2026 年第 5 期 第 21 卷

长期暴露于不同粒径颗粒物与中老年代谢综合征人群心血管疾病风险的关联研究

Association study of long-term exposure to different particle sizes with cardiovascular disease risk in middle-aged and elderly patients with metabolic syndrome

作者：雷棵行黄觊

英文作者：Lei Kehang Huang Ji

单位：首都医科大学附属北京安贞医院心内冠心病中心六区，北京100029

英文单位：The Sixth Ward of Coronary Atherosclerotic Heart Disease Center Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：代谢综合征；空气污染；心血管疾病风险

英文关键词：Metabolicsyndrome;Airpollution;Cardiovasculardiseaserisk

• 摘要：

• 目的 本研究旨在评估长期暴露于不同粒径颗粒物［细颗粒物（PM2.5）、可吸入颗粒物（PM10）］与中老年代谢综合征（MS）人群心血管疾病（CVD）风险之间的关联。方法 本研究基于中国健康与养老追踪调查2011—2018年数据，纳入1 959名≥60岁人群，依据CVD患病情况分为非CVD组（1 445例）和CVD组（514例）。依据相关代谢指标划分MS情况。采用PM2.5、PM10年均浓度估算个体暴露水平。依据颗粒物浓度四分位数将研究对象分为Q1～Q4共4组，其中Q1组为最低暴露组（对照），Q4组为最高暴露组，对比不同颗粒物暴露水平的风险。应用Cox比例风险回归模型评估PM2.5及PM10对CVD发病风险的影响，利用限制性立方样条分析颗粒物平均浓度与CVD发病风险的剂量-反应关系。结果 高暴露于PM2.5和PM10均与CVD发病风险显著升高相关（均P<0.05）。多模型逐步校正社会人口学、生活方式、生理指标及既往病史后，对于PM2.5，Q4组CVD风险仍独立存在（风险比＝1.60，95%置信区间：1.22～2.08）；PM10呈一致趋势，且均呈显著剂量-反应关系。限制性立方样条分析显示，PM2.5、PM10浓度与CVD的关联在非MS人群中显著（P=0.009 6、0.001 5），而在MS人群中关联不显著（均P>0.05）。结论 PM2.5及PM10暴露与中老年人CVD发病风险呈正相关，该关联在MS人群中存在“天花板效应”，在非MS人群中表现得较为显著，提示二者可能是CVD的独立危险因素。

• Objective To evaluate the association between long-term exposure to different particle sizes ［fine particulate matter (PM2.5), inhalable particulate matter (PM10)］ and cardiovascular disease (CVD) risk in middle-aged and elderly individuals with metabolic syndrome (MS). Methods Based on the 2011-2018 data from the China Health and Retirement Longitudinal Study, 1 959 participants aged ≥60 years were enrolled and divided into non-CVD group (1 445 cases) and CVD group (514 cases) according to CVD status. MS status was classified based on relevant metabolic indicators. Individual exposure levels were estimated using annual average concentrations of PM2.5 and PM10. Participants were divided into four groups (Q1-Q4) according to quartiles of particulate matter concentration, with Q1 as the lowest exposure group (control) and Q4 as the highest exposure group, to compare risks at different exposure levels. Cox proportional hazards regression model was applied to assess the effects of PM2.5 and PM10 on CVD incidence risk, and restricted cubic spline was used to analyze the dose-response relationship between average particulate matter concentration and CVD incidence risk. Results High exposure to PM2.5 and PM10 was both significantly associated with elevated CVD incidence risk (both P<0.05). After stepwise adjustment for sociodemographic factors, lifestyle, physiological indicators and past medical history in multiple models, the independent association of CVD risk remained significant in the Q4 group for PM2.5 (hazard ratio=1.60, 95% confidence interval: 1.22-2.08); a consistent trend was observed for PM10, with significant dose-response relationships in both. Restricted cubic spline analysis showed that the associations of PM2.5 and PM10 concentrations with CVD were significant in non-MS individuals (P=0.009 6, 0.001 5) but not significant in MS individuals (both P>0.05). Conclusions Exposure to PM2.5 and PM10 is positively correlated with CVD incidence risk in middle-aged and elderly individuals. This association exhibits a "ceiling effect" in MS individuals and is more significant in non-MS individuals, suggesting that both may be independent risk factors for CVD.