大氣空氣品質和腎臟透析病人的死亡相關：系統性文獻回顧

Association between ambient air quality and the mortality risk of dialysis patients: a systematic review

目標：過去的研究顯示長期暴露於空氣中懸浮微粒和罹病與死亡危險有關，包括腎臟疾病的惡化，但少有相關研究統整大氣空氣品質與腎臟疾病死亡的關聯，希冀藉由此系統性文獻回顧及整合，探討空氣品質和洗腎病人健康的相關，提供未來相關研究的實證參考。方法：建立關鍵字並搭配自然語言及Mesh term於五個資料庫進行搜尋2022年6月前的中英文資料庫，總共發現163篇，經排除重複、納入及排除條件篩選後，最終納入5篇符合文章主題之文獻，並以CAPS（Critical Appraisal Skills Programme, CAPS）世代研究評讀工具及Oxford CEBM檢測文章品質及證據等級。結果：共納入5篇研究，結果發現長期暴露於NO_2 7年的洗腎病人的死亡危險增加1.33-3.78倍；暴露於高濃度PM_(2.5) 7年的老年洗腎病人可能會與死亡有關。結論：長期暴露於大氣NO_2、PM_(2.5)可能和洗腎患者的死亡危險有關；SO_2與PM_(10)因有發表偏差問題，可能需要日後更多研究針對此議題再加以探討證實。另受限於目前研究多是探討室外空氣品質和洗腎病人健康的相關，因此日後應針對室內空氣污染做更進一步的臨床試驗實證研究，以提供更全面與系統性的探討與分析。

Objectives: Studies have associated the long-term exposure to ambient particulates with mortality from various types of disease, including kidney disease. However, few studies integrating the relationship between ambient air quality and the mortality risk from kidney disease. The objective of this study is to evaluate this association using systematic literature review to provide empirical references for future research. Methods: Mesh term and free-text words were used for literature search. Articles were retrieved from electronic databases including PubMed, Cochrane Library, ProQuest, EMBASE, and Airiti Library. A total of 163 articles published before June 2022 met the search criteria. After screening the abstract, title, and main text of the studies to delete repetitions, we identified five studies eligible for the qualitative synthesis. Each study was appraised using the CASP-Cohort checklist and Oxford CEBM. Results: We examined the data in these five studies and found that the hazard ratio of mortality from dialysis ranged 1.33-3.78 for population with long-term exposure to NO2. A study also found that the elderly patients with dialysis exposing to high levels of PM2.5 for 7 years were also at an elevated hazard of deaths. Conclusions: These studies showed that long-term exposure to NO2 and PM2.5 might associate with an increased hazard of deaths from dialysis. However, these studies were conducted based on the outdoor air quality. Research based on indoor air quality and experimental study are required to verify the association with the mortality risk. (Taiwan J Public Health. 2022;41(5):551-563)