空气污染与肾病课件.pptx

JASN 在中国 空气污染可增加肾脏疾病风险 1 2020 3 19 众所周知 空气污染会导致呼吸系统和心血管疾病 一项最新研究表明 它也有可能导致肾脏损伤 该研究发表在肾脏病顶级杂志 JASN上 呼吁关注空气污染对肾脏病发展的作用 2 2020 3 19 JAmSocNephrol 2016Jun30 JAmSocNephrol 2016Jun30 3 2020 3 19 INTRODUCTION GlomerulardiseaseremainstheleadingcauseofESRDinAsia Publishedstudieshaveshowngeographicalandracialvariationsinthepatternsofglomerulardiseases IgAnephropathy IgAN isthemostcommonprimaryglomerulopathyinAsia Europe Australia andsomeregionsoftheUnitedStates Nopublishedstudieshaveevaluatedtheeffectofenvironmentalfactorsonthechangingpatternofglomerulardiseases JAmSocNephrol 2016Jun30 4 2020 3 19 Chinacomprises20 oftheworldpopulation Withrapiddevelopmentsinitseconomyandurbanization especiallyduringthepastdecade airpollutionhasbecomeapublichealthprobleminsomecities Exposuretoairpollution especiallyparticulatematterof 2 5 m PM2 5 hasbeenassociatedwithincreaseddeathandincidenceofcardiovascularevents JAmSocNephrol 2016Jun30 5 2020 3 19 Inthisstudy weanalyzeddatafroman11 yearrenalbiopsyseriesincluding71 151patientsfrom938hospitalsin282citiesacrossChina encompassingallagegroupsandbothtertiaryandcommunityhospitals toevaluatesecularpatternofglomerulardiseases Wefurtherexaminedtheassociationbetweenlong termexposuretoPM2 5andspecifictypesofglomerulardiseases JAmSocNephrol 2016Jun30 6 2020 3 19 JAmSocNephrol 2016Jun30 RESULTS 7 2020 3 19 JAmSocNephrol 2016Jun30 8 2020 3 19 JAmSocNephrol 2016Jun30 9 2020 3 19 JAmSocNephrol 2016Jun30 10 2020 3 19 JAmSocNephrol 2016Jun30 11 2020 3 19 FrequencyofMNvariedgreatlyamonggeographicalregions Figure2A Inourstudy thefrequencyofMNwashigherinthenorthernregion especiallyinHebeiprovince themostpollutedareainChina Figure2B TheaverageannualincreaseinPM2 5concentration PM2 5slope was0 85 g m3peryear withthehighestincrease 3 2 g m3peryear observedinthecitiesinHebeiprovince JAmSocNephrol 2016Jun30 12 2020 3 19 DISCUSSION ThisisthefirstandthelargeststudyofanationwidebiopsyseriestoexaminetheeffectofairpollutiononthechangingpatternofglomerulardiseasesinChina WefoundaremarkableriseintheproportionofMNoveraperiodof11yearsfrom2004to2014 JAmSocNephrol 2016Jun30 13 2020 3 19 From2004to2014 theadjustedfrequencyofMNincreasedfrom12 2 to24 9 inthisChinesepopulation TheriskforMNincreased13 annuallyinaregressionanalysis Projectedfromthistrend MNwouldsoonpassIgANtobecometheleadingtypeofnephropathyinChina JAmSocNephrol 2016Jun30 14 2020 3 19 Each10 g m3increaseinPM2 5concentrationassociatedwith14 higheroddsforMN oddsratio 1 14 95 confidenceinterval 1 10to1 18 inregionswithPM2 5concentration 70 g m3 JAmSocNephrol 2016Jun30 15 2020 3 19 MNwasalsoreportedinIndia acountrywithahighlevelofenvironmentalexposures Incomparison MNwasshowntobedeclininginotherEastAsiancountrieswithlowexposurelevels suchasJapanandKorea JAmSocNephrol 2016Jun30 16 2020 3 19 Themechanismbywhichlong termexposuretofineparticulateairpollutionmayincreasetheriskofMNremainstobeelucidated MNhasbeenrecognizedasanautoimmunediseasecharacterizedbytheformationofcirculatingautoantibodiesandsubepithelialimmunecomplexdepositsinthekidney JAmSocNephrol 2016Jun30 17 2020 3 19 Animalstudieshaveshownthatexposuretofineparticulatepromotestheproductionofautoantibodiesandimmunecomplexes Airpollutionin