空气污染物与绿化环境暴露水平对心肌梗塞死亡交互作用的病例交叉研究

目的 探索空气污染物与绿化暴露水平对心梗死亡的发生所产生的交互作用。方法 主要收集天津市2017—2019年因心梗死亡的个案病例，估计每名病例环境因素的暴露水平，采用条件logistic回归模型，分析空气污染物与绿化暴露水平对心梗死亡的发生所产生的交互作用。结果 在不同的季节，空气污染物浓度、气象因素和绿化环境暴露水平存在着差异（P＜0.001）。在单污染物模型中，每升高10 μg/m3的NO2（lag2期），可使心梗死亡发生的风险升高0.4%（OR = 1.004，95%CI:1.000～1.008）。在多污染物模型中，每升高10 μg/m3的NO2（lag2期）、PM2.5（lag2期）和PM10（lag6期），可使心梗死亡发生的风险升高1.1%（OR = 1.011，95%CI:1.005～1.018）、0.4%（OR = 1.004，95%CI:1～1.008）和0.3%（OR = 1.003，95%CI: 1.000～1.006）。对于滞后期lag1、lag2、lag6和lag7的暴露水平来说，颗粒污染物［可入肺颗粒物（PM1）、PM2.5 和PM10］与绿化环境暴露水平对心梗死亡的发生具有拮抗作用。结论 绿化环境可以起到降低颗粒污染物升高心梗死亡风险的作用，为指导人们有效的防护空气污染的危害，减轻颗粒污染物对心梗以及其他心血管疾病的发生和死亡提供依据。

The interactive effects of air pollutants and green spaces on the mortality of myocardial infarction: a case-crossover study

Objective To explore the interaction of air pollutants and green spaces on the mortality of myocardial infarction. Methods Cases of myocardial infarction in Tianjin from 2017 to 2019 were collected. The exposure level of environmental factors of each case was estimated. The interaction between air pollutants and green exposure level on the occurrence of myocardial infarction death was analyzed by conditional logistic regression model. Results There were significant differences in the exposure levels of air pollutant concentrations, meteorological factors, and green spaces between seasons (P<0.001). In the single pollutant model, for each 10 μg/m3 increase of NO2 (lag 2), the risk of mortality of myocardial infarction increased by 0.4% (OR=1.004, 95%CI: 1-1.008). In the multi-pollutant model, for each 10 μg/m3 increase of NO2 (lag 2), PM2.5 (lag2) and PM10 (lag6), the risk of mortality of myocardial infarction increased by 1.1% (OR=1.011, 95%CI: 1.005-1.018), 0.4% (1.004, 95%CI: 1-1.008), and 0.3% (OR=1.003, 95%CI: 1-1.006), respectively. For the exposure levels during the lag1, lag2, lag6, and lag7 periods, the effects of particulate contaminants (accessible pulmonary particulate matter (PM1), PM2.5, and PM10) and the impacts of green spaces had antagonistic effects on the myocardial infarction mortality. Conclusion Green spaces can alleviate the risk of particulate contaminants on the myocardial infarction mortality, and it can provide reference for reducing the harm of air pollution effectively and the mortality of myocardial infarction and other cardiovascular diseases.