Susceptibility of prediabetes to the health effect of air pollution: a community-based panel study with a nested case-control design
Susceptibility of prediabetes to the health effect of air pollution: a community-based panel study with a nested case-control design
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DOI：
10.1186/s12940-019-0502-6
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发表时间：
2019-07-15
影响因子：
6
通讯作者：
Zhu, Tong
中科院分区：
文献类型：
--
作者：
Han, Yiqun;Wang, Yanwen;Zhu, Tong
背景近年来的研究表明，糖尿病患者或有糖尿病风险的人，即糖尿病前期(PreDM)，对空气污染具有潜在的易感性，但其潜在的机制尚不清楚，因为现有的流行病学研究没有纳入健康对照组，而且只关注有限的健康结果。我们假设急性暴露于周围细颗粒物(PM2.5)会导致糖尿病前期患者的肺和心脏代谢改变比健康人更严重。方法从北京中国社区的22,343名成年人中招募60名糖尿病前期患者和60名健康人，安排每个受试者完成最多7次重复临床访问，包括6个心肺生物标志物、6个细胞因子、4个血压和内皮功能结果以及4个糖代谢生物标志物。结果所有受试者的呼出一氧化氮、白细胞、中性粒细胞、白介素1α和糖化血红蛋白水平均显著升高，暴露于PM2.5环境中。糖尿病前期患者的6项心脏代谢生物标志物，即白介素2、白介素8、收缩压、舒张压、升压和血糖均较健康组有明显的不良反应。6种标志物在糖尿病前期人群中的最大升高分别为8.6%[CI：4.1~13.3%]、10.0%[CI：3.9~16.4%]、1.9%[CI：0.2~3.6%]、1.2%[CI：-0.1~2.4%]、5.7%[CI：-0.1~11.8%]、2.4%[CI：0.7~4.2%]，在前1-14天的整个曝光窗口内，环境PM2.5(61.4微克(-3))的四分位数增加。两组间肺生物标志物变化差异无统计学意义。结论糖尿病前期人群较健康人群更易受空气污染的急性心脏代谢影响。鉴于糖尿病前期的高患病率以及中国和世界各地无处不在的空气污染，可以推断出相当大的公共健康负担。
BackgroundRecent studies suggest that people with diabetes or who are at risk of developing diabetes, i.e. prediabetic (preDM), are potentially susceptible to air pollution, but the underlying mechanisms remain unclear because the existing epidemiological studies did not include healthy control groups and only focused on limited health outcomes. We hypothesized that acute exposure to ambient fine particles (PM2.5) will lead to enhanced pulmonary and cardiometabolic changes in preDM than healthy individuals.MethodsWe recruited 60 preDM and 60 healthy individuals from a community of 22,343 adults in Beijing China, and arranged each subject to complete up to seven repeated clinical visits with measures of 6 cardiopulmonary biomarkers, 6 cytokines, 4 blood pressure and endothelial function outcomes and 4 glucose metabolism biomarkers.. Moving averaged daily ambient PM2.5 in preceding 1-14days was matched to each subject and the PM2.5 associated effect on multiple biomarkers was estimated and compared between PreDM and healthy subjects based on linear mixed effect model.ResultsAll the subjects exhibited significant acute elevation of exhaled nitric oxide, white blood cells, neutrophils, interleukin-1 alpha, and glycated haemoglobin with increased exposure to PM2.5. PreDM subjects had significant stronger adverse changes compared to healthy subjects in 6 cardiometabolic biomarkers, namely, interleukin-2, interleukin-8, systolic and diastolic blood pressure, augmentation pressure, and glucose. The maximum elevation of these 6 biomarkers in PreDM subjects were 8.6% [CI: 4.1-13.3%], 10.0% [CI: 3.9-16.4%], 1.9% [CI: 0.2-3.6%], 1.2% [CI: -0.1-2.4%], 5.7% [CI: -0.1-11.8%], 2.4% [CI: 0.7-4.2%], respectively, per an interquartile increase of ambient PM2.5 (61.4 mu gm(-3)) throughout the exposure window of the preceding 1-14days. No significant difference was observed for the changes in pulmonary biomarkers between the two groups.ConclusionsPreDM individuals are more susceptible to the acute cardiometabolic effect of air pollution than the healthy individuals. A considerable public health burden can be inferred, given the high prevalence of prediabetes and the ubiquity of air pollution in China and worldwide.