不同暴露窗口空气污染对体外受精妊娠结局的影响

目的探讨不同窗口期空气污染物暴露水平与体外受精(in vitro fertilization, IVF)/卵胞质内单精子注射(intracytoplasmic sperm injection, ICSI)患者妊娠结局之间的关系, 并探索对空气污染物暴露敏感的时间窗。方法对2014年1月至2021年12月期间在哈尔滨医科大学附属第一医院生殖医学科接受首次新鲜卵裂期胚胎移植的2 071例40岁以下不孕症患者的资料进行回顾性队列研究。按促性腺激素(gonadotropin, Gn)启动日是否供暖将患者分为供暖季组和非供暖季组, 比较两组的基线资料和妊娠结局。按IVF/ICSI治疗时间线划分为4个离散的暴露时间窗:暴露窗1, 即Gn启动前75 d到Gn启动日;暴露窗2, 即Gn启动日到取卵前一天;暴露窗3, 即取卵日到第3天胚胎移植日;暴露窗4, 即胚胎移植日到血清人绒毛膜促性腺激素检测日。分别计算每个患者在各个暴露窗口期6种空气污染物[细颗粒物(fine particulate matter, PM2.5)、可吸入颗粒物(inhalable particulate matter, PM10)...     

北京大气污染物暴露对大鼠嗅觉的影响

目的研究北京大气PM2.5和O3暴露对SD大鼠嗅觉的影响。方法于2018年10月,采用随机数字表法将20只8周龄的SD大鼠分为暴露组和对照组(每组各10只),分别饲养于大气污染物暴露系统和清洁级实验环境中,并检测各系统的PM2.5和O3浓度。采用食物小球埋藏实验(BFT)评价不同饲养时间SD大鼠的嗅觉损伤的程度,并采用重复性方差分析两组大鼠的BFT时间差异。结果暴露组大鼠暴露PM2.5和O3浓度分别为(22.65±11.47)、(12.36±5.87)μg/m3;对照组均为0 μg/m3。重复测量资料的方差分析结果显示,PM2.5和O3暴露组BFT所用时间长于对照组(F=6.49,P=0.031);随着饲养时间的增加,BFT所用时间有所延长(F=61.69,P<0.001)。结论大气中PM2.5和O3暴露可能导致大鼠嗅觉损伤。     

嵌合染色体变异全基因组关联研究进展

嵌合染色体变异(mCA)指体细胞突变大规模发生在染色体上使体内有多种核型细胞系的现象, 被视为人类衰老表型之一。mCA与血液系统癌症、心脑血管疾病等多种慢性病存在关联, 但mCA自身的遗传基础(遗传易感位点等)尚在探索。本文对基于大型人群的常染色体mCA、性染色体mCA[Y染色体嵌合缺失(mLOY)和X染色体嵌合缺失(mLOX)]的全基因组关联研究进行综述。其中, 常染色体mCA研究发现的遗传易感位点多与拷贝数中性杂合性缺失类型关联;性染色体mCA的研究多聚焦于嵌合缺失突变, mLOY遗传易感位点数目较多(最多达156个), 而mLOX遗传易感位点数目则较少。     

蔬菜和水果摄入与心脑血管疾病关系的研究进展

心脑血管疾病(心血管病)已成为影响我国居民健康的重要公共卫生问题, 蔬菜和水果摄入不足是包括心血管病在内的主要慢性病发生、发展的重要危险因素。合理摄入且摄入不同种类的蔬菜和水果对心血管病的防治有积极的意义。本文就近年来国内外针对蔬菜和水果摄入量、种类及加工方式与心血管病的发生、发展和死亡之间的关系, 及其可能机制的研究进展进行综述, 为推广合理膳食, 促进居民形成营养均衡的膳食习惯, 完善我国一般和高危人群心血管病预防及心血管病患者管理的策略和措施提供进一步的支持。     

中国成年高血压患者达到强化收缩压控制目标与心脑血管疾病发生风险的关联研究

目的在中国成年高血压人群中, 分析达到强化收缩压(SBP)控制目标(≤130 mmHg)与新发心脑血管疾病风险的关联。方法本研究基于中国慢性病前瞻性研究中成年高血压患者数据。采用logistic回归模型分析达到强化和常规SBP控制目标的影响因素, 采用Cox比例风险回归模型分析达到强化和常规SBP控制目标与发生心脑血管疾病风险的关联。结果共纳入3 628名自报连续服药控制血压的参与者, 其中5.0%达到了强化SBP控制目标。在调整性别、年龄以及城乡后, 文化程度大专及以上(OR=2.36, 95%CI:1.32～4.04)、坚持健康膳食(OR=2.09, 95%CI:1.45～2.96)、每日摄入新鲜水果(OR=1.67, 95%CI:1.17～2.36)以及采用联合用药(OR=1.82, 95%CI:1.03～3.09)的患者更容易达到强化SBP控制目标。随访(10.0±3.7)年后, 复合心脑血管结局发生1 278名。本研究未观察到达到强化SBP控制目标与常规目标者发生复合心脑血管结局风险差异有统计学意义(HR=0.89, 95%CI:0.63～1.25)。主要心血管不良事件、脑血...     

血清高密度脂蛋白胆固醇水平与心脑血管疾病死亡的相关性

目的分析血清高密度脂蛋白胆固醇(HDL-C)水平与心脑血管疾病死亡的相关性。方法选取2009—2014年在浙江省宁波市鄞州区卫生信息大数据平台建档的18岁以上且有完整基线资料的71 618名居民作为研究对象。根据血清HDL-C水平将研究对象分组:低水平组(HDL-C<1.0 mmol/L);中水平组(1.0 mmol/L≤HDL-C<1.5 mmol/L);中高水平组(1.5 mmol/L≤HDL-C<2.0 mmol/L);高水平组(HDL-C≥2.0 mmol/L), 利用Cox比例风险模型分析HDL-C不同水平组人群心脑血管疾病死亡的风险比。结果研究对象累计随访427 989.4人年, 随访时间(5.98±1.04)年, 随访期间共有799例患者死于心脑血管疾病。调整混杂因素后, 以HDL-C中高水平组为参照, 低水平组患者心脑血管疾病死亡的HR(95%CI)为1.43(1.13～1.82), 中水平组患者心脑血管疾病死亡的HR(95%CI)为1.22(1.02～1.46)。结论 HDL-C<1.5 mmol/L会增加人群心脑血管疾病死亡的风险, HDL-...     

新年寄语

瑞雪纷纷, 晶露为霜, 岁岁新年, 今又始航。在这辞旧迎新的时刻, 《中华地方病学杂志》向长期以来关心、支持本刊的各位领导、专家、学者、广大读者及地方病科研、防治工作者致以最诚挚的感谢和最美好的祝福!     

如何应对宝宝猛长期

<正>     

口腔正畸知多少

<正>     

配眼镜有学问

<正>     

Effects of long-term exposure to CO and PM2.5 on microalbuminuria in type 2 diabetes

Objective

No study has examined the effects of air pollutants on albuminuria in type 2 diabetes. Therefore, the present study investigated this association.

Preterm birth and exposure to air pollutants during pregnancy

Background

Research has shown that prenatal exposure to air pollutants may have a detrimental effect on fetal development, with the strength of the relationship depending on the effect being studied. The evidence to date, however, is insufficient to establish a direct causal link between such exposure and preterm delivery. This study evaluates the specific effect of prenatal exposure to NO₂ and benzene on preterm births.

Methods

The population under study comprised 785 pregnant women who formed part of the INMA cohort in Valencia, Spain (2003–2005). Multiple regression models were used for mapping outdoor nitrogen dioxide (NO₂) and benzene levels throughout the area. Individual exposure was assigned as the estimated outdoor levels at each woman’s home measured during each trimester as well as throughout the entire pregnancy. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated in order to assess the association between preterm birth and exposure to NO₂ and benzene. The shape of the exposure–response curve between air pollution and the risk of preterm birth was analyzed with a flexible approach, introducing a natural cubic spline for air pollution levels into the model.

Results

Pregnant women exposed to NO₂ and benzene have an increased risk of preterm birth. This risk was shown to be significant when women were exposed to NO₂ levels >46.2 μg/m³ during the second and third trimesters as well as throughout the entire pregnancy and to benzene levels >2.7 μg/m³ throughout the entire pregnancy.

Conclusion

These results suggest that maternal exposure to traffic-related air pollution is associated with preterm birth.     

长期接触煤矿井下噪声对心血管易感因素的影响

目的通过比较接触煤矿粉尘和噪声的职业人群与仅接触煤矿粉尘的职业人群的心血管疾病易感因素之间的差异,探索噪声对心血管疾病易感因素的影响。方法用现况研究方法,对观察组和对照组的一般情况和心血管易感因素进行统计分析。结果观察组收缩压、舒张压异常率,以及高血压I级发生率较对照组高,且两组之间差异有统计学意义（P〈0．05）。观察组与对照组心电图窦性心动过速改变差异有统计学意义（P〈0．05）。动脉粥样硬化指数（AI）观察组与对照组的差异有统计学意义（P〈0．05）。结论长期的噪声接触可对接噪人员心血管易感因素产生影响。     

Maternal exposure to ambient air pollutants and risk of congenital anomalies

Studies have suggested an association between maternal exposure to ambient air pollution and risk of congenital anomaly. The aim of this study is to investigate the association between exposure to black smoke (BS; particulate matter with aerodynamic diameter <4 μg/m³) and sulphur dioxide (SO₂) during the first trimester of pregnancy and risk of congenital anomalies. We used a case-control study design among deliveries to mothers resident in the UK Northern health region during 1985-1990. Case data were ascertained from the population-based Northern Congenital Abnormality Survey and control data from national data on all births. Data on BS and SO₂ from ambient air monitoring stations were used to average the total pollutant exposure during the first trimester of pregnancy over the daily readings from all monitors within 10 km of the mother's residence. Logistic regression models estimated the association via odds ratios. A significant but weak positive association was found between nervous system anomalies and BS (OR=1.10 per increase of 1000 μg/m³ total BS; 95% CI: 1.03, 1.18), but not with other anomaly subtypes. For SO₂, a significant negative association was found with congenital heart disease combined and patent ductus arteriosus: OR significantly <1 for all quartiles relative to the first quartile. The relationship between SO₂ levels and other anomaly subtypes was less clear cut: there were either no significant associations or a suggestion of a U-shaped relationship (OR significantly <1 for moderate compared to lowest levels, but not with high SO₂ levels). Overall, maternal exposure to BS and SO₂ in the Northern region had limited impact on congenital anomaly risk. Studies with detailed exposure assessment are needed to further investigate this relationship.     

天津市大气气态污染物与居民每日死亡关系的时间序列分析

目的 研究天津市大气气态污染物二氧化硫(SO2)和二氧化氮(NO2)与城区居民每日死亡间的相关性.方法 收集天津市城区2005-2007年大气主要污染物[SO2、NO2和可吸入颗粒物(PM10)]日平均浓度、日平均气温和相对湿度以及每日死因别死亡人数,采用广义相加模型,控制长期和季节趋势、气温和相对湿度等气象因素的影响,探讨SO2和NO2日平均浓度与每日死因别死亡间的相关性,分析PM10及模型参数对其相对危险度估计的影响.结果 大气SO2和NO2与人群每日非意外死亡和循环系统疾病死亡间显著相关,与呼吸系统疾病间无显著关联.SO2浓度每升高10μg/m3,人群非意外死亡和循环系统疾病死亡分别增加0.56%(0.23%～0.89%)和0.49%(0.06%～0.93%);NO2浓度每升高10 μg/m3,人群非意外死亡和循环系统疾病死亡分别增加0.94%(0.17%～1.70%)和1.29%(0.29%～2.30%).结论 天津市大气SO2和NO2污染与城区居民每日非意外死亡和循环系统疾病死亡显著相关.     

孕期大气细颗粒物PM2.5暴露及对早产的影响研究

目的 探讨空气中粒径≤2.5μm的颗粒物(PM_2.5)对早产的影响情况。方法 以受孕日期在2013年1月1日至12月31日之间、山西医科大学第一医院妇产科分娩的太原市区1882例产妇作为研究对象。按照WHO对早产的定义,将研究对象分为早产组和足月产组,关联性分析时再将早产组分为轻度早产组、早期早产和极早早产组。收集其一般人口学特征资料、健康状况、分娩情况、家庭准确住址等资料;收集太原市8个监测点2013年1月1日至2014年10月10日PM_2.5日平均浓度,根据反距离加权法计算孕妇孕期每天PM_2.5暴露浓度,通过多因素非条件logistic回归模型分析PM_2.5对早产的影响情况。结果 1839例产妇的早产发生率为8.21%(151/1839)。调整孕妇年龄、孕妇文化程度、孕前BMI等因素后结果显示,在分娩前第2周PM_2.5浓度暴露值每增加10μg/m³,早产风险增加8.7%(OR=1.087,95%CI:1.001~1.182),轻度早产风险增加9.9%(OR=1.099,95%CI:1.007~1.200)。分娩前第2周孕妇处于PM_2.5高水平环境(≥75μg/m³)中,早产风险增加0.8%(OR=1.008,95%CI:1.000~1.017),轻度早产风险增加1.0%(OR=1.010,95%CI:1.001~1.018)。结论 孕妇在孕晚期尤其是在分娩前半个月,PM_2.5高浓度暴露会导致早产风险增加。     

PM2.5短期暴露对我国死亡和急诊量影响的Meta分析

目的 利用Meta分析定量评价空气中粒径≤ 2.5 μm的颗粒物（PM_2.5）短期暴露与我国居民全因死亡和急诊之间的关系。方法 于2018年3月系统检索中国知网、万方数据知识服务平台、PubMed和EMBASE收集相关文献,提取相对危险度（RR）、超额危险度（ER）及其95% CI,根据异质性检验结果,采用固定或随机效应模型对数据进行合并,并对其进行亚组分析、Meta回归和检验发表偏倚。结果 共纳入33篇原始文献,分别利用39组死亡数据和4组急诊量数据进行Meta分析,结果显示,在47.7~176.7 μg/m³的浓度范围内,PM_2.5每上升10 μg/m³,居民每日全因死亡增加0.49%（95% CI：0.39%~0.59%）,全因急诊量增加0.30%（95% CI：0.10%~0.51%）。对死亡数据的亚组分析显示北方地区（ER=0.42%,95% CI：0.30%~0.54%）合并效应值低于南方地区（ER=0.63%,95% CI：0.44%~0.82%）,研究期间PM_2.5浓度<75 μg/m³地区的合并效应值（ER=0.50%,95% CI：0.37%~0.62%）高于PM_2.5浓度≥ 75 μg/m³的地区（ER=0.39%,95% CI：0.26%~0.52%）。结论 在47.7~176.7 μg/m³的浓度范围内,PM_2.5短期暴露可能与全因死亡和急诊量增加有关。     

Cumulative exposure to particulate matter air pollution and long-term post-myocardial infarction outcomes

Introduction

Chronic environmental exposure to particulate matter < 2.5 μm in diameter (PM_2.5) has been associated with cardiovascular disease; however, the effect of air pollution on myocardial infarction (MI) survivors is not clear. We studied the association of chronic exposure to PM_2.5 with death and recurrent cardiovascular events in MI survivors.

Methods

Consecutive patients aged ≤ 65 years admitted to all medical centers in central Israel after first-MI in 1992–1993 were followed through 2005 for cardiovascular events and 2011 for survival. Data on sociodemographic and prognostic factors were collected at baseline and during follow-up. Residential exposure to PM_2.5 was estimated for each patient based on data recorded at air quality monitoring stations. Cox and Andersen–Gill proportional hazards models were used to study the pollution-outcome association.

Results

Among the 1120 patients, 469 (41.9%) died and 541 (48.3%) experienced one or more recurrent cardiovascular event. The adjusted hazard ratios associated with a 10 μg/m³ increase in PM_2.5 exposure were 1.3 (95% CI 0.8–2.1) for death and 1.5 (95% CI 1.1–1.9) for multiple recurrences of cardiovascular events (MI, heart failure and stroke).

Conclusion

When adjustment for socio-demographic factors is performed, cumulative chronic exposure to PM_2.5 is positively associated with recurrence of cardiovascular events in patients after a first MI.     

Exposure to air pollution and pulmonary function in university students

Objectives: Exposure to air pollution has been reported to be associated with increase in pulmonary disease. The aims of the present study were to examine the use of personal nitrogen dioxide (NO₂) samplers as a means of measuring exposure to air pollution and to investigate the relationship between personal exposure to air pollution and pulmonary function. Methods: We measured individual exposures to NO₂ using passive personal NO₂ samplers for 298 healthy university students. Questionnaire interview was conducted for traffic-related factors, and spirometry was performed when the samplers were returned after 1 day. Results: Personal NO₂ concentrations varied, depending on the distance between residence and a main road (P=0.029). Students who used transportation for more than 1 h were exposed to higher levels of NO₂ than those using transportation for less than 1 h (P=0.032). In terms of transportation, riding in a bus or subway caused significantly higher exposure than not using them (P=0.046). NO₂ exposure was not significantly associated with forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV₁) but was associated with the ratio of FEV₁/FVC and mid-expiratory flow between 25% and 75% of the forced vital capacity (FEF_25–75) (P<0.05). Conclusions: This study indicates that concentrations of personal exposure to NO₂ are significantly influenced by traffic-related air pollution and are associated with decreased pulmonary function.     

The effects of chronic exposure to traffic derived air pollution on the ocular surface

Objectives

The purpose of this study was to explore the clinical relevance of chronic exposure to ambient levels of traffic derived air pollution on the ocular surface.

Methods

A panel study involving 55 volunteers was carried out in São Paulo, Brazil. We measured the mean individual levels of nitrogen dioxide (NO₂) exposure for 7 days. All subjects answered the Ocular Symptom Disease Index (OSDI) and a symptoms inventory. Subsequently, subjects underwent Schirmer I test, biomicroscopy, vital staining and tear breakup time (TBUT) assessment. Subject's mean daily exposure to NO₂ was categorized in quartiles. Statistical analysis was performed using one-way ANOVA, Tukey HSD and Chi-Square tests.

Results

A dose-response pattern was detected between OSDI scores and NO₂ quartiles (p<0.05). There was a significant association between NO₂ quartiles and reported ocular irritation (Χ²=9.2, p<0.05) and a significant negative association between TBUT and NO₂ exposure (p<0.05, R=−0.316, Spearman's correlation). There was a significant increase in the frequency of meibomitis in subjects exposed to higher levels of NO₂ (p<0.05).

Conclusions

Subjects exposed to higher levels of traffic derived air pollution reported more ocular discomfort symptoms and presented greater tear film instability, suggesting that the ocular discomfort symptoms and tear breakup time could be used as convenient bioindicators of the adverse health effects of traffic derived air pollution exposure.