【摘要】 目的 探究短期暴露于大气细颗粒物(particulate matter 2.5,PM_2.5)/可吸入颗粒物(particulate matter 10,PM₁₀)对肝硬化食管胃静脉曲张破裂出血（esophagogastric variceal bleeding, EGVB）患者的影响。方法 纳入2014年1月1日至2018年12月31日因EGVB接受急诊内镜检查的患者，采用时间分层的病例交叉研究设计，通过条件Logistic回归分析评估不同滞后时间（lag time, lag）下PM_2.5/PM₁₀与EGVB之间的关联。结果 共纳入4 204例EGVB患者。观察到PM_2.5/PM₁₀与EGVB之间存在一定的相关性，PM_2.5在lag 07（累积滞后7 d）效应最强，浓度每增加1μg/m³,EGVB风险增加0.17%（95%CI:0.01%～0.33%）,PM₁₀在lag 02（累积滞后2 d）效应最强，浓度每增加1μg/m³,EGVB风险增加0.11%（95%CI:0.03%～0.19%）。引入气态污染物的双污染物模型验证了PM_2.5和PM₁₀风险估计的稳健性。按出血部位分层时，胃静脉曲张组中PM_2.5/PM₁₀与EGVB风险增加相关，食管静脉曲张组无影响，按年龄、性别和季节分层时差异无统计学意义（P>0.05）。结论 短期暴露于PM_2.5/PM₁₀与EGVB风险增加存在一定的相关性，PM_2.5对EGVB的影响比PM₁₀更大。在两种污染物模型中，PM_2.5/PM₁₀的影响是稳健的，在进行分层分析时，胃静脉曲张组的影响更为明显。更多还原

【Abstract】 Objective To evaluate the effect of PM_2.5/PM₁₀ on emergency admission for cirrhosis patients with esophagogastric variceal bleeding（EGVB）. Methods Patients who underwent emergency gastroscopic hemostasis therapy for EGVB from Jan. 1, 2014 to Dec. 31, 2018 were enrolled. A time-stratified case-crossover study design was performed and conditional Logistic regression analysis was used to evaluate the association between components of air pollutants and EGVB for different lag structures. Results A total of 4 204 cirrhosis patients with EGVB were enrolled. Significant associations between PM_2.5/PM₁₀ and emergency admission for EGVB was observed, and PM_2.5 exerted highest effect on lag 07, and a 1 μg/m³ increase in PM_2.5 concentration was associated with a 0.17%（95% CI: 0.01%-0.33%） increased risk of emergency admission for EGVB, and PM₁₀ exerted highest effect on lag 02, and a 1 μg/m³ increase in PM₁₀ concentration was associated with a 0.11%（95% CI: 0.03%-0.19%） increased risk of emergency admission for EGVB. Two pollutants models within gaseous pollutants confirmed the robustness of the risk estimates for PM_2.5/PM₁₀. When stratified by bleeding location, significant associations were found in gastric varices group and no significant effects were found in esophageal varices group, and there was no significant difference when stratified by age, sex, and season（P>0.05）. Conclusion This study provides evidence that short-term exposure to PM_2.5/PM₁₀ leads to increased EGVB risk, and PM_2.5 was thought to exert greater effect on EGVB than PM₁₀. The effects of PM_2.5/PM₁₀ were robust in two pollutants models and more pronounced in gastric varices group when performing stratified analysis.更多还原