摘要
臭氧(ozone,O_(3))污染是当前威胁全球人群心血管健康的重要环境因素,然而,O_(3)暴露的早期心血管效应仍不清楚.人的一生中约1/3的时间在睡眠中度过,研究表明,睡眠期间心率增加是心血管疾病和死亡的关键危险因素.本研究采用重复测量研究设计,对46名稳定期慢性阻塞性肺疾病(简称慢阻肺)患者开展定期随访,每次随访期间对研究对象的24 h个体O_(3)暴露以及睡眠期间心率进行实时监测,同时收集研究对象的肺功能、呼吸道症状、合并症和睡眠质量信息.采用线性混合效应模型分析个体O_(3)短期暴露与睡眠期间心率的关联,采用交互作用模型探讨潜在的易感因素.分析结果显示,数分钟的个体O_(3)暴露即与患者睡眠期间心率升高显著相关,在滞后0~8 h效应达到最强,O_(3)浓度每升高19.6μg m^(-3),睡眠期间心率增加3.28次/min(95%CI:3.12~3.44).暴露-反应关系显示,O_(3)浓度超过33μg m^(-3)时,睡眠期间心率呈现明显的增加趋势.具有较差的健康状态(包括肺功能更低、呼吸道症状更重、活动受限、不良心理精神状态、合并心血管疾病以及睡眠质量较差)的患者睡眠期间心率更容易受到O_(3)的影响.上述结果表明O_(3)短期暴露是慢阻肺患者睡眠期间心率加快的重要危险因素,即使在明显低于我国现行空气质量标准的浓度下,仍可观察到O_(3)的不良心血管影响.本研究可为易感人群心血管疾病的早期防控提供重要科学依据.
The rise in global ozone(O_(3))pollution has sparked growing concerns about its impact on public health,most notably its pronounced role in exacerbating chronic obstructive pulmonary disease(COPD),which is concerning given the irritant effects of O_(3)on the respiratory system.Cardiovascular disease is the most common comorbidity of COPD and contributes to the poor prognosis of COPD.In recent years,a growing body of research has shown that ambient O_(3)is significantly associated with cardiovascular morbidity,hospitalization,and mortality.To date,the early cardiovascular effects of O_(3)exposure in COPD patients remain poorly understood.Human beings spend about one-third of their lives sleeping.Increased heart rate during sleep has been shown to be a critical predictor of cardiovascular morbidity and mortality.However,there is a lack of evidence on the association between short-term exposure to O_(3)and changes in heart rate during sleep.We conducted a repeated-measure study designed to specifically investigate the effects and potential susceptibility factors of O_(3)exposure within hours on heart rate during sleep in COPD patients.Forty-six stable COPD patients were recruited and followed up regularly from March 2021 to September 2023 in Beijing,China.At each clinical visit,24-hour personal O_(3)concentration and heart rate during sleep were monitored in real-time.In addition,spirometry was performed to assess lung function,and respiratory symptoms,quality of life,comorbidities,and sleep quality were investigated using questionnaires.The linear mixed effect models were used to estimate the effects of personal O_(3)exposure on heart rate during sleep,and interaction models examined effect modification by COPD-related health status and sleep quality.Sensitivity analysis was performed by constructing a two-pollutant model that further adjusted the concentration of personal fine particulate matter(PM_(2.5))exposure during the same period.The average personal O_(3)concentration during sleep was 33.2±17.3μg m^(-3)during the study period.We observed personal O_(3)exposure within a few minutes was significantly associated with elevated heart rate during sleep,and the effect reached to be the strongest at lag 0-8 h.For an interquartile range(IQR=19.6μg m^(-3))increase in O_(3),the effect estimates for changes in heart rate during sleep increased from 1.29(95%CI:1.15-1.44)beats/min at lag 0 to 3.28(95%CI:3.12-3.44)beats/min at lag 0-8 h.The associations were robust after adjusting PM_(2.5)levels.The exposure-response relationship showed that heart rate during sleep showed a significant tendency to increase when the O_(3)concentration exceeded 33μg m^(-3).Notably,stronger effects of O_(3)were observed among individuals with worse COPD-related health status,including lower lung function,more severe respiratory symptoms,greater activity limitation,poor psychological status,cardiovascular comorbidities,and poorer sleep quality(P-values for interaction terms<0.001).In summary,these findings suggest that short-term O_(3)exposure is a significant risk factor for an increased heart rate during sleep in COPD patients,even at levels that fall below the current air quality standards set by China and the World Health Organization.Additionally,the study identifies key factors that may exacerbate COPD patients’cardiovascular reactions to O_(3)exposure.These insights contribute new and critical scientific evidence for the early prevention and management of cardiovascular disease in vulnerable groups.Given the global rise in O_(3)pollution,this research underscores the urgency of reducing O_(3)exposure to protect the health of susceptible populations.
作者
张文楼
陈柏锜
赵晨
姬学朝
王珺怡
陈亚红
郭新彪
邓芙蓉
Wenlou Zhang;Baiqi Chen;Chen Zhao;Xuezhao Ji;Junyi Wang;Yahong Chen;Xinbiao Guo;Furong Deng(Department of Occupational and Environmental Health Sciences,School of Public Health,Peking University,Beijing 100191,China;Huayuan Road Community Health Service Center,Haidian District,Beijing 100088,China;Department of Pulmonary and Critical Care Medicine,Peking University Third Hospital,Beijing 100191,China)
出处
《科学通报》
北大核心
2025年第22期3642-3649,共8页
Chinese Science Bulletin
基金
国家自然科学基金(22076006,22376005)
首都卫生发展科研专项(2020-2Z-40917)资助。
关键词
臭氧
慢性阻塞性肺疾病
睡眠
心率
易感因素
ozone
chronic obstructive pulmonary disease
sleep
heart rate
predisposing factors
