Lancet：交通污染對呼吸和心血管功能的影響
1
交通污染對呼吸和心血管功能的影響
空氣污染已成為世界範圍內的嚴重環境威脅，長期接觸污染可以增加死亡風險，主要是誘發缺血性心臟病及加重慢性阻塞性肺病，針對短時交通污染對相關疾病及健康人群的影響尚待研究。
入選60歲以上的受試者119名（40名健康、40名慢阻肺、39名缺血性心臟病）隨機分為兩組，在行車街道（較多柴油車尾氣）和公園環境中行走2小時，其中行車街道污染物濃度高於公園（黑碳，NO2，PM10，PM2.5，超微顆粒），發現COPD患者在行車街道中步行會更多出現以下癥狀，咳嗽（OR 1.95, 95%CI 0.96-3.95; p＜0.1 ），痰液（3.15，1.39–7.13; p＜0.05 ），氣促(1.86，0.97–3.57；p＜0.1)，喘息(4.00，1.52–10.50; p＜0.05)。
所有受試者中，公園行走能改善26小時內的肺功能（一秒用力呼氣容積FEV1和用力肺活量FVC），降低PWV（脈搏波速度），增強指數（全身動脈硬度），而街道環境削弱了行走運動的獲益。
COPD患者中，FEV1、FVC下降和氣道阻力升高與NO2、超微顆粒和PM2.5有關，並且PWV、增強指數的提高與NO2、超微顆粒有關。在健康自願者中，PWV、增強指數與黑碳和超微顆粒相關。
結果發現，短期交通污染會減少步行的心肺獲益，針對以上損害健康結果，制定政策時需要考慮控制繁忙街道的空氣污染水平。（編譯：北京天壇醫院 李晶津）
原文鏈接:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32643-0/fulltext
2
納曲酮緩釋劑和丁丙諾啡納洛酮防阿片類物質復吸研究
緩釋納曲酮(XR-NTX)是μ型阿片受體拮抗劑，丁丙諾啡納洛酮 (BUP-NX) 是μ型阿片受體部分激動劑，兩者是藥理和概念都不同的治療阿片成癮復吸的藥物。
本研究旨在評價兩種療法在真實世界中無復吸生存率的差別。共納入受試者570例，年齡均≥18歲，均按照DSM-5診斷為阿片類藥物使用相關障礙，均在過去30天內使用過非處方的阿片類藥物。
隨機分為緩釋納曲酮組或丁丙諾啡納洛酮組。主要指標是24周門診治療中的無復吸生存率。納曲酮須激發試驗陰性才能使用，有明顯的誘導障礙，成功啟動治療的受試者比例低於納洛酮組(72%vs94%； p＜0.0001). 570例意向處理人群中，納曲酮組24周內復吸事件比例高於納洛酮組(65%vs57%; HR1.36,95%CI 1.10–1.68)。
這應歸因於納曲酮誘導失敗；這部分受試者幾乎全部出現早期復吸(89%)。但只要誘導成功（符合方案人群474例），24周的復吸比例兩組相似(p=0.44)。意向處理人群中，納洛酮組尿檢陰性(P＜0.0001)和戒斷天數(P＜0.0001)表現更優，但符合方案人群中兩組表現類似。
起初納曲酮組自報對阿片類藥物渴求較低(p=0.0012)，第24周時兩組趨同(p=0.20)。嚴重不良事件無差別。
結論：緩釋納曲酮治療阿片成癮復吸較難啟動，但一旦啟動，其與丁丙諾啡納洛酮均安全有效。（編譯：北京中醫藥大學東直門醫院 党進）
原文鏈接:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32812-X/fulltext
原文摘要
1
Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study
Dr. Joshua D Lee, MD, Edward V Nunes Jr, MD, Patricia Novo, MPH, Ken Bachrach, PhD，Genie L Bailey, MD, Snehal Bhatt, MD,et al.
Background
Long-term exposure to pollution can lead to an increase in the rate of decline of lung function, especially in older individuals and in those with chronic obstructive pulmonary disease (COPD), whereas shorter-term exposure at higher pollution levels has been implicated in causing excess deaths from ischaemic heart disease and exacerbations of COPD. We aimed to assess the effects on respiratory and cardiovascular responses of walking down a busy street with high levels of pollution compared with walking in a traffic-free area with lower pollution levels in older adults.
Methods
In this randomised, crossover study, we recruited men and women aged 60 years and older with angiographically proven stable ischaemic heart disease or stage 2 Global initiative for Obstructive Lung Disease (GOLD) COPD who had been clinically stable for 6 months, and age-matched healthy volunteers. Individuals with ischaemic heart disease or COPD were recruited from existing databases or outpatient respiratory and cardiology clinics at the Royal Brompton & Harefield NHS Foundation Trust and age-matched healthy volunteers using advertising and existing databases. All participants had abstained from smoking for at least 12 months and medications were taken as recommended by participants" doctors during the study. Participants were randomly assigned by drawing numbered disks at random from a bag to do a 2 h walk either along a commercial street in London (Oxford Street) or in an urban park (Hyde Park). Baseline measurements of participants were taken before the walk in the hospital laboratory. During each walk session, black carbon, particulate matter (PM) concentrations, ultrafine particles, and nitrogen dioxide (NO2) concentrations were measured.
Findings
Between October, 2012, and June, 2014, we screened 135 participants, of whom 40 healthy volunteers, 40 individuals with COPD, and 39 with ischaemic heart disease were recruited. Concentrations of black carbon, NO2, PM10, PM2.5, and ultrafine particles were higher on Oxford Street than in Hyde Park. Participants with COPD reported more cough (odds ratio [OR] 1·95, 95% CI 0·96–3·95; p
Interpretation
Short-term exposure to traffic pollution prevents the beneficial cardiopulmonary effects of walking in people with COPD, ischaemic heart disease, and those free from chronic cardiopulmonary diseases. Medication use might reduce the adverse effects of air pollution in individuals with ischaemic heart disease. Policies should aim to control ambient levels of air pollution along busy streets in view of these negative health effects.
2
Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial
Joseph M. Connors, M.D., Wojciech Jurczak, M.D., Ph.D., David J. Straus, M.D., et al.
Background
Extended-release naltrexone (XR-NTX), an opioid antagonist, and sublingual buprenorphine-naloxone (BUP-NX), a partial opioid agonist, are pharmacologically and conceptually distinct interventions to prevent opioid relapse. We aimed to estimate the difference in opioid relapse-free survival between XR-NTX and BUP-NX.
Methods
We initiated this 24 week, open-label, randomised controlled, comparative effectiveness trial at eight US community-based inpatient services and followed up participants as outpatients. Participants were 18 years or older, had Diagnostic and Statistical Manual of Mental Disorders-5 opioid use disorder, and had used non-prescribed opioids in the past 30 days. We stratified participants by treatment site and opioid use severity and used a web-based permuted block design with random equally weighted block sizes of four and six for randomisation (1:1) to receive XR-NTX or BUP-NX. XR-NTX was monthly intramuscular injections (Vivitrol; Alkermes) and BUP-NX was daily self-administered buprenorphine-naloxone sublingual film (Suboxone; Indivior). The primary outcome was opioid relapse-free survival during 24 weeks of outpatient treatment. Relapse was 4 consecutive weeks of any non-study opioid use by urine toxicology or self-report, or 7 consecutive days of self-reported use. This trial is registered with ClinicalTrials.gov, NCT02032433.
Findings
Between Jan 30, 2014, and May 25, 2016, we randomly assigned 570 participants to receive XR-NTX (n=283) or BUP-NX (n=287). The last follow-up visit was Jan 31, 2017. As expected, XR-NTX had a substantial induction hurdle: fewer participants successfully initiated XR-NTX (204 [72%] of 283) than BUP-NX (270 [94%] of 287; p
Interpretation
In this population it is more difficult to initiate patients to XR-NTX than BUP-NX, and this negatively affected overall relapse. However, once initiated, both medications were equally safe and effective. Future work should focus on facilitating induction to XR-NTX and on improving treatment retention for both medications.
TAG:血管 |