過去研究顯示空氣污染濃度增加與心血管疾病住院醫療有關。然而，目前較少研究在探討空氣污染對於急性缺血性心血管及腦血管疾病的影響，以及在不同的空氣污染暴露程度，是否會影響短期空氣污染暴露對於急性缺血性腦心血管疾病住院醫療的危險性。因此本研究的目的是利用病例交叉研究來評估短期空氣污染暴露與急性缺血性腦心血管疾病住院醫療的關係，並且尋找主要受到空氣污染影響的急性缺血性腦心血管疾病族群。本研究的研究對象是以台北市1996年到2006年間因急性心肌梗塞、心絞痛、腦前動脈及腦動脈的阻塞及狹窄、短暫性腦部缺血住院醫療的新發病患，利用空氣污染及氣象監測資料做為環境暴露因子，並以對照日的空氣污染暴露濃度進行分析。結果發現，不論是在高溫日裡（≧23℃）或是低溫日裡（＜23℃）以單一污染物模式分析，當懸浮微粒(PM10)、二氧化硫(SO2)、二氧化氮(NO2)、一氧化碳(CO)及臭氧(O3)的濃度增加與急性缺血性腦心血管疾病住院醫療危險性增加有關。在兩種污染物模式中，除了SO2以外，在其他的污染物(PM10, NO2, CO, O3)仍然可以發現與住院醫療危險性增加有關，而在低溫日O3的危險對比值為最高(低溫日OR:1.14-1.43; O3每增加10 ppb)。在低溫日以單一污染物模式分析，PM10對照日暴露濃度在41 μg/m3以下的病患，當PM10暴露濃度每增加15 μg/m3，其住院醫療危險對比值為5.95 (5.57-6.36)，比對照日暴露濃度大於41 μg/m3的病患，住院醫療危險性還要高(OR 1.00, 0.99-1.02)。在NO2、CO及O3也可以發現同樣的情形：急性缺血性腦心血管疾病住院醫療的危險性於對照日暴露濃度NO2在28 ppb以下 (OR 3.38, 3.20-3.56; NO2每增加5 ppb)、CO在1.1 ppm以下 (OR 1.51, 1.48-1.55; CO每增加0.2 ppm)及O3在17 ppb以下 (OR 3.53, 3.21-3.89; O3每增加10 ppb) 的病患，比對照日暴露濃度在NO2大於28 ppb、CO大於1.1 ppm及O3大於17 ppb以上的病患，其住院醫療的危險性還要大。在兩種污染物模式之中則可以發現相同的結果。研究結果證實，當對照日處於較低的空氣污染暴露濃度，受到空氣污染暴露濃度增加對於急性缺血性腦心血管疾病住院醫療危險性，比對照日處於較高暴露濃度的危險性高。然而，仍然需要更多生物機轉方面的研究來解釋空氣污染對於急性缺血性腦心血管疾病造成的影響。
關鍵字：空氣污染、缺血性腦心血管疾病、對照日暴露濃度

Studies have suggested the association between increased air pollution and hospital admission for cardiovascular disease. However, there are few studies investigating the adverse air pollution effect for acute ischemic cardiovascular and cerebrovascular diseases and the differential air pollution level affect the risk of acute ischemic cardiovascular and cerebrovascular hospitalization. Therefore, a case-crossover study was conducted to evaluate the association between acute ambient air pollution exposure and hospital admissions for acute ischemic cardiovascular and cerebrovascular diseases and to fine out the patients who were most affected by air pollution. Cases were defined as those patients admitted to hospitals for the first time with primary diagnoses of acute myocardial infarction, angina pectoris, occlusions and stenosis of precerebral and cerebral arteries, and transient cerebral ischemia between 1996 and 2006 in Taipei. Environmental exposure data were used from air pollution and meteorological monitoring data. In the single-pollutant models, significant positive associations were found between the levels of particulate matter ＜10 μm aerodynamic diameter (PM10), sulfate dioxide (SO2), nitrogen dioxide (NO2¬), carbon monoxide (CO) and ozone (O3) and hospital risk of acute ischemic cardiovascular and cerebrovascular diseases on both warm (≧23℃) and cool days (＜23℃). In two-pollutant models, all pollutants except SO2 were significantly associated with the hospital risk. The highest OR were O3 in cold days (OR:1.14-1.43; O3 per 10 ppb). In cool days, the OR for those patients with referent days PM10 level ≦41 μg/m3 was 5.95 (95% CI: 5.57-6.36, per 15 μg/m3 increase) in the single-pollutant models. However, the OR for those with referent days PM10 level ＞41 μg/m3 was 1.00 (0.99-1.02). Similarly, hospitalization risks for those with referent days NO2 level ≦28 ppb (OR 3.38, 3.20-3.56; per 5 ppb increase), CO level ≦1.1 ppm (OR 1.51, 1.48-1.55; per 0.2 ppm) or O3 level ≦17 ppb (OR 3.53, 3.21-3.89; per 10 ppb increase) were greater than those with referent days NO2 level ＞28 ppb, CO level ＞1.1 ppm or O3 level ＞17 ppb. The same situation could be found in two-pollutant models. Our results demonstrate that the hospitalization risk for patients in low referent days exposure category was significantly higher than that for patients in high referent days exposure category. The biological significance would be explored.

Keywords: air pollution, ischemic cardiovascular and cerebrovascular disease, referent days exposure level

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