大气细颗粒物对妊娠期血压的急性效应研究

目的 研究大气细颗粒物对妊娠期血压的影响,为进一步探讨妊娠高血压疾病的发病机制提供依据.方法 利用上海市孕产期保健队列研究数据及大气细颗粒物监测数据,采用广义相加混合效应模型等方法分析大气细颗粒物对妊娠期血压的急性和滞后效应.结果 研究于2010年共纳入7 402例孕晚期妇女,结果表明在仅考虑气温、湿度、季节和长期趋势及周末效应的情况下,PM1每增加一个四分位数间距(滞后0天、1天、3天和5天),妊娠期妇女收缩压可分别增加0.509mmHg (95％ CI:0.045 ～0.974)、0.504mmHg(95％ CI:0.047～0.961)、0.456mmHg (95％ CI:0.011 ～0.901)、0.466mmHg(95％ CI:0.028 ～0.904),差异均有统计学意义(均P＜0.05);调整气象条件、周末效应、季节因素、产妇年龄、孕产史、高血压家族史、孕前BMI的情况下,妊娠期妇女收缩压可分别增加0.503mmHg(95％CI:0.066 ～0.940)、0.486mmHg(95％CI:0.055 ～0.916)、0.443mmHg(95％ CI:0.022 ～0.865)、0.480mmHg (95％ CI:0.064 ～0.895),差异均有统计学意义(均P＜0.05),但PM2.5浓度对妊娠期收缩压的影响差异无统计学意义(均P＞ 0.05).在仅考虑气温、湿度、季节、长期趋势及周末效应的情况下,PMI每增加一个四分位数间距,滞后3天妊娠期妇女舒张压可增加0.402mmHg(95％CI:0.027 ～0.777),差异有统计学意义(P＜0.05),然而在调整上述因素后,PM2.5水平变化对妊娠期舒张压的影响无统计学意义(P＞0.05).结论 PM1是妊娠期血压增高的独立危险因素,是较有价值的附加空气质量指标,孕期妇女应根据雾霾预警进行及时有效的防护.

Acute effects of fine matter particulate on blood pressure during pregnancy

Objective To study the influence of fine matter particulate on blood pressure during pregnancy so as to provide basis for exploring the mechanism of hypertensive disorders during pregnancy.Methods A cohort study data of health care in pregnancy and monitor data of fine matter particulate in Shanghai were used to analyze the acute and lagged effects of fine maiter particulate on blood pressure in pregnancy by using generalized addictive mixed model.Results A total of 7 402 women at late pregnancy were recruited in the study in 2010.The results showed that IQR increase of PMI (lagged 0,1,3,5 days) could induce the increase of 0.509mmHg (95％ CI:0.045 -0.974),0.504mmHg (95％CI:0.047-0.961),0.456mmHg (95％CI:0.011-0.901) and 0.466mmHg (95％CI:0.028-0.904) in systolic pressure when temperature,humidity,season and long-term trend,and weekend effect were considered,and the differences were statistically significant (all P ＜ 0.05).When adjusting meteorological condition,weekend effect,season factor,maternal age,pregnancy and delivery history,family history of hypertensive disorder and BMI before pregnancy,the systolic pressure might increase 0.503mmHg (95 ％ CI:0.066-0.940),0.486mmHg (95 ％ CI:0.055-0.916),0.443mmHg (95 ％ CI:0.022-0.865) and 0.480 mmHg (95％CI:0.064-0.895),respectively,and the differences were significant (all P ＜ 0.05).However,there was no statistical significance of PM2.5 exposure on systolic blood pressure during pregnancy (all P ＞ 0.05).IQR increase of PM1 (lagged 0,1,3,5 days) could induce the increase of 0.402mmHg (95 ％ CI:0.027-0.777) in diastolic pressure at 3 lagged day with statistical significance (P ＜0.05) when temperature,humidity,season and long-term trend,and weekend effect were considered.When adjusting the above factors,diastolic pressure was not influenced by PM2.5 (P ＞ 0.05).Conclusion PM1 is the independent risk factor of blood pressure increase,and it is a valuable index for air quality.Women in pregnancy should conduct timely and effective protection when receiving smog warning.