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目的研究空气中粒径≤10μm细颗粒物(particulate matter≤10μm in aerodynamic diameter,PM10)暴露对成人哮喘患者肺功能的影响。方法于2016年1至10月在北京地区常住居民中招募17例成年哮喘患者,在9个月时间内,每3个月完成一次肺量仪通气功能检查,至少需要完成2次检查,共获得26组有前后肺功能对比的数据。分析受试者每3个月间隔时间内肺功能的变化值与该时段内PM10暴露平均值之间的关系。肺功能分析值选取舒张试验前第1秒用力呼气容积占预计值的百分比(pre-bronchodilator forced expiratory volume in 1 second expressed as percent predicted,Pre FEV_1%)、舒张试验前用力肺活量占预计值的百分比(pre-bronchodilator forced vital capacity expressed as percent predicted,Pre FVC%)、舒张试验前1秒率(pre-bronchodilator FEV_1/FVC,Pre FEV_1/FVC)、舒张试验后第1秒用力呼气容积占预计值的百分比(post-bronchodilator forced expiratory volume in 1 second expressed as percent predicted,Post FEV_1%)、舒张试验后用力肺活量占预计值的百分比(post-bronchodilator forced vital capacity expressed as percent predicted,Post FVC%)、舒张试验后1秒率(post-bronchodilator FEV_1/FVC,Post FEV_1/FVC)等6个指标。6项指标的变化值分别设定为ΔPre FEV_1%、ΔPre FVC%、ΔPre FEV_1/FVC、ΔPost FEV_1%、ΔPost FVC%和ΔPost FEV_1/FVC。肺功能指标的变化以及PM10暴露的差异采用两独立样本t检验或非参数秩和检验。结果在3个月时间段内,以PM10中位数划分为相对较高PM10暴露组[(98.00±10.99)g/m~3,n=13]与相对较低PM10暴露组[(79.23±6.30)g/m~3,n=13]。ΔPre FEV_1%、ΔPre FEV_1/FVC、ΔPost FEV_1%和ΔPost FEV_1/FVC在PM10相对较高暴露组[4个指标变化分别为(-6.96±10.49)%、(-3.79±7.92)%、(-4.07±5.72)%和(-2.85±5.14)%]与相对较低暴露组[4个指标变化分别为(4.32±12.02)%、(2.22±5.38)%、(7.61±12.66)%和(7.79±7.93)%]比较均有显著降低(P值分别为0.005、0.016、0.004、0.020)。ΔPre FVC%[两组变化值分别为(-4.62±8.83)%、(2.63±13.49)%]、ΔPost FVC%[两组变化值分别为(-2.65±6.74)%、(0.28±13.58)%]在相对较高PM10暴露组虽有下降趋势,但两组间差异无统计学意义。结论 PM10的长期暴露对成人哮喘患者肺通气功能会产生负面健康效应,需要引起重视。
Objective To study the effects of air particulate matter with particle size ≤10μm in aerodynamic diameter (PM10) on lung function in adult asthma patients. Methods From January to October 2016, 17 adults with asthma were enrolled in Beijing resident population. Spirometry was performed every 3 months in 9 months, and at least 2 examinations were completed. 26 groups have data on the pulmonary function before and after. The relationship between the change in lung function at each 3-month interval of the subject and the average PM10 exposure during this period was analyzed. Pulmonary Function Analysis Value Pre-bronchodilator forced expiratory volume in 1 second expressed as percent predicted, Pre-FEV_1%, pre-diastolic test, forced vital capacity as a percentage of predicted (pre-bronchodilator forced vital capacity expressed as percent predicted, Pre FVC%), pre-bronchodilator FEV 1 / FVC, Pre FEV 1 / FVC, and forced expiratory volume one second after diastolic test Post-bronchodilator forced expiratory volume in 1 second expressed as percent predicted, Post FEV 1%, post-bronchodilator forced vital capacity expressed as percent predicted, Post FVC%, diastolic Post-test 1 second rate (post-bronchodilator FEV 1 / FVC, Post FEV 1 / FVC) and other 6 indicators. The change values of the six indexes are respectively set as ΔPre FEV_1%, ΔPre FVC%, ΔPre FEV_1 / FVC, ΔPost FEV_1%, ΔPost FVC%, and ΔPost FEV_1 / FVC. Changes in lung function indicators and PM10 exposure differences using two independent samples t-test or non-parametric rank sum test. Results The median PM10 was divided into the higher PM10 exposed group [(98.00 ± 10.99) g / m ~ 3, n = 13] and the lower PM10 exposed group [(79.23 ± 6.30 ) g / m ~ 3, n = 13]. ΔPre FEV_1%, ΔPre FEV_1 / FVC, ΔPost FEV_1% and ΔPost FEV_1 / FVC were significantly higher in PM10-exposed groups [-6.96 ± 10.49%, -3.79 ± 7.92%, -4.07, ± 5.72% and -2.85 ± 5.14%, respectively] and those in the relatively lower exposure group (4.32 ± 12.02%, 2.22 ± 5.38%, 7.61 ± 12.66% and 7.79 ± 7.93)%] were significantly reduced (P values were 0.005,0.016,0.004,0.020 respectively). ΔPre FVC% [(-4.62 ± 8.83)%, (2.63 ± 13.49)%], ΔPost FVC% (-2.65 ± 6.74%, (0.28 ± 13.58)%, Although there was a downward trend in the relatively high PM10 exposure group, there was no significant difference between the two groups. Conclusions Long-term exposure to PM10 can have negative health effects on lung ventilation in adults with asthma, requiring considerable attention.