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[大学生论坛]:一项随机的交叉研究(慢性肺病或心脏病)

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zyf950201 发表于 2017-12-31 21:28:22 | 显示全部楼层 |阅读模式
本帖最后由 zyf950201 于 2017-12-31 22:15 编辑

Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study
探究60岁及以上患有慢性肺病或心脏病的患者以及年龄匹配健康在志愿者在交通污染区行走时与在无车区行走时的呼吸及心血管反应:一项随机的交叉研究

Summary
摘要


Background
背景
Long-term exposure to pollution can lead to an increase in the rate of decline of lung function, especially in older individuals and in those with chronic obstructive pulmonary disease (COPD), whereas shorter-term exposure at higher pollution levels has been implicated in causing excess deaths from ischaemic heart disease and exacerbations of COPD. We aimed to assess the effects on respiratory and cardiovascular responses of walking down a busy street with high levels of pollution compared with walking in a traffic-free area with lower pollution levels in older adults.
长期处于污染环境中可导致肺功能下降的速率的增加,特别是老年人和那些患有慢性阻塞性肺病(COPD)的人,而短期暴露在高污染水平环境中会增加缺血性心脏病死亡人数以及加重急性慢性阻塞性肺病。我们的目的是评估老年人在繁忙的街道上行走时(高污染)呼吸和心血管反应的影响,与在无车区行走时(低污染)相比较。

Methods方法In this randomised, crossover study, we recruited men and women aged 60 years and older with angiographically proven stable ischaemic heart disease or stage 2 Global initiative for Obstructive Lung Disease (GOLD) COPD who had been clinically stable for 6 months, and age-matched healthy volunteers. Individuals with ischaemic heart disease or COPD were recruited from existing databases or outpatient respiratory and cardiology clinics at the Royal Brompton & Harefield NHS Foundation Trust and age-matched healthy volunteers using advertising and existing databases. All participants had abstained from smoking for at least 12 months and medications were taken as recommended by participants' doctors during the study. Participants were randomly assigned by drawing numbered disks at random from a bag to do a 2 h walk either along a commercial street in London (Oxford Street) or in an urban park (Hyde Park). Baseline measurements of participants were taken before the walk in the hospital laboratory. During each walk session, black carbon, particulate matter (PM) concentrations, ultrafine particles, and nitrogen dioxide (NO2) concentrations were measured.
在这个随机、交叉的研究中,我们招募了60岁及以上的男性或女性志愿者,这些志愿者通过血管造影证实患有稳定的缺血性心脏病或处于第二阶段全球自发性的阻塞性肺病(GOLD)COPD,在临床中已经稳定了6个月,还有一些年龄相匹配的,健康的志愿者。这些患有缺血性心脏病或慢性阻塞性肺病的志愿者是从现有的数据库或皇家布朗普顿和哈菲尔德NHS信托基金呼吸和心脏病门诊招募的,年龄匹配的健康志愿者则是通过广告和现有数据库招募的。所有参与者戒烟至少12个月,并在研究过程中服用医生推荐的药物。参与者地从一个袋子中随机抽取出编号的磁盘,随机派遣至伦敦的商业街(牛津街)或在城市公园(海德公园)进行2小时的步行。在任务开始前,参与者在医院实验室做了基线测量。在每次行走过程中,我们测量了黑碳、颗粒物(PM)浓度、超细颗粒物和二氧化氮(NO2)浓度。


Findings
发现
Between October, 2012, and June, 2014, we screened 135 participants, of whom 40 healthy volunteers, 40 individuals with COPD, and 39 with ischaemic heart disease were recruited. Concentrations of black carbon, NO2, PM10, PM2.5, and ultrafine particles were higher on Oxford Street than in Hyde Park. Participants with COPD reported more cough (odds ratio [OR] 1·95, 95% CI 0·96–3·95; p<0·1), sputum (3·15, 1·39–7·13; p<0·05), shortness of breath (1·86, 0·97–3·57; p<0·1), and wheeze (4·00, 1·52–10·50; p<0·05) after walking down Oxford Street compared with Hyde Park. In all participants, irrespective of their disease status, walking in Hyde Park led to an increase in lung function (forced expiratory volume in the first second [FEV1] and forced vital capacity [FVC]) and a decrease in pulse wave velocity (PWV) and augmentation index up to 26 h after the walk. By contrast, these beneficial responses were attenuated after walking on Oxford Street. In participants with COPD, a reduction in FEV1 and FVC, and an increase in R5–20 were associated with an increase in during-walk exposure to NO2, ultrafine particles and PM2.5, and an increase in PWV and augmentation index with NO2 and ultrafine particles. In healthy volunteers, PWV and augmentation index were associated both with black carbon and ultrafine particles.
从2012年10月到2014年6月,我们筛选了135名参与者,其中40名健康志愿者,40名COPD患者,39名患有缺血性心脏病的患者。牛津街的黑碳、二氧化氮、PM10、PM2.5和超细颗粒物浓度比海德公园高。与海德公园相比,患有慢性阻塞性肺病(COPD)的参与者走牛津街时报告较多的咳嗽(比值比[OR] 1·95,95% CI 0·96 - 3·95;p < 0·1)痰(3·15日1·39-7·13;p< 0·05),呼吸短促(1·86,0·97 - 3·57);p< 0·1)和喘息(4·00,1·52 - 10·50;p< 0·05)。在所有参与者中,不论其疾病状况如何,在海德公园散步的志愿者导致肺功能增加(第一秒用力呼气量[FEV1]和用力肺活量[FVC]),以及在行走后的脉搏波速度(PWV)降低和行走之后指数增加至26h。相比之下,被试在牛津大街行走后,这些有益的反应减弱了。在COPD患者中,FEV1和FVC降低,R5 - 20增高与NO2、超细颗粒和PM2.5的持续接触有关,PWV增加,NO2和超微颗粒的指数增加。在健康的志愿者中,PWV和增强指数都与黑碳和超细颗粒有关。

Interpretation
解释
Short-term exposure to traffic pollution prevents the beneficial cardiopulmonary effects of walking in people with COPD, ischaemic heart disease, and those free from chronic cardiopulmonary diseases. Medication use might reduce the adverse effects of air pollution in individuals with ischaemic heart disease. Policies should aim to control ambient levels of air pollution along busy streets in view of these negative health effects.
短期处于交通污染的环境抑制那些患有慢性阻塞性肺病(COPD)、缺血性心脏病以及那些没有慢性心肺疾病的人的有益心肺效应。药物使用可以减少缺血性心脏病患者受空气污染的不良影响。针对这些负面的健康影响,政策的目标应该是控制繁忙街道上的空气污染水平。
本文来自:http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32643-0/fulltext
作者:Rudy Sinharay等
日期:05 December 2017

2014级商务英语 张远峰 3141204012






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