大气污染暴露与儿童青少年血脂代谢的关系研究

doi:10.3969/j.issn.1673-5501.2021.02.009

摘要/Abstract

摘要： 背景目前较缺乏中国儿童青少年中大气污染暴露水平与血脂代谢的关系研究。目的分析大气污染暴露与儿童青少年血脂代谢的关系。设计横断面调查。方法研究对象来自2014年1项关于中国儿童青少年心血管健康研究的横断面调查,纳入上海市方便抽样的4所中小学校中年龄7~18岁、经监护人知情同意后采集静脉血并完成血脂检测的在校学生。血脂浓度检测项目包括HDLC、LDLC、TG和TC,血脂异常定义为存在HDLC≤1.04 mmol·L^-1、LDLC≥3.37 mmol·L^-1、TG≥1.70 mmol·L^-1和TC≥5.18 mmol·L^-1中任一项。将回收问卷中的家庭住址标准化并转化为经纬度坐标,采用基于环境监测点位数据的空气污染物时空暴露模型,估算研究对象在采血前1、3、6个月的PM_2.5、O₃和NO₂的平均暴露水平。利用线性回归和logistic回归模型,分析PM_2.5、O₃和NO₂暴露水平与血脂水平、血脂异常风险的关系。在多因素模型的基础上,通过各类污染物浓度相互调整检查污染暴露与血脂代谢关系的独立性。主要结局指标 根据研究对象家庭地址估计的大气污染暴露水平、研究对象的空腹静脉血脂水平及是否存在血脂异常状态。结果共纳入1 317名中小学生,女生660名(50.1%)。研究对象平均HDLC、LDLC和TC浓度分别为(1.52±0.29)mmol·L^-1、(2.35±0.63)mmol·L^-1和(4.03±0.72)mmol·L^-1,TG中位数浓度为0.59(0.43,0.80) mmol·L^-1。142(10.8%)人患有血脂异常。研究对象在采血前1、3、6个月的PM_2.5、O₃和NO₂的日均暴露水平范围为51.4~61.5 μg·m^-3、20.4~22.8 μg·m^-3和11.1~12.8 μg·m^-3。研究对象住址既往3、6个月平均PM_2.5浓度每升高1个四分位间距,HDLC分别显著降低0.07(95%CI:0.03~0.11)mmol·L^-1和0.09(95%CI:0.05~0.14)mmol·L^-1;既往6个月平均PM_2.5浓度每升高1个四分位间距,相应血脂异常风险OR为1.86(95%CI: 1.42~2.44),这些关联在调整其他污染物暴露水平后仍显著。未发现其他血脂水平与大气污染物暴露之间的独立显著关联。结论 PM_2.5暴露对儿童青少年的血脂代谢有不良影响。

关键词: 血脂异常, 大气污染, 儿童青少年

Abstract: Background There's a scare of evidence in association between air pollution exposure and lipid metabolism in Chinese children and adolescents.Objective To explore the association between ambient air pollution exposure and blood lipids metabolism of children and adolescents.DesignCross-sectional study.Methods Students aged 7-18 years were recruited from 4 Shanghai primary, middle and high schools in a cross-sectional study whose fasting blood samples were collected during 2014. Informed consents for participating in the study and blood collection were got from guardians. Serum HDLC, LDLC, TG and TC were examined and dyslipidemia was defined as occurrence of abnormality in any one of them (HDLC≤1.04 mmol·L^-1,LDLC≥3.37 mmol·L^-1,TG≥1.70 mmol·L^-1 or TC≥5.18 mmol·L^-1). With home address provided by the participants and a spatio-temporal model of air pollution, daily average concentrations of PM_2.5, O₃ and NO₂ in the latest 1, 3 and 6 months before blood collection at the participants' home addresses were measured. With linear regression and logistic regression, associations of home exposure to individual air pollutants at different durations with lipids' concentration and risk of dyslipidemia were examined. On the basis of multiple adjustment, pollutants were further mutually adjusted to check independence of association between pollutants exposure and lipids metabolism.Main outcome measures Air pollution exposure of children based on their home location, fasting venous serum lipid profile and dyslipidemia.Results A total of 1,317 students were included in this analysis with 660 girls(50.1%). Mean(SD) concentrations of HDLC, LDLC and TC were (1.52±0.29)mmol·L^-1, (2.35±0.63) mmol·L^-1 and (4.03±0.72) mmol·L^-1, while median (1^st quartile, 3^rd quartile) concentration of TG was 0.59(0.43,0.80) mmol·L^-1, and 142(10.8%) students were identified to have dyslipidemia. Daily concentrations of PM_2.5, O₃ and NO₂ in the past 1, 3 and 6 months varied at ranges of 51.4~61.5, 20.4~22.8 and 11.1~12.8 μg·m^-3. With every IQR increase of PM_2.5 concentration in the latest 3 and 6 months, HDLC decreased by 0.07(95%CI:0.03~0.11)mmol·L^-1 and 0.09(95%CI:0.05~0.14)mmol·L^-1, and OR(95%CI) for risk of dyslipidemia was 1.86(95%CI:1.42~2.44) with each IQR increase of PM_2.5 in the latest 6 months. These associations remained significant after adjusting for exposure of other pollutants, but no independently significant associations of other serum lipids and ambient air pollution exposure were found.Conclusion This study found a significant association of PM_2.5 exposure with adverse lipid profiles in children and adolescents.

Key words: Dyslipidemia, Air pollution, Children and adolescents

黄相源, 张羿, 陈逍天, 姜袁, 王胤, 窦亚兰, 许嘉, 韩斌, 严卫丽. 大气污染暴露与儿童青少年血脂代谢的关系研究[J]. 中国循证儿科杂志, 2021, 16(2): 124-129.

HUANG Xiangyuan, ZHANG Yi, CHEN Xiaotian, JIANG Yuan, WANG Yin, DOU Yalan, XU Jia, HAN Bin, YAN Weili. Association of ambient air pollution exposure and lipid metabolism in children and adolescents[J]. Chinese Journal of Evidence-Based Pediatrics, 2021, 16(2): 124-129.

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