摘要
大气二氧化氮(NO_(2))短期暴露与缺血性心脏病的发病、死亡风险增加有关,而ST段压低事件是心肌缺血的敏感性指标.探索NO_(2)短期个体暴露与ST段压低事件发生风险之间的关联有助于进一步阐明大气NO_(2)短期个体暴露与缺血性心脏病关联的潜在生物学机制.本研究基于一项在天津、上海和西安开展的定组研究(90人)以及一项在北京开展的随机双盲对照干预性研究(102人)探索NO_(2)短期个体暴露与ST段压低事件发生风险之间的关联,并在干预研究中评估补充L-精氨酸潜在的保护作用.定组研究结果显示,NO_(2)24 h个体暴露浓度每增加1个四分位间距(18.1 ppb,parts per billion)与前导联、前外侧导联、下导联以及总导联的ST段压低事件发生次数分别显著增加29.14%(12.26%,48.55%)、18.96%(5.75%,33.84%)、86.22%(58.26%,119.07%)和22.46%(13.61%,31.98%)有关;干预研究中,NO_(2)4 h个体暴露与所有导联的ST段压低事件发生次数显著增加有关,NO_(2)8 h个体暴露与前导联、前外侧导联和总导联的ST段压低事件次数显著增加有关.干预研究显示口服L-精氨酸补充剂对NO_(2)短期个体暴露引起的前导联和前外侧导联的ST段压低事件发生风险起到拮抗作用.本研究显示NO_(2)短期个体暴露与心肌缺血发生风险有关,未来需要更大样本量的研究进一步验证研究结果的稳定性.
There exists an association between short-term exposure to ambient nitrogen dioxide(NO_(2))and an increased risk of morbidity and mortality from ischemic heart disease(IHD).The ST-segment depression event is a sensitive clinical indicator of myocardial ischemia.Therefore,investigating the association between short-term NO_(2) exposure and the risk of ST-segment depression events may contribute to further elucidating the biological mechanisms underlying the association between short-term NO_(2) exposure and IHD.This study,which was based on a multicenter panel study conducted in Tianjin,Shanghai,and Xi’an(n=90)and a randomized double-blind controlled intervention study conducted in Beijing(n=102),explored the association between short-term personal NO_(2) exposure and the risk of 24-h ambulatory ECG ST-segment depression events across different leads.The panel study employed a generalized linear mixed-effects model with adjustments for potential confounders to analyze the associations between short-term personal NO_(2) exposure and the number of ST-segment depression events across different leads.For the intervention study,a generalized linear model with adjustments for potential confounders was used to investigate the associations between short-term personal NO_(2) exposure and the number of ST-segment depression events across different leads.All of the results were provided as percent changes in the number of ST-segment depression events,with 95%confidence intervals associated with per interquartile(IQR)increase in personal NO_(2) exposure concentrations.Furthermore,the potential protective effects of L-arginine supplementation were evaluated in the intervention study.The panel study revealed that per IQR(18.4 ppb)increase in 24-hour personal NO_(2) exposure concentrations was related to significant increases,namely,29.14%(12.26%,48.55%),18.96%(5.75%,33.84%),86.22%(58.26%,119.07%),and 22.46%(13.61%,31.98%),in the number of ST-segment depression events in the anterior,anterolateral,inferior,and total leads,respectively.In the intervention study,an association was found between per IQR(19.3 ppb)increase in 4-hour personal NO_(2) exposure and significant increases of 24.12%(14.05%,35.09%),22.01%(13.29%,31.41%),18.78%(8.99%,29.45%),21.06%(9.69%,33.61%),and 21.13%(15.28%,27.28%)in the number of ST-segment depression events in the anterior,anterolateral,lateral,inferior,and total leads,respectively.It was also found that 8-h personal NO_(2) exposure was only associated with significant increases in the number of ST-segment depression events in the anterior,anterolateral,and total leads.In the intervention study,L-arginine supplementation attenuated the increase in the number of ST-segment depression events in the anterior and anterolateral leads associated with short-term personal NO_(2) exposure.Thus,the present study demonstrated that short-term personal NO_(2) exposure is related to a potentially increased risk of myocardial ischemia,and that L-arginine supplementation may alleviate the adverse myocardial ischemic effects of shortterm NO_(2) exposure.
作者
姜云星
雷磊
兰阳
王凯
房小红
邓芙蓉
汤乃军
王艳
郭新彪
吴少伟
Yunxing Jiang;Lei Lei;Yang Lan;Kai Wang;Xiaohong Fang;Furong Deng;Naijun Tang;Yan Wang;Xinbiao Guo;Shaowei Wu(Department of Occupational and Environmental Health,School of Public Health,Xi’an Jiaotong University Health Science Center,Xi’an 710061,China;Key Laboratory of Environment and Genes Related to Diseases(Xi’an Jiaotong University),Ministry of Education,Xi’an 710061,China;Department of Cardiovascular Medicine,First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Occupational and Environmental Health Sciences,School of Public Health,Peking University,Beijing 100191,China;Department of Occupational and Environmental Health,School of Public Health,Tianjin Medical University,Tianjin 300070,China;The Ninth People’s Hospital of Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)
出处
《科学通报》
北大核心
2025年第22期3671-3680,共10页
Chinese Science Bulletin
基金
国家重点研发计划(2022YFC3702604,2017YFC0211601)资助。
关键词
空气污染
二氧化氮
心肌缺血
ST段压低
缺血性心脏病
air pollution
nitrogen dioxide
myocardial ischemia
ST-segment depression
ischemic heart disease
