基于队列人群的天气骤变及PM2.5对高血压患者影响机制研究

Given the dramatic changes in global climate and atmospheric particulate matter pollution, the effects of weather and environment on public health have received special attention. So far, there is a lack of suitable evaluation indicators for analyzing the association between sudden weather change as well as PM2.5 and the health of hypertension patients; the potential underlying biological mechanisms are also unclear.. Firstly, a retrospective study will be carried out to collect data on outpatient, emergency and inpatient hospital admissions for hypertension and related meteorological and environmental data in Jinchang, Gansu. Statistical models will be used to identify sensitive weather change indicators of hypertension incidence and to evaluate the exposure-response relationship between sudden weather change and hypertension-related admissions. . Secondly, the interaction between sensitive weather change indicators and PM2.5 and their combined effect on the health of hypertension patients will also be analyzed. Thus, high risk weather and environmental conditions will be confirmed, and their comprehensive effects among hypertension patients will be revealed. On this basis, a prospective study of 8404 hypertension patients in Jinchang cohort, which enrolled 50 thousand people, and a small sample panel study will be conducted to analyze the effects of weather change and PM2.5 on environment-related blood indicators, including physiological, biochemical, hemorheology, and the renin-angiotensin system. Then, the most sensitive biological indicators will be ascertained, in an effort to reveal the potential biological mechanisms of change in the health status of hypertension patients following exposure to sudden weather change as well as PM2.5. . In the end, this program could provide a scientific basis for deeply assessing the health risk of sudden weather change and PM2.5 on hypertension, developing medical meteorology forecasting and finally improving prevention and control measures for hypertension.

随着全球气候异常变化的加剧及大气颗粒物污染的加重，气象环境变化对人群健康影响倍受关注。本项目针对目前天气骤变及PM2.5对高血压患者影响评价指标不足及人群机制研究的局限性，拟通过对2000-2014年甘肃省金昌市5家医院高血压急门诊、住院病例数据与相应气象环境数据的回顾性调查分析，遴选反映高血压患病的敏感天气骤变指标，定量评价其对高血压患病的暴露反应关系，确定其与PM2.5协同效应及有效作用阈值，深化高风险气象环境变化对高血压患者综合影响的理解；在此基础上，通过以5万金昌队列为基础的8404例高血压患者前瞻性研究及小样本定组研究，分析天气骤变及PM2.5对高血压人群相关理化、血液流变学、肾素-血管紧张素系统指标影响的关联效应，探明敏感生物学指标及其阈值，揭示其对高血压作用的潜在生物学机制，为深入开展气象环境变化对高血压患者影响的健康风险评估、医疗气象预报及完善高血压防控体系提供科学依据。

本项目立足于我国西北地区金昌市，利用2011-2016年高血压急诊/住院病例数据以及金昌队列随访数据，开展了天气骤变指标及PM10，PM2.5对高血压患病影响及潜在机制研究。研究发现：1）温度（平均温度、最低温度及最高温度）、24小时变温及日较差对高血压患病人数的增加更加敏感，且相对稳定；2）PM10，PM2.5均对金昌市高血压患病人数具有影响，当温度较低，颗粒物浓度较高时，高血压患病就诊的风险相应增大；3）人群血压具有明显的季节波动性；4）随着血压水平的升高，温度与人群血压水平间的暴露反应关系由非线性（U型）变为线性，而高血压组人群血压受温度的影响最为明显；5）对于高血压患者，收缩压、脉压差、总胆固醇、高密度脂蛋白、低密度脂蛋白、血红蛋白及红细胞等指标对气温变化及PM10更加敏感。基于以上结果，提示气象环境因素的改变可能是人群中高血压发生或预后的潜在危险因素，其可能通过对血压、血脂等理化指标的改变而诱发或促进疾病。因此，加强气象环境预报预警，特别对于高血压患者，应注意大幅温度变化或严重颗粒物污染的天气环境，并提前做好相应的疾病预防工作，以降低潜在的疾病发生风险。