0.97-1.04），50μg/m 1.01（0.97-1.06）]；臭氧暴露与 WUS 事件有关，其对 WUS 事件的影响比非 WUS 事件更强且更持久（1-96 小时）[1-6 小时]。大于或等于 65 岁、超重（BMI≥25）和糖尿病患者与无这些条件的患者相比，与 PM 浓度增加相关的 WUS 风险显著增加（12-96 小时前）。高血压和吸烟史患者与 PM 浓度增加相关的非 WUS 风险显著增加（1-6 小时前）。寒冷季节 PM 浓度的增加增加了 WUS 和非 WUS 事件的风险。大气污染物滞后触发 WUS 并迅速触发非 WUS，即使污染物程度相对较低。年龄较大、超重和患有糖尿病的患者似乎特别容易发生 WUS，而患有高血压和吸烟史的患者则容易发生非 WUS。我们需要扩大样本，以进一步研究环境污染物触发 WUS 或非 WUS 的机制。
