目的: 探讨抗高血压药物对二氧化氮(nitrogen dioxide，NO₂)和慢性肾脏病(chronic kidney disease，CKD)关联的修饰效应。方法: 基于中国CKD流行病学调查研究的2007—2010年全国成年人代表性横断面数据进行NO₂暴露数据的收集与匹配，按照是否合并高血压和使用抗高血压药物进行分层，采用广义相加混合效应模型研究不同人群NO₂长期暴露与CKD的关联效应及差异，分别利用自然样条平滑函数拟合NO₂和CKD的暴露反应关系，分析抗高血压药物对NO₂-CKD关联及暴露反应曲线的修饰效应。结果: 共纳入45 136例研究对象，平均年龄为(49.5±15.3)岁，NO₂年平均暴露浓度为(7.2±6.4) μg/m³，使用抗高血压药物者共6 517人(14.4%)，CKD患者为4 833人(10.7%)。调整混杂因素后，合并高血压、未使用抗高血压药物的人群中，NO₂长期暴露能导致CKD风险显著增加(OR：1.38，95%CI：1.24~1.54，P < 0.001)；使用抗高血压药物的人群中，NO₂长期暴露与CKD风险无显著关联(OR：0.96，95%CI：0.86~1.07，P=0.431)。NO₂-CKD的暴露反应曲线显示，NO₂暴露与CKD的关联存在一定的非线性趋势。抗高血压药物对NO₂-CKD关联和暴露反应曲线均具有显著的效应修饰作用(交互项P值< 0.001)。结论: NO₂的长期暴露与CKD风险的关联受到抗高血压药物的修饰作用，使用抗高血压药物可有效降低NO₂的长期暴露对CKD的影响。

Objective: To investigate the potential effect of modification of antihypertensive medications on the association of nitrogen dioxide (NO₂) long-term exposure and chronic kidney disease (CKD). Methods: Data of the national representative sample of adult population from the China National Survey of Chronic Kidney Disease (2007-2010) were included in the analyses, and exposure data of NO₂ were collected and matched. Generalized mixed-effects models were used to analyze the associations between NO₂ and CKD, stratified by the presence of hypertension and taking antihypertensive medications. The stratified exposure-response curves of NO₂ and CKD were fitted using the natural spine smoothing function. The modifying effects of antihypertensive medications on the association and the exposure-response curve of NO₂ and CKD were analyzed. Results: Data of 45 136 participants were included, with an average age of (49.5±15.3) years. The annual average exposure concentration of NO₂ was (7.2±6.4) μg/m³. Altogether 6 517 (14.4%) participants were taking antihypertensive medications, and 4 833 (10.7%) participants were identified as having CKD. After adjustment for potential confounders, in the hypertension population not using antihypertensive medications, long-term exposure to NO₂ was associated with a significant increase risk of CKD (OR: 1.38, 95%CI: 1.24-1.54, P < 0.001); while in the hypertension population using antihypertensive medications, no significant association between long-term exposure to NO₂ and CKD (OR: 0.96, 95%CI: 0.86-1.07, P=0.431) was observed. The exposure-response curve of NO₂ and CKD suggested that there was a non-linear trend in the association between NO₂ and CKD. The antihypertension medications showed significant modifying effects both on the association and the exposure-response curve of NO₂ and CKD (interaction P < 0.001). Conclusion: The association between long-term exposure to NO₂ and CKD was modified by antihypertensive medications. Taking antihypertensive medications may mitigate the effect of long-term exposure to NO₂ on CKD.