Liao Kuo-Hsing, Chan Ta-Chien, Wu Chia-Chieh, Huang Wen-Cheng, Hsu Chin-Wang, Chuang Hsiao-Chi, Wiratama Bayu Satria, Chiu Wen-Ta, Lam Carlos
Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Division of Critical Medicine, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Front Neurol. 2023 May 10;14:1087767. doi: 10.3389/fneur.2023.1087767. eCollection 2023.
The detrimental effects of air pollution on the brain are well established. However, few studies have examined the effect of air pollution on traumatic brain injury (TBI). This pilot study evaluated the association between short-term air pollution exposure and traumatic intracranial hemorrhage (TIH).
Hospital data of patients with TBI following road traffic accidents were retrospectively collected from the electronic medical records at five trauma centers in Taiwan between 1 January and 31 December 2017. TIH was employed as an outcome measure. All road accident locations were geocoded, and air quality data were collected from the nearest monitoring stations. Air pollutants were entered into five multivariable models. A sensitivity analysis was performed on patients who are vulnerable to suffering TBI after road accidents, including motorcyclists, bicyclists, and pedestrians.
Among 730 patients with TBI, 327 had TIH. The ages of ≥65 [odds ratio (OR), 3.24; 95% confidence interval (CI), 1.85-5.70], 45-64 (OR, 2.61; 95% CI, 1.64-4.15), and 25-44 (OR, 1.79; 95% CI, 1.13-2.84) years were identified as significant risk factors in the multivariable analysis. In the best-fit multivariable model, exposure to higher concentrations of particulate matter ≤ 2.5 μm in aerodynamic diameter (PM) was associated with an elevated TIH risk (OR, 1.50; 95% CI, 1.17-1.94). The concentration of nitrogen oxides (NO) did not increase the risk of TIH (OR, 0.45; 95% CI, 0.32-0.61). After categorizing the air pollution concentration according to quartile, the trend tests in the multivariate model showed that the concentrations of PM and NO were significant ( = 0.017 and < 0.001, respectively). There was a negative borderline significant association between temperature and TIH risk (OR, 0.75; 95% CI, 0.56-1.00, = 0.05). Notably, the single-vehicle crash was a significant risk factor (OR, 2.11; 95% CI, 1.30-3.42) for TIH.
High PM concentrations and low temperatures are risk factors for TIH in patients with TBI. High NO concentrations are associated with a lower TIH risk.
空气污染对大脑的有害影响已得到充分证实。然而，很少有研究探讨空气污染对创伤性脑损伤（TBI）的影响。这项初步研究评估了短期空气污染暴露与创伤性颅内出血（TIH）之间的关联。
回顾性收集2017年1月1日至12月31日期间台湾五个创伤中心电子病历中道路交通事故后创伤性脑损伤患者的医院数据。将创伤性颅内出血用作结局指标。对所有道路事故地点进行地理编码，并从最近的监测站收集空气质量数据。将空气污染物纳入五个多变量模型。对道路事故后易患创伤性脑损伤的患者进行了敏感性分析，包括摩托车手、自行车骑行者和行人。
在730例创伤性脑损伤患者中，327例发生了创伤性颅内出血。多变量分析确定年龄≥65岁（比值比[OR]，3.24；95%置信区间[CI]，1.85 - 5.70）、45 - 64岁（OR，2.61；95%CI，1.64 - 4.15）和25 - 44岁（OR，1.79；95%CI，1.13 - 2.84）为显著危险因素。在最佳拟合多变量模型中，暴露于空气动力学直径≤2.5μm的颗粒物（PM）浓度较高与创伤性颅内出血风险升高相关（OR，1.50；95%CI，1.17 - 1.94）。氮氧化物（NO）浓度并未增加创伤性颅内出血风险（OR，0.45；95%CI，0.32 - 0.61）。根据四分位数对空气污染浓度进行分类后，多变量模型中的趋势检验表明，PM和NO浓度具有显著性（分别为 = 0.017和 < 0.001）。温度与创伤性颅内出血风险之间存在边缘性负相关（OR，0.75；95%CI，0.56 - 1.00， = 0.05）。值得注意的是，单车碰撞是创伤性颅内出血的显著危险因素（OR，2.11；95%CI，1.30 - 3.42）。
高PM浓度和低温是创伤性脑损伤患者发生创伤性颅内出血的危险因素。高NO浓度与较低的创伤性颅内出血风险相关。
