空气污染与心血管疾病发病及预后的研究进展

近年来以细颗粒物（PM2.5）为代表的可吸入颗粒物（PM）日益被视为全球空气污染相关死亡率升高的主要原因。有确凿的证据支持炎症、氧化应激、动脉粥样硬化、血栓形成以及自主调节异常等多种机制的相互作用,最终可增加短期及长期接触污染空气人群心血管疾病发病率与死亡率。空气污染带来的心血管风险是可以部分规避的。     

空气污染与心率变异性关系的研究进展

心血管疾病是威胁中国居民健康的首要原因,空气污染是影响心血管疾病发生和发展的重要环境危险因素。心率变异性是评价自主神经功能的指标,并且与心血管疾病预后密切相关。研究表明,空气污染可能通过影响心脏自主神经功能而导致心血管疾病的发生,但目前研究结果并不一致。现对国内外空气污染与心率变异性关系的研究现状进行综述。     

高血压与心律失常相关性研究的进展

高血压是心血管疾病最常见的危险因素,研究表明高血压和心律失常之间存在复杂的相互作用,与多种房性和室性心律失常的发生、发展有关。本文总结了有关高血压与心律失常相关性的现有文献,对高血压与心房颤动、室性心律失常、心源性猝死的流行病学、发病机制和临床意义进行综述。     

石家庄市空气污染与儿科呼吸系统疾病住院率的相关性研究

目的 研究石家庄市空气污染与儿科呼吸系统疾病(哮喘发作、喘息性支气管炎、肺炎)住院率的相关性.方法 连续记录河北省石家庄市2016年1月至2017年1月空气质量检测数据,并收集同期河北省儿童医院哮喘发作、喘息性支气管炎及肺炎住院率,结合同期环境监测资料,进行直线相关回归分析,分析大气污染物对儿科呼吸系统疾病住院率的影响.结果 喘息性支气管炎住院率与大气中SO2和NO2月平均浓度呈中度正相关(r=0.598、0.626,均P<0.05),喘息性支气管炎住院率与PM10、CO、PM2.5和O3均无直线相关关系;肺炎住院率与SO2、NO2、PM10、CO和PM2.5月平均浓度均呈高度正相关(r=0.867、0.811、0.825、0.931和0.860,均P<0.05),与O3月平均浓度无直线相关关系.污染物浓度每增加10单位,喘息性支气管炎住院率增加0.1%,肺炎住院率增加2.4%.结论 石家庄市大气污染物PM10、PM2.5、NO2、SO2和CO污染对儿童呼吸系统造成一定的损伤,并导致相应疾病住院率的增加.     

心律失常与心肌梗塞部位及预防的相关性研究

本文总结了60例AMI件心律失常的病例，并结合文献复习，对不同部位AMI时心律失常发生的频率、类型、程度、预防以及机理作以阐述。     

空气污染对哮喘患者健康的负面影响

空气污染与哮喘发生和加重相关,其机制包括过氧化和损伤,气道重塑,炎性通路和异常免疫反应,以及呼吸系统对过敏原敏感性的增强等。哮喘患者暴露于臭氧、NO2和SO2等空气污染物可发生气道急性效应。预防空气污染所致哮喘的方法包括食用维生素C饮食、补充维生素D、肥胖哮喘患者积极减肥,减少二手烟污染,以及控制空气中细颗粒物浓度。     

脑钠肽与心律失常的相关性研究

目的探讨慢性肺心病患者脑钠肽（BNP）与心律失常的相关性。方法选择157例慢性肺心病患者分两组,A组（BNP＆lt;80pg/mL）87例和B组（BNP＆gt;80pg/mL）70例,进行心电图及BNP检测。结果A组87例中并发心律失常33例（43.4%）,B组70例并发心律失常43例（56.6%）。结论肺心病患者中BNP升高时,心律失常的发生率高,呈正相关。     

室性心律失常与心率变异性的相关性研究

作者用２４ｈ动态心电图研究６６例冠心病患者室性心律失常和心率变异的相关性。结果发现,高危室早（Ｌｏｗｎ分级≥Ⅲ级）的发生与性别、年龄、冠脉病变程度和心肌梗死与否无明显相关,但高危室早者的ＳＤＮＮ（Ｐ〈０．０１）,ＳＤＡＮＮ（Ｐ〈０．０１）和ＬＦ（Ｐ〈０．０５）低于低危室早者（Ｌｏｗｎ分级≤Ⅱ级）。提示ＳＤＮＮ,ＳＤＡＮＮ和ＬＦ减小是高危室早发生的独立危险因子。     

社会心理因素与室性心律失常相关性研究

对５０例临床上没有心脏器质性损害证据的室性心律失常（ＶＡ）患者和５０例正常人进行对照研究。结果表明：病例组所经历的生活事件频数、负性生活事件紧张值、Ａ型行为评分、消极应付方式均明显高于对照组（Ｐ〈０．００１）。社会支持总分和应付方式均显著低于对照组。多元线性回归发现ＶＡ的主要社会心理危险因素为：神经质、焦虑、敌对负性生活事件，而社会支持和阳性生活事件为保护因素。这些均提示ＶＡ的发生发展是多因素共同     

缝隙连接蛋白与心律失常的相关性研究进展

以往认为心律失常的发生主要与心肌细胞兴奋性异常有关但近年来的研究表明细胞间电耦联障碍是心律失常的另一个重要原因之一,其所起的致心律失常作用甚至大于兴奋性异常。由心肌缝隙连接蛋白(connexin,Cx)构成的缝隙连接(gapjunction,GJ)通道是心肌细胞之间的一种特殊连接通道,     

兰尼碱受体2调节及其与心律失常的关系

兰尼碱受体2是广泛存在于肌浆网上的Ca2+释放通道,受到多种因子的调节,兰尼碱受体2参与心肌细胞的兴奋-收缩耦联,兰尼碱受体2的结构或调节异常与心力衰竭及致死性心律失常的发生关系密切。现对兰尼碱受体2的结构、调节及其在心律失常中的作用机制作一阐述。     

空气污染与心血管疾病专家共识

空气污染是全球性的严重公共卫生问题,也是对我国民众健康的严峻挑战。空气污染可增加心血管疾病发病及死亡风险,已成为一项重要且可干预的心血管疾病危险因素。空气污染导致的死亡主要为心血管疾病死亡。本共识汇总了国内外关于空气污染与心血管疾病的最新流行病学及临床研究证据,推荐室内使用清洁能源烹饪及采暖、在重污染天气佩戴符合国家标准的N95防护口罩等措施以降低个体对空气污染物的暴露水平。该共识为进一步加强医疗卫生人员对空气污染危害心血管健康的认识,帮助其开展健康宣教和确定未来科研方向,并为相关部门制定公共卫生政策提供参考。     

恶性心律失常的急诊识别与处理

恶性心律失常是心脏性猝死的主要原因,常可在短期内导致严重后果,应早期识别、早期处理。目前关于恶性心律失常的处理尚无完全统一的急诊处理规范,Trappe新提出的“5A”及“BCD”治疗策略覆盖了缓慢型及快速型恶性心律失常,是恶性心律失常急诊治疗的新概念、新方法。     

Early-Lifetime Exposure to Air Pollution and Allergic Sensitization in Children with Asthma

Observations on the association between exposure to common outdoor air pollutants and allergic sensitization have not been consistent. Little research has been done on the effects of prenatal exposure or the effect among asthmatics. The association between prenatal and early-life exposures and outdoor air pollutants with allergic sensitization was examined within a cohort of 170 children ages 6–11 years with asthma, living in the Central Valley of California. Allergic sensitization was ascertained by skin-prick tests to 14 allergens. Prenatal and early-life exposure to ozone (O₃), nitrogen dioxide (NO₂), carbon monoxide (CO) and particulate matter with a median aerodynamic diameter < 10 μ m (PM₁₀) was reconstructed for each child. Models were developed for sensitized to (a) any allergen, (b) at least one outdoor allergen, and (c) at least one indoor allergen. In multivariable analyses, higher exposure to CO during pregnancy was associated with an increased risk of sensitization to at least one outdoor allergen. The largest effect was seen for the association between exposure to 8-hour daily maximum CO during pregnancy and sensitization to at least one outdoor allergen. (OR = 1.55 (95% CI: 1.01, 2.37)) per interquartile range (IQR) increase.) Similar effects estimates were seen for 2nd trimester exposure to CO, but these were less precisely estimated (OR = 1.45 (95%CI: 0.90, 2.35)). No significant associations with the pollutants were seen for sensitization to allergens in general or to at least one indoor allergen. Exposure to traffic-related pollutants during pregnancy may increase the risk of sensitization to outdoor allergens among asthmatic children.     

Efficacy of an Outdoor Air Pollution Education Program in a Community at Risk for Asthma Morbidity

Background. Asthma management guidelines recommend avoiding exposure to indoor and outdoor air pollutants. A limitation of such recommendations is that they do not provide information about how the public should obtain and act on air quality information. Although the Air Quality Index (AQI) provides simplified outdoor air quality forecasts, communities with high rates of asthma morbidity tend to have low rates of internet access due to factors such as low socioeconomic status. Assessments of knowledge about air quality among low-income minority communities are lacking, as are community-based programs to educate the public about using the AQI. Methods. An air quality education program and system for disseminating air quality information were developed to promote pollutant avoidance during the reconstruction of a major highway in a low-income minority community on Chicago's South Side. The program, which centered on workshops run by community asthma educators, was evaluated using a pre-test, post-test, and 1-year follow-up questionnaire. Results. A total of 120 community workshop participants completed at least a portion of the evaluation process. At baseline, knowledge about air quality was limited. Following the workshops, substantial increases were noted in rates of correct answers to questions about health effects of air pollution, the availability of air quality information, and the color code for an AQI category. Approximately 1 year after the workshops were held, few participants could recall elements of the training. Few participants have internet access, and alternative means of distributing air quality information were suggested by study participants. Conclusions. Baseline knowledge of air quality information was limited in the community studied. Air quality education workshops conducted by community educators can increase knowledge about outdoor air quality and its impact on health over the short term. Refresher workshops or other efforts to sustain the knowledge increase may be useful. Given the known short-term and long-term effects of air quality on morbidity and mortality, air quality education efforts should be further developed, evaluated, and promoted for the general public, for people with underlying cardiopulmonary disease, and given the documented health disparities within the general population, for low-income and minority communities.     

Clean Air,Smart Cities,Healthy Hearts: Action on Air Pollution for Cardiovascular Health

More than twenty percent of all cardiovascular disease (CVD) deaths are caused by air pollution — more than three million deaths every year — and these numbers will continue to rise unless the global community takes action. Nine out of ten people worldwide breathe polluted air, which disproportionately affects those living in low-resource settings. The World Heart Federation (WHF) is committed to reducing the impact of air pollution on people’s health and has made this a priority area of its global advocacy efforts. In pursuit of this goal, WHF has formed an Air Pollution Expert Group to inform action on air pollution for CVD health and recommend changes to public health policy. This policy paper lays out the health impacts of air pollution, examines its position on the global policy agenda, demonstrates its relevance to the cardiovascular community, and proposes actionable policy measures to mitigate this deadly risk factor to health. The paper considers the important roles to be played by the Members of WHF, including scientific societies and the physicians that constitute them, heart health foundations, and patient advocacy groups. The paper concludes with a detailed table of recommendations for the various sub-target groups at the global, national, local, and patient level.