摘要:

[背景]越來越多的證據(jù)表明空氣污染對健康的損害以及體力活動對健康的益處，而空氣污染和體力活動對神經(jīng)系統(tǒng)的影響需要更多研究。

[目的]探究短期空氣污染暴露與體力活動對健康老年人神經(jīng)損傷生物標志的影響。

[方法]采用定組研究方法，在新鄉(xiāng)醫(yī)學院招募身心健康的退休職工，于2018年12月至2019年4月定期進行5次隨訪。使用問卷獲取人口學特征及體力活動信息，根據(jù)體力活動強度和時間計算每周的體力活動水平。檢測血清中神經(jīng)損傷生物標志包括腦源性神經(jīng)營養(yǎng)因子（BDNF）、神經(jīng)絲輕鏈（NF-L）、神經(jīng)元特異性烯醇化酶（NSE）、蛋白基因產(chǎn)物9.5（PGP9.5）和鈣結(jié)合蛋白S100B（S100B）的濃度。同時收集空氣污染數(shù)據(jù)（包括PM2.5、PM10、O3、SO2、CO、NO2）。采用廣義估計方程分析空氣污染物濃度、體力活動水平與神經(jīng)損傷生物標志濃度的關(guān)系。

[結(jié)果]研究共納入29名志愿者，年齡（63.5±5.89）歲；男性11人，占比37.93%；初中以上文化程度占半數(shù)以上（62.07%），體力活動水平為（80.23±54.51）MET-h·周?1。研究期間PM2.5、PM10、O3、SO2、CO、NO2的日均質(zhì)量濃度分別為（68.27±60.98）μg·m?3、（130.57±58.71）μg·m?3、（36.86±13.89）μg·m?3、（17.86±10.59）μg·m?3、（4.94±1.34）mg·m?3和（50.83±8.03）μg·m?3。血清BDNF、NF-L、NSE、PGP9.5和S100B的質(zhì)量濃度分別為（139.12±46.71）μg·L?1、（402.60±183.31）ng·L?1、（11.26±10.32）ng·L?1、（14.32±13.57）ng·L?1和（127.57±41.74）ng·L?1。廣義估計方程分析結(jié)果表明，較高濃度的PM2.5和O3與血清中NSE濃度增加有關(guān)（OR=1.359，95%CI：1.224~1.509，P<0.001；OR=1.286，95%CI：1.076~1.537，P=0.006），而較高濃度的NO2與NSE濃度降低有關(guān)（OR=0.692，95%CI：0.549~0.873，P=0.002）；較高濃度的O3和SO2與血清中NF-L濃度降低有關(guān)（OR=0.855，95%CI：0.740~0.989，P=0.035；OR=0.813，95%CI：0.700~0.946，P=0.007）；較高濃度的NO2與血清中PGP9.5濃度降低有關(guān)（OR=0.866，95%CI：0.777~0.965，P=0.009）；較高體力活動水平與血清中S100B濃度增加有關(guān)（OR=1.038，95%CI：1.003~1.074，P=0.034）；未發(fā)現(xiàn)體力活動、污染物與血清中BDNF的關(guān)系具有統(tǒng)計學意義（P>0.05）。

[結(jié)論]短期空氣污染暴露和高水平體力活動可能與老年人神經(jīng)損傷有關(guān)。顆粒污染物（PM2.5）與NSE增加有關(guān)，氣態(tài)污染物（O3、NO2、SO2）與NF-L、PGP9.5降低有關(guān)。

Abstract:

[Background]Emerging evidence has shown the damage of air pollution and the benefits of physical activity to human health, and the effects of air pollution and physical activity on the nervous system need more research.

[Objective]To explore the effects of short-term air pollution exposure and physical activity on neural damage biomarkers in healthy elderly.

[Methods]Using a design of panel study, physically and mentally healthy retired employees were recruited from Xinxiang Medical University, and were followed up five times regularly from December 2018 to April 2019. The demographic characteristics and physical activity information were obtained by questionnaire, and the weekly physical activity level was calculated according to intensity and duration of physical activity. Biomarkers of neural damage in serum were measured, including brain-derived neurotrophic factor (BDNF), neurofilament light chain (NF-L), neuron specific enolase (NSE), protein gene product 9.5 (PGP9.5), and S100 calcium-binding protein B (S100B). Air pollution data (including PM2.5, PM10, O3, SO2, CO, and NO2) of the follow-up period were collected. Generalized estimation equation was used to analyze the association of air pollution concentration and physical activity level with the concentration of neural damage biomarkers.

[Results]A total of 29 volunteers were included in the study, with an average age of (63.5±5.9) years; there were 11 men accounting for 37.93%; more than half of them (62.07%) received above junior middle school education; the mean physical activity level was (80.23±54.51) MET-h·week?1. The daily average concentrations of PM2.5, PM10, O3, SO2, CO, and NO2 during the study period were (68.27±60.98) μg·m?3, (130.57±58.71) μg·m?3, (36.86±13.89) μg·m?3, (17.86±10.59) μg·m?3, (4.94±1.34) mg·m?3, and (50.83±8.03) μg·m?3, respectively. The average serum concentrations of BDNF, NF-L, NSE, PGP9.5, and S100B were (139.12±46.71) μg·L?1, (402.60±183.31) ng·L?1, (11.26±10.32) ng·L?1, (14.32±13.57) ng·L?1, and (127.57±41.74) ng·L?1, respectively. The results of generalized estimation equation showed that a higher concentration of PM2.5 or O3 was associated with increased serum NSE (OR=1.359, 95%CI: 1.224-1.509, P<0.001;OR=1.286, 95%CI: 1.076-1.537, P=0.006), while a higher concentration of NO2 was associated with decreased serum NSE (OR=0.692, 95%CI: 0.549-0.873, P=0.002); a higher concentration of O3 or SO2 was related to the reduction of serum NF-L concentration (OR=0.855, 95%CI: 0.740-0.989, P=0.035; OR=0.813, 95%CI: 0.700-0.946, P=0.007); a higher concentration of NO2 was associated with decreased PGP9.5 in serum (OR=0.866, 95%CI: 0.777-0.965, P=0.009); a higher level of physical activity was associated with increased serum S100B (OR=1.038, 95%CI: 1.003-1.074, P=0.034); and no significant association of physical activity level or air pollution with BDNF (P>0.05).

[Conclusion]Acute exposure to air pollution and high-level physical activity might affect the neural damage of elderly populations. Specifically, particulate matter (PM2.5) could increase NSE, while gaseous pollutants (O3, NO2, and SO2) could decrease NF-L and PGP9.5.

表  1  

研究期間空氣污染物濃度及老年志愿者神經(jīng)損傷生物標志濃度

Table  1  

The levels of air pollutants and neural damage biomarkers in elderly volunteers during study period

變量(Variable)$ bar x $$ s $最小值
MinP25P50P75最大值
Max顆粒物濃度
Particulate matter level　PM2.5/(μg·m?3)68.2760.9826.1731.3345.8848.71189.29　PM10/(μg·m?3)130.5758.7178.2187.17117.42120.63246.08氣態(tài)污染物濃度
Gasous pollutant level　O3/(μg·m?3)36.8613.8918.9628.7932.5042.9660.92　SO2/(μg·m?3)17.8610.5910.3316.4618.3320.0826.42　CO/(mg·m?3)4.941.342.384.665.175.966.36　NO2/(μg·m?3)50.838.0334.7149.4252.9256.8358.96神經(jīng)損傷生物標志濃度
Neural damage biomarker level　BDNF/(μg·L?1)139.1246.71123.00175.00191.00203.00672.00　NF-L/(ng·L?1)402.60183.3187.84250.63391.08523.89866.52　NSE/(ng·L?1)11.2610.320.323.177.2817.1852.05　PGP9.5/(ng·L?1)14.3213.572.328.2512.0815.49125.52　S100B/(ng·L?1)127.5741.7494.40105.69113.09132.37341.43

表  2  

老年志愿者神經(jīng)損傷生物標志影響因素的GEE模型結(jié)果

Table  2  

Generalized estimation equation model results on influencing factors of neural damage biomarkers in elderly volunteers

參數(shù)(Variable)BDNFNF-LNSEPGP9.5S100 BbOR(95% CI)bOR(95% CI)bOR(95% CI)bOR(95% CI)bOR(95% CI)體力活動 (Physical activity)?0.0090.991(0.963~1.020)0.0051.005(0.882~1.146)0.1591.173(0.942~1.461)0.0161.106(0.887~1.164)0.0371.038(1.003~1.074)*PM2.5濃度(PM2.5 level)/(μg·m?3)　>45.88 (vs. ≤45.88)?0.0190.981(0.962~1.002)0.0281.028(0.983~1.072)0.3071.359(1.224~1.509)*?0.0020.998(0.924~1.078)?0.0240.997(0.945~1.010)PM10濃度(PM10 level)/(μg·m?3)　>117.42 (vs. ≤117.42)?0.0020.998(0.964~1.032)?0.1000.905(0.781~1.047)?0.1470.864(0.681~1.096)0.1351.144(0.986~1.328)?0.0190.981(0.981~1.080)O3濃度(O3 level)/(μg·m?3)　>32.50 (vs. ≤32.50)0.0401.041(0.980~1.105)?0.1560.855(0.740~0.989)*0.2521.286(1.076~1.537)*0.0401.041(0.862~1.257)?0.0030.997(0.952~1.044)SO2濃度(SO2 level)/(μg·m?3)　>18.33 (vs. ≤18.33)0.0051.005(0.942~1.073)?0.2070.813(0.700~0.946)*0.0451.046(0.853~1.283)0.0751.078(0.861~1.350)?0.0050.995(0.946~1.047)CO濃度(CO level)/(mg·m?3)　>5.17 (≤5.17)?0.0130.987(0.939~1.037)0.0571.058(0.982~1.140)?0.0050.995(0.864~1.145)0.0131.013(0.900~1.141)0.0161.016(0.998~1.044)NO2濃度(NO2 level)/(μg·m?3)　>52.92 (≤52.92)0.0351.036(0.982~1.094)?0.0450.956(0.831~1.099)?0.3680.692(0.549~0.873)*?0.1440.866(0.777~0.965)*0.0391.040(0.963~1.122)[注]*：P < 0.05。[Note] *: P < 0.05. [1]

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