大气细颗粒物对慢性阻塞性肺疾病状态影响的随访

目的探讨大气细颗粒物对慢性阻塞性肺疾病(COPD)患者的影响。 方法选择在我院确诊并且病情处于稳定期的COPD患者100例，随访4次，检测研究对象的肺功能、炎症因子水平、氧化应激指标水平以及心率等指标，使用线性混合效应模型分析大气细颗粒物对COPD患者肺功能的影响。 结果累积暴露1～7 d，PM_2.5与COPD患者的第1秒用力肺活量(FEV₁)呈负相关，PM_2.5每升高IQR浓度，患者FEV₁变化为-3.05%(95%CI：-5.11%～-1.05%)～-2.47%(95%CI：-4.26%～-0.78%)；PM_2.5与COPD患者的第1秒用力呼气量占所有呼气量的比例(FEV₁/FVC%)之间呈负相关，PM_2.5每升高IQR浓度，患者FEV₁/FVC%变化为-2.57%(95%CI：-4.69%～-1.53%)～-3.39%(95%CI：-4.02%～-0.74%)。根据COPD患者血清超敏C反应蛋白(hs-CRP)、超氧化物歧化酶(SOD)、丙二醛(MDA)浓度中位数水平进行分层分析，PM_2.5对FEV₁、FEV₁/FVC肺功能指标的降低效应在高hs-CRP 、高SOD、MDA患者中更强。在高hs-CRP患者中，PM2.5每升高IQR浓度，患者FEV₁变化-3.35%(95%CI：-6.47%～-0.28%)；在高MDA患者中，PM_2.5每升高IQR浓度，患者FEV₁变化-4.12%(95%CI：-8.43%～-0.23%)；在高SOD患者中，PM_2.5每升高IQR浓度，患者FEV₁变化-3.76%(95%CI：-7.32%～-0.22%)；在高hs-CRP患者中，PM_2.5每升高IQR浓度，患者FEV₁/FVC变化-3.76%(95%CI：-7.35%～-0.21%)；在高MDA患者中，PM_2.5每升高IQR浓度，患者FEV₁/FVC%变化-0.98%(95%CI：-1.89%～-0.11%)；在高SOD患者中，PM_2.5每升高IQR浓度，患者FEV₁/FVC%变化1.69%(95%CI：-3.01%～-0.17%)。 结论大气细颗粒物可影响COPD患者的氧化应激反应、炎症反应、心血管系统，影响患者的肺功能。

Long-term follow-up study of the effects of atmospheric fine particles on COPD disease status

ObjectiveTo investigate the effect of fine particles on the patients with COPD. Methodsin this study, 100 COPD patients who were diagnosed in our hospital and whose condition was stable were selected. The pulmonary function, inflammatory factor level, oxidative stress index level and heart rate of the subjects were measured four times after follow-up. The effects of atmospheric fine particles on the pulmonary function of COPD patients were analyzed by linear mixed effect model. Resultsafter cumulative exposure for 1-7 days, PM2.5 was negatively correlated with FEV₁ in COPD patients. For every increase of IQR concentration in PM2.5, FEV₁ in COPD patients changed -3.05% (95%CI: -5.11%~- 1.05%)~-2.47% (95%CI: -4.26%~-0.78%); There was a negative correlation between PM_2.5 and FEV₁/FVC% of COPD patients. For every increase of IQR concentration in PM_2.5, FEV₁/FVC% of patients changed from -2.57% (95%CI: -4.69%~-1.53%)~-3.39% (95%CI: -4.02%~-0.74%). According to the stratified analysis of the median levels of H S CRP, SOD and MDA in COPD patients, the effect of PM_2.5 on FEV₁ and FEV₁/FVC was stronger in patients with high hs CRP, high SOD and MDA. In hs-CRP patients, the FEV₁ of PM_2.5 increased by -3.35%(95%CI: -6.47%~-0.28%). In the patients with high SOD, the FEV₁ of PM_2.5 increased by -3.76%(95%CI: -7.32%~-0.22%), In hs-CRP patients, FEV₁/FVC of PM_2.5 increased by -3.76%(95%CI: -7.35%~-0.21%). In patients with high MDA, FEV₁/FVC% changed by -0.98%(95%CI: -1.89%~-0.11%) for every increase of IQR concentration in PM_2.5, and FEV₁/FVC% changed by 1.69%(95%CI: -3.01%~-0.17%) for every increase of IQR concentration in patients with high sod; Conclusionaerosols can affect the oxidative stress, inflammatory response, cardiovascular system, lung function of COPD patients.