【摘要】 目的研究大气超细颗粒物对慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者肺功能的影响。方法招募45名COPD稳定期患者,采用定组研究方法,于2014年11月至2015年12月进行4次临床随访,进行肺功能检查,收集尿样测定烟草内暴露标志物——可替宁水平,采集血样测定系统性炎症超敏C反应蛋白（hs-CRP）水平;收集区域同期大气超细颗粒物粒数浓度和气象资料,利用线性混合效应模型分析大气超细颗粒物对COPD患者肺功能的影响。结果累积暴露1～7 d空气动力学直径20～50 nm颗粒物粒数浓度(PNC_20-50)与患者FVC%预计值呈负向关联,PNC_20-50每升高四分位间距浓度,患者FVC%预计值变化-3.07%（95%CI:-5.06%～-1.07%）～-2.51%（95%CI:-4.27%～-0.74%）。累积暴露3～7 d空气动力学直径50～100 nm颗粒物粒数浓度(PNC_50-100)与患者FVC%预计值呈负向关联,PNC_50-100每升高四分位间距浓度,患者FVC%预计值变化-5.07%（95%CI:-8.65%～-1.49%）～-3.16%（95%CI:-6.28%～-0.04%）。累积暴露1～7 d空气动力学直径≤100 nm颗粒物粒数浓度（UFPs）与患者FVC%预计值呈负向关联,UFPs每升高四分位间距浓度,患者FVC%预计值变化-3.99%（95%CI:-6.76%～-1.21%）～-2.48%（95%CI:-4.87%～-0.09%）。累积暴露5⁶ d PNC_50-100与COPD患者FEV₁%预计值呈负向关联,PNC_50-100每升高四分位间距浓度,患者FEV₁%预计值变化-2.93%（95%CI:-5.61%～-0.24%）～-2.90%（95%CI:-5.63%～-0.18%）。以COPD患者系统性炎症标志物hs-CRP中位数进行分层,超细颗粒物在高系统性炎症COPD患者中有更强的降低肺功能效应。结论UFPs急性暴露与COPD患者肺功能存在负向关联,系统性炎症反应水平较高的COPD患者UFPs和肺功能关联的效应更明显。更多还原

【Abstract】 Objective To understand the association between exposure to ambient ultrafine particles（UFPs）and lung function in patients with chronic obstructive pulmonary disease（COPD）.Methods Forty-five COPD patients in stable phase were recruited and underwent four repeated measurements of panel study from November 2014 to December 2015.The lung function,individual levels of exposure to smoke cotinine in urine and levels of systemic inflammation hypersensitive C-reaction protein（hs-CRP）in serum were measured at each visit.Ambient ultrafine particles and meteorologic parameters were measured continuously.Linear mixed-effect models were constructed to estimate the effects of exposure to ambient ultrafine particles on lung function in patients with COPD after adjusting for confounders.Results Significant declines in FVC associated with per IQR increase in number concentrations of particles in sizes ranging from 20 nm to 50 nm(PNC_20-50)were 3.07%（95%CI:1.07%-5.06%）to 2.51%（95%CI:0.74%-4.27%）at moving average 1 to 7 days prior to clinic visit.Significant declines in FVC associated with per IQR increase in number concentrations of particles in size ranging from 50 nm to 100 nm(PNC_50-100)were5.07%（95%CI:1.49%-8.65%）to 3.16%（95%CI:0.04%-6.28%）at moving average 3 to 7 days.Significant declines in FVC associated with per IQR increase in number concentrations of particles with diameter less than 100 nm（ultrafine particles,UFPs）were 3.99%（95%CI:1.21%-6.76%）to 2.48%（95%CI:0.09%-4.87%）at moving average 1 to 7 days.Significant declines in FEV₁associated with per IQR increase in PNC_50-100were 2.93%（95%CI:0.24%-5.61%）to 2.90%（95%CI:0.18%-5.63%）at moving average 5 to 6 days.Results of statified analysis showed a stronger association between ultrafine particles and reduced lung function in COPD patients with higher levels of hs-CRP.Conclusion Short-term exposure to UFPs is associated with significantly reduced lung function in the COPD patients;Systemic inflammation may contribute to effects of exposure to ambient ultrafine particles on lung function in patients COPD更多还原