血清尿酸水平在空气污染物与心房颤动风险关联中的中介作用分析
Mediation effects of serum uric acid levels in the association between air pollutants and atrial fibrillation
刘博 1张心悦 1葛鸽 1智宏 2汪爱莲 3王莉娜1
作者信息
- 1. 东南大学公共卫生学院流行病与卫生统计学系,南京 210009
- 2. 东南大学附属中大医院心血管内科,南京 210009
- 3. 南京市栖霞区尧化社区卫生服务中心,南京 210046
- 折叠
摘要
目的 探讨空气污染物暴露水平与心房颤动(房颤)风险之间的关联,并评价血清尿酸水平在这二者风险关联中的中介作用.方法 该研究为病例对照研究,房颤组数据来源于2014年1月—2021年4月在东南大学附属中大医院确诊为房颤的患者,对照组为2019年3-4月在南京市栖霞区社区筛查中确认为非房颤的人群;通过倾向性评分匹配法,将研究对象的性别、年龄按照1∶1进行成组匹配.空气污染物暴露数据来自2014年1月—2021年4月于南京市9个空气质量监测站点的监测数据,空气污染物包括NO2、CO、PM2.5及PM10,依据公式近似地将空气污染物暴露转换为经呼吸道暴露水平.采用多因素logistic回归模型分析空气污染物与房颤风险之间的关联.采用中介分析探讨血清尿酸在4种空气污染物(PM2.5、PM10、NO2、CO)与房颤关联通路上所起的中介作用.结果 房颤组1 050例,年龄(68.7±11.3)岁,男性544例(51.8％);对照组1 050例,年龄(68.5±8.9)岁,男性543例(51.7％).多因素logistic回归模型提示,4种空气污染物暴露水平均是房颤的正相关因素,其中NO)2暴露水平每增加 1 µg·kg-·d-1,房颤的风险增加 12.1％(OR=1.121,95％CI:1.098～1.144);CO暴露水平每增加1μg·kg-1·d-1,房颤的风险增加0.7％(OR=1.007,95％CI:1.006～1.008);PM2.5暴露水平每增加 1 µg·kg-1·d-,房颤的风险增加 14.2％(0R=1.142,95％CI:1.120～1.164);PM10暴露水平每增加 1 μg· kg-1·d-1,房颤风险增加3.7％(OR=1.037,95％CI:1.028～1.046).中介分析的结果提示,血清尿酸水平在PM2.5增加房颤风险中起到5.6％的中介作用(P=0.032),在CO增加房颤风险中起到7.5％的中介作用(P=0.010).结论 空气污染物暴露是房颤发生的正相关因素,尿酸在PM2.5和CO增加房颤风险中起到了中介作用.
Abstract
Objective To investigate the association between air pollutant exposure levels and the risk of atrial fibrillation and to evaluate the mediating role of serum uric acid levels in the association between air pollutant levels and atrial fibrillation risks.Methods This study was a case-control study,and the data of the atrial fibrillation group was derived from atrial fibrillation patients diagnosed at the Zhongda Hospital,Affiliated to Southeast University,from January 2014 to April 2021,and data of control group was derived from those without atrial fibrillation at the screening in Qixia District,Nanjing City,in March to April 2019.A 1∶1 propensity score matching was performed with the matched variables of age and sex.Air pollutant exposure data were collected from 9 air quality monitoring stations in Nanjing from January 2014 to April 2021,including NO2,CO,PM2.5 and PM10.Exposure to air pollutants was converted to respiratory exposure levels according to an approximate formula.Multivariate logistic regression models were used to analyze the association between air pollutants and the risk of atrial fibrillation.Mediation analysis was used to investigate the mediating role and magnitude of serum uric acid in the association pathway between the four air pollutants(PM25,PM10,NO2,and CO)and atrial fibrillation.Results The atrial fibrillation group was aged(68.7±11.3)years,with 544(51.8％)males;the control group was aged(68.5±8.9)years,with 543(51.7％)males.Multivariate logistic regression models suggested that individual exposure levels of all four air pollutants were associated with the increased risks of atrial fibrillation.Every 1 μg·kg1·d-1 increased in NO2 was associated 12.1％increased risk of atrial fibrillation among the individuals(OR=1.121,95％CI:1.098-1.144);For every 1 μg·kg1·d-1 increased in CO,the individual risk of atrial fibrillation increased by 0.7％(OR=1.007,95％CI:1.006-1.008).For each 1 μg·kg-1·d-1 increase in PM2.5 exposure level,the individual risk of atrial fibrillation increased by 14.2％(OR=1.142,95％CI:1.120-1.164).For each 1 μg·kg 1·d-1 increase in PM10 exposure level,the individual risk of atrial fibrillation increased by 3.7％(OR=1.037,95％CI:1.028-1.046).The results of the mediation analysis suggested that serum uric acid levels mediated 5.6％(P=0.032)causal effects of PM25on atrial fibrillation risks and 7.5％(P=0.010)mediated by CO.Conclusion Air pollutant exposure was a risk factor for the development of atrial fibrillation and uric acid mediated the increased risk of atrial fibrillation by PM2.5 and CO.
关键词
空气污染物/尿酸/心房颤动/中介作用分析/PM2.5/COKey words
Air pollutants/Uric acid/Atrial fibrillation/Mediation analysis/PM25/CO引用本文复制引用
基金项目
江苏省研究生研究与实践创新计划(SJCX22_0075)
江苏省卫生健康委医学科研项目(2019)(H2019079)
出版年
2024
NETL
NSTL
万方数据