Effects of Reducing Indoor Air Particles on Cardiovascular and Respiratory Physiological Indexes in the Elderly: a Randomized Crossover Controlled Trial

doi:10.12114/j.issn.1007-9572.2022.0799

Chinese General Practice ›› 2023, Vol. 26 ›› Issue (17): 2114-2119.DOI: 10.12114/j.issn.1007-9572.2022.0799

Special Issue: 老年问题最新文章合辑；心血管最新文章合辑；老年人群健康最新文章合辑；环境与健康最新文章合辑

• Original Research • Previous Articles Next Articles

Effects of Reducing Indoor Air Particles on Cardiovascular and Respiratory Physiological Indexes in the Elderly: a Randomized Crossover Controlled Trial

1. Geriatric Department, Chongqing Emergency Medical Center/the Fourth People's Hospital of Chongqing, Chongqing 400030, China
2. Western Investment Construction Co., LDT of CCTEB, Chengdu 610041, China
3. School of Civil Engineering, Chongqing University, Chongqing 400045, China
4. School of Life Sciences, Central China Normal University, Wuhan 430079, China

Received:2022-08-08 Revised:2023-02-13 Published:2023-06-15 Online:2023-03-01
Contact: YU Wei

减少室内空气颗粒物对老年人心血管和呼吸系统生理指标的影响：一项随机双盲交叉试验

1．400030　重庆市急救医疗中心　重庆市第四人民医院老年科
2．610041　四川省成都市，中建三局西部投资建设有限公司
3．400045　重庆市，重庆大学土木工程学院
4．430079　湖北省武汉市，华中师范大学生命科学学院

通讯作者: 喻伟
作者简介:
作者贡献：周敏负责调查研究、方法设计、提供资源、有效验证、初稿写作；郑子光负责调查研究、项目管理；游宏宇负责形式分析、软件处理；郭淼负责数据策划、可视化分析；喻伟负责方案策划、获取资助、项目管理、提供资源、监督指导、写作审编等；杨旭负责方法设计、监督指导。
基金资助:
国家自然科学基金面上项目（52078076）——室内高湿环境老年人暴露途径及其呼吸系统功能蓄积特征解析; 中央高校基本业务费"医工融合"项目（2019CDYGYB023）——室内环境风险因子耦合暴露对老年人COPD的致病机理

Abstract

Abstract:

Background

Exposure to indoor air particles pollution increases the incidence and mortality of respiratory and cardiovascular diseases, especially in the elderly population.

Objective

To explore the effect of indoor air particles on cardiopulmonary-related physiological indexes of the elderly and short-term use of air purifiers on the improvement of cardiopulmonary health of the elderly.

Methods

A randomized, double-blind, crossover trial was conducted in January 2020 on 24 healthy older adults selected from a senior apartment in Jiangbei District of Chongqing. These included older adults equally divided into two groups alternately using real and sham air purifiers for 48 h with a 12-days washout interval by complete randomization. 14 health indexes including biomarkers of circulatory system inflammation, coagulation, oxidative stress and pulmonary function, blood pressure, heart rate, exhaled fractional nitric oxide (FeNO) were measured. Linear mixed-effect model was used to evaluate the effect of the air purifiers on health indexes.

Results

The results of the linear mixed-effect model showed that compared with the sham purifiers, fibrinogen, MCP-1 and MPO in the blood inflammatory indicators were changed by -15.1%〔95%CI (-23.1%, -6.3%) , P<0.05〕, -17.7%〔95%CI (-22.9%, -12.3%) , P<0.05〕 and -17.2%〔95%CI (-23.9%, -9.8%) , P<0.05〕, PAI-1 and t-PA in the coagulation factors changed by -14.9%〔95%CI (-21.1%, -8.2%) , P<0.05〕 and -13.5%〔95%CI (-18.7%, -8.0%) , P<0.05〕, heart rate changed by -5.8%〔95%CI (-10.6%, -0.8%) , P<0.05〕in the real purifiers, respectively. For every 1 μg/m³ increase in PM_2.5 concentration, fibrinogen, MCP-1, MPO, PAI-1, t-PA, D-dimer and heart rate in the elderly increased by 0.51%, 0.48%, 0.56%, 0.49%, 0.43%, 0.31% and 0.20%, respectively (P<0.05) .

Conclusion

Indoor air purifiers are associated with decreased concentrations of systemic and local inflammation and coagulation biomarkers. Reducing air particles may be a public health measure to improve circulatory and cardiopulmonary health in the elderly.

Key words: Particulate matter, Air filters, Aged, Randomized controlled trial, Cross-over studies, Public health

摘要：

背景

暴露于室内空气颗粒物污染会增加呼吸道和心血管疾病的发病率和死亡率，在老年人群中尤其明显。

目的

探究室内空气颗粒物对老年人心肺相关生理指标的影响及短期使用空气净化器是否改善老年人的心肺健康。

方法

2020年1月选取中国重庆市江北区老年公寓24名健康老年人为研究对象进行一项随机双盲交叉试验。采用完全随机分组方法将老年人平均分为两组，交替使用真、假空气净化器48 h，期间有12 d的洗脱期。每次净化结束后测试老年人14种循环系统的炎症、凝血和氧化应激的生物标志物及肺功能、血压、心率和呼出气一氧化氮（FeNO）等健康指标。应用线性混合效应模型评估空气净化器对健康指标的影响。

结果

线性混合效应模型结果显示，与假净化器相比，使用真净化器的老年人血液炎症因子中纤维蛋白原、单核细胞趋化蛋白1（MCP-1）、髓过氧化物酶（MPO）的改变量为-15.1%〔95%CI（-23.1%，-6.3%），P<0.05〕、-17.7%〔95%CI（-22.9%，-12.3%），P<0.05〕和-17.2%〔95%CI（-23.9%，-9.8%），P<0.05〕；凝血因子中纤溶酶原激活物抑制剂1（PAI-1）改变量为-14.9%〔95%CI（-21.1%，-8.2%），P<0.05〕，组织型纤溶酶原激活物（t-PA）改变量为-13.5%〔95%CI（-18.7%，-8.0%），P<0.05〕；心率改变量为-5.8%〔95%CI（-10.6%，-0.8%），P<0.05〕；室内细颗粒物（PM_2.5）浓度每升高1 μg/m³，老年人纤维蛋白原、MCP-1、MPO、PAI-1、t-PA、D-二聚体、心率相应升高0.51%、0.48%、0.56%、0.49%、0.43%、0.31%、0.20%（P<0.05）。

结论

室内空气净化器与炎症和凝血生物标志物的浓度降低有关。减少空气颗粒物可能成为一种改善老年人循环和心肺健康的公共卫生措施。

关键词: 颗粒物, 空气过滤器, 老年人, 随机对照试验, 交叉研究, 公共卫生

ZHOU Min,ZHENG Ziguang,YOU Hongyu, et al. Effects of Reducing Indoor Air Particles on Cardiovascular and Respiratory Physiological Indexes in the Elderly: a Randomized Crossover Controlled Trial[J]. Chinese General Practice, 2023, 26(17): 2114-2119. DOI: 10.12114/j.issn.1007-9572.2022.0799.
周敏,郑子光,游宏宇等. 减少室内空气颗粒物对老年人心血管和呼吸系统生理指标的影响：一项随机双盲交叉试验[J]. 中国全科医学, 2023, 26(17): 2114-2119. DOI: 10.12114/j.issn.1007-9572.2022.0799.

Figures/Tables 4

References 18

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组别	例数	血液炎症因子^a								凝血因子^a
组别	例数	CRP （µg/L）	纤维蛋白原（µg/L）	P选择蛋白（ng/L）	MCP-1 （ng/L）	IL-1β （ng/L）	IL-6 （ng/L）	TNF-α （ng/L）	MPO （µg/L）	sCD40L （ng/L）	PAI-1 （ng/L）	t-PA （ng/L）
假净化器	24	2 084.7±426.5	993.3±195.6	4 461.6±575.5	240.6±27.1	53.1±5.8	20.0±2.8	314.0±74.4	78.2±10.8	628.4±146.6	657.4±110.6	211.7±22.7
真净化器	24	1 864.3±397.5	859.5±174.1	4 225.6±522.5	198.6±21.8	51.3±5.8	19.3±2.7	293.7±70.7	65.2±12.4	610.3±18.1	564.8±129.6	183.6±29.7
组别	D-二聚体（µg/L）	SBP （mm Hg）	DBP （mm Hg）	心率（次/min）	肺功能及肺部炎症^b				氧化应激因子^a
组别	D-二聚体（µg/L）	SBP （mm Hg）	DBP （mm Hg）	心率（次/min）	PEF （L/min）	FEV₁ （L）	FVC （L）	FeNO （ppb）	ROS （µg/L）	GSH （ng/L）
假净化器	3 728.4±706.7	145±30	87±13	74±13	104.5±32.4	0.87±0.45	1.03±0.62	18.9±10.0	11.5±1.4	76.6±11.8
真净化器	3 470.3±536.9	142±27	88±15	70±10	96.9±41.6	0.87±0.48	1.08±0.70	16.0±9.7	11.0±1.3	82.2±12.4

组别	例数	血液炎症因子^a								凝血因子^a
组别	例数	CRP （µg/L）	纤维蛋白原（µg/L）	P选择蛋白（ng/L）	MCP-1 （ng/L）	IL-1β （ng/L）	IL-6 （ng/L）	TNF-α （ng/L）	MPO （µg/L）	sCD40L （ng/L）	PAI-1 （ng/L）	t-PA （ng/L）
假净化器	24	2 084.7±426.5	993.3±195.6	4 461.6±575.5	240.6±27.1	53.1±5.8	20.0±2.8	314.0±74.4	78.2±10.8	628.4±146.6	657.4±110.6	211.7±22.7
真净化器	24	1 864.3±397.5	859.5±174.1	4 225.6±522.5	198.6±21.8	51.3±5.8	19.3±2.7	293.7±70.7	65.2±12.4	610.3±18.1	564.8±129.6	183.6±29.7
组别	D-二聚体（µg/L）	SBP （mm Hg）	DBP （mm Hg）	心率（次/min）	肺功能及肺部炎症^b				氧化应激因子^a
组别	D-二聚体（µg/L）	SBP （mm Hg）	DBP （mm Hg）	心率（次/min）	PEF （L/min）	FEV₁ （L）	FVC （L）	FeNO （ppb）	ROS （µg/L）	GSH （ng/L）
假净化器	3 728.4±706.7	145±30	87±13	74±13	104.5±32.4	0.87±0.45	1.03±0.62	18.9±10.0	11.5±1.4	76.6±11.8
真净化器	3 470.3±536.9	142±27	88±15	70±10	96.9±41.6	0.87±0.48	1.08±0.70	16.0±9.7	11.0±1.3	82.2±12.4

健康指标	改变百分比（%）	95%CI（%）	SE	t值	P值	健康指标	改变百分比（%）	95%CI（%）	SE	t值	P值
血液炎症指标						血压
CRP	-9.9	（-19.2，0.6）	109.46	-1.950	0.081	SBP	-1.8	（-5.9，2.4）	3.06	-1.060	0.288
纤维蛋白原	-15.1	（-23.1，-6.3）	46.23	-3.380	0.001	DBP	1.1	（-3.0，5.3）	1.83	0.590	0.556
P选择蛋白	-4.7	（-9.5，0.5）	114.11	-1.890	0.079	心率	-5.9	（-10.1，-1.4）	1.69	-2.800	0.005
MCP-1	-17.7	（-22.8，-12.2）	7.16	-6.050	<0.001	肺功能及肺部炎症
IL-1β	-3.4	（-8.4，1.8）	1.41	-1.290	0.197	PEF	-7.1	（-21.9，10.4）	9.07	-0.535	0.593
IL-6	-3.7	（-10.7，3.9）	0.75	-0.964	0.335	FEV₁	-0.3	（-12.8，14.1）	0.06	0.173	0.863
TNF-α	-5.9	（-18.5，8.6）	21.13	-0.890	0.374	FVC	3.6	（-10.3，19.7）	0.09	0.870	0.386
MPO	-17.2	（-23.9，-9.8）	2.98	-4.430	<0.001	FeNO	-14.0	（-30.2，6.0）	2.45	-1.000	0.317
凝血因子						氧化应激因子
sCD40L	-2.2	（-13.9，11.0）	40.13	-0.457	0.648	ROS	-1.5	（-7.7，5.2）	0.36	-0.520	0.606
PAI-1	-14.9	（-21.1，-8.2）	22.13	-4.200	<0.001	GSH	6.8	（-2.2，16.6）	3.55	1.480	0.140
t-PA	-13.5	（-18.7，-8.0）	5.83	-4.770	<0.001
D-二聚体	-8.9	（-17.3，0.4）	173.06	-2.060	0.063

健康指标	改变百分比（%）	95%CI（%）	SE	t值	P值	健康指标	改变百分比（%）	95%CI（%）	SE	t值	P值
血液炎症指标						血压
CRP	-9.9	（-19.2，0.6）	109.46	-1.950	0.081	SBP	-1.8	（-5.9，2.4）	3.06	-1.060	0.288
纤维蛋白原	-15.1	（-23.1，-6.3）	46.23	-3.380	0.001	DBP	1.1	（-3.0，5.3）	1.83	0.590	0.556
P选择蛋白	-4.7	（-9.5，0.5）	114.11	-1.890	0.079	心率	-5.9	（-10.1，-1.4）	1.69	-2.800	0.005
MCP-1	-17.7	（-22.8，-12.2）	7.16	-6.050	<0.001	肺功能及肺部炎症
IL-1β	-3.4	（-8.4，1.8）	1.41	-1.290	0.197	PEF	-7.1	（-21.9，10.4）	9.07	-0.535	0.593
IL-6	-3.7	（-10.7，3.9）	0.75	-0.964	0.335	FEV₁	-0.3	（-12.8，14.1）	0.06	0.173	0.863
TNF-α	-5.9	（-18.5，8.6）	21.13	-0.890	0.374	FVC	3.6	（-10.3，19.7）	0.09	0.870	0.386
MPO	-17.2	（-23.9，-9.8）	2.98	-4.430	<0.001	FeNO	-14.0	（-30.2，6.0）	2.45	-1.000	0.317
凝血因子						氧化应激因子
sCD40L	-2.2	（-13.9，11.0）	40.13	-0.457	0.648	ROS	-1.5	（-7.7，5.2）	0.36	-0.520	0.606
PAI-1	-14.9	（-21.1，-8.2）	22.13	-4.200	<0.001	GSH	6.8	（-2.2，16.6）	3.55	1.480	0.140
t-PA	-13.5	（-18.7，-8.0）	5.83	-4.770	<0.001
D-二聚体	-8.9	（-17.3，0.4）	173.06	-2.060	0.063

健康指标	男				女
健康指标	改变百分比（%）	SE	t值	P值	改变百分比（%）	SE	t值	P值
CRP	-23.43	130.67	-4.040	<0.001	7.69	110.86	1.120	0.262
纤维蛋白原	-17.00	60.44	-2.870	0.004	-11.89	61.41	-2.058	0.040
P选择蛋白	-5.87	163.06	-0.610	0.107	-4.43	167.36	-1.250	0.210
MCP-1	-22.54	6.53	-8.660	<0.001	-12.75	12.84	-2.370	0.018
IL-1β	-6.14	1.63	-1.980	0.048	0.32	2.52	0.020	0.984
IL-6	-0.31	0.93	0.026	0.979	-5.57	1.28	-0.919	0.358
TNF-α	-7.44	30.28	-0.793	0.428	-3.72	34.37	-0.342	0.732
MPO	-17.07	3.29	-0.403	<0.001	-18.41	5.47	-2.653	0.110
sCD40L	-3.78	59.61	-0.480	0.631	1.05	62.63	0.033	0.974
PAI-1	-22.74	25.75	-5.597	<0.001	-7.29	15.86	-3.041	0.002
t-PA	-12.47	7.91	-3.229	0.001	-13.96	9.32	-3.110	0.002
D-二聚体	-6.12	261.02	-0.913	0.361	-12.20	251.43	-1.970	0.089
SBP	-0.72	4.82	-0.330	0.741	-3.33	4.48	-1.190	0.235
DBP	-0.37	2.22	-0.193	0.847	1.15	3.01	0.489	0.422
心率	-5.06	2.81	-1.390	0.165	-6.69	2.10	-2.810	0.005
PEF	-4.26	14.48	-0.090	0.927	-8.48	8.99	-0.704	0.482
FEV₁	0.31	0.09	0.370	0.780	0.43	0.67	0.062	0.950
FVC	4.83	0.16	0.744	0.457	2.76	0.08	0.410	0.682
FeNO	-17.34	2.83	-1.220	0.223	-8.84	4.70	-0.240	0.809
ROS	-0.08	0.56	0.383	0.702	-4.36	0.37	-1.362	0.173
GSH	-0.10	5.78	0.652	0.514	8.97	4.53	1.482	0.138

Effects of Reducing Indoor Air Particles on Cardiovascular and Respiratory Physiological Indexes in the Elderly: a Randomized Crossover Controlled Trial

减少室内空气颗粒物对老年人心血管和呼吸系统生理指标的影响：一项随机双盲交叉试验

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健康指标	改变百分比（%）	SE	t值	P值
CRP	0.18	3.438	1.067	0.314
纤维蛋白原	0.51	1.326	3.633	<0.001
P选择蛋白	0.11	3.546	1.426	0.184
MCP-1	0.48	0.243	4.380	<0.001
IL-1β	0.10	0.043	1.194	0.230
IL-6	0.15	0.022	1.356	0.173
TNF-α	0.07	0.626	0.368	0.763
MPO	0.56	0.089	4.387	<0.001
sCD40L	0.03	1.177	0.246	0.860
PAI-1	0.49	0.705	4.011	<0.001
t-PA	0.43	0.176	4.658	<0.001
D-二聚体	0.31	4.907	2.319	0.028
SBP	0.03	0.100	0.497	0.708
DBP	-0.01	0.059	-0.022	0.917
心率	0.20	0.055	2.820	0.009
PEF	0.21	0.280	0.489	0.625
FEV₁	0.01	0.002	-0.169	0.866
FVC	-0.10	0.003	-0.732	0.464
FeNO	0.41	0.079	0.788	0.431
ROS	0.03	0.010	0.371	0.710
GSH	-0.18	0.102	-1.380	0.168

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