广州、哈尔滨气象及空气污染因素与脑卒中入院人数关系的研究

发布时间：2018-01-08 18:06

  本文关键词：广州、哈尔滨气象及空气污染因素与脑卒中入院人数关系的研究　出处：《南方医科大学》2017年博士论文　论文类型：学位论文

  更多相关文章： 脑卒中 空气污染 气象 入院风险

【摘要】：研究背景脑卒中是一种病死率、致残率较高的疾病,气象、空气污染是脑卒中的危险因素之一。通过本研究,分析广州、哈尔滨气象、空气污染因素变化与人群出血性脑卒中入院风险(HSr)、缺血性脑卒中入院风险(ISr)的关系。方法收集从2009年1月1日至2014年12月31日,观察医院的脑卒中入院病例、气象和大气污染物资料。为了简述,平均气温简称气温,相对湿度简称湿度,N02浓度简称NO2,SO2浓度简称SO2,PM10浓度简称PM10。采用描述性统计分析数据的分布,用广义相加、分布滞后非线性模型展开研究。统计分析用R软件完成。结果共收集到病例108991例,其中广州67640例、哈尔滨41351例,缺血性脑卒中83060例、出血性脑卒中25931例。1.气象因素与脑卒中的关系(1)气温的影响。分别以广州23℃(50th)时及哈尔滨7(50th)时的脑卒中入院人数为参考值,发现:在广州,当气温为7℃时(1th),HSr上升,RR:1.251(95%CI:1.109-1.412);在哈尔滨,当气温为 27℃时(75th),HSr 下降,RR:0.54(95%CI:0.448-0.650)。在广州,当气温为 31℃时(99th),ISr 上升,RR:1.089(95%CI:1.022-1.162)。(2)相对湿度的影响。分别以广州湿度79%(50th)时及哈尔滨湿度68%(50th)时的脑卒中入院人数为参考值,发现:相对湿度与两地的出血性脑卒中入院风险无显著相关性。在广州,当湿度97%(99th)时,ISr下降,RR:0.913(95%CI:0.866-0.963);在哈尔滨,当湿度 29%(1th)时,ISr 下降,RR:0.851(95%CI:0.779-0.929)。(3)气温差的影响。分别以广州气温差8℃(50th)时及哈尔滨气温差12℃(50th)时的脑卒中入院人数为参考值,发现:在广州,当气温差5℃(25th)时,HSr 上升,RR:1.058(95%CI:1.006-1.114);气温差 10℃(75th)时,HSr 下降,RR:0.934(95%CI:0.896-0.975)。在哈尔滨,当气温差 22℃(99th)时,HSr 下降,RR:0.805(95%CI:0.670-0.966)。在广州,当气温差 16℃(99th)时,ISr 下降,RR:0.912(95%CI:0.855-0.972);在哈尔滨,当气温差 3℃(1th)时,ISr下降,RR:0.898(95%CI:0.816-0.989)。2.空气污染与脑卒中的关系(1)N02的影响。分别以两地NO2浓度值(40μg/m3)时脑卒中入院人数为参考值,发现:在广州,当NO2为128μg/m3(99th)时,HSr上升,RR:1.282(95%CI:1.140-1.441)。在广州,当 NO2 为 128μg/m3(99th)时,ISr 上升,RR:1.124(95%CI:1.062,1.190);在哈尔滨,当 N02为137μg/m3(99th 时,ISr上升,RR:1.131(95%CI:1.045,1.223)。(2)S02的影响。分别以两地S02浓度值(20μg/m3)时脑卒中入院人数为参考值,发现:在广州,当SO2为34μμg/m3(75th)时,HSr上升,RR:1.045(95%CI:1.004-1.088)。在广州,当 SO2 为4μg/m3(1th)时,Isr 下降;RR:0.897(95%CI:0.865,0.942);当 SO2 为 85μg/m3(99th)时,ISr 上升,RR:1.062(95%CI:1.012,1.154)。在哈尔滨,当 S02为 203μg/m3(99th)时,ISr上升,RR:1.255(95%CI:1.114,1.413)。(3)PM10的影响。分别以两地PM10浓度值(5μg/m3)时脑卒中入院人数为参考值,发现:在广州,当PM10为178μg/m3(99th)时:HSr上升,RR:1.128(95%CI:1.007-1.264);ISr上升,RR:1.107(95%CI:1.054-1.163)。在哈尔滨,119μg/m3(75th)时,ISr 下降,RR:0.961(95%CI:0.931-0.992)。3.气温与脑卒中的滞后关系(1)气温与HSr的关系。分别以广州23℃(50th)时及哈尔滨7℃(50th)时的脑卒中入院人数为参考值,发现:7℃(1th)时,广州HSr滞后1天的风险最高,RR:1.106(95%CI:1.043,1.172);27℃(99th)时,哈尔滨HSr滞后 1天的风险最高,RR:0.838(95%CI:0.751,0.935)。(2)气温与ISr的关系。分别以广州23℃(50th)时及哈尔滨7℃(50th)时的脑卒中入院人数为参考值,发现:7℃(1th)时,广州ISr滞后1天的风险最高,RR:0.951(95%CI:0.928,0.976)。-25℃(1th)时,哈尔滨 ISr 滞后 1天的风险最高,RR:1.086(95%CI:1.012,1.165)。27℃(99th)时,哈尔滨ISr滞后 1 天的风险最高,RR:0.926(95%CI:0.879,0.975)。4.空气污染与广州脑卒中的滞后关系(1)NO2的影响。HSr滞后1天的风险最高,RR:1.011(95%CI:1.006,1.016)。ISr滞后 1 天的风险最高,RR:1.002(95%CI:1.000,1.005)。(2)SO2的影响。HSr滞后1天的风险最高,RR:1.008(95%CI:1.001,1.014)。ISr 滞后 1 天的风险最高,RR:1.004(95%CI:1.001,1.006)。(3)PM10 的影响。HSr滞后 1 天的风险最高,RR:1.004(95%CI:1.001,1.007)。ISr 滞后 1 天的风险最高,RR:1.001(95%CI:1.000,1.002)。结论1、气温与出血性、缺血性脑卒中相关,存在暴露反应及滞后效应。2、相对湿度与缺血性脑卒中相关,广州高相对湿度降低入院风险,哈尔滨低相对湿度降低入院风险。3、NO2、SO2、PM10与脑卒中入院风险相关,但对两个地区不同卒中类型的效应不同,且滞后和累积滞后效应不同。
[Abstract]:Background stroke is a higher morbidity mortality rate, meteorological diseases, air pollution is one of the risk factors of stroke. Through this research, analysis of Guangzhou, Harbin meteorology, stroke admission hemorrhage risk factors of air pollution and population change (HSr), short hospital ischemic stroke risk (ISr).. methods from January 1, 2009 to December 31, 2014, the observation of hospital stroke hospitalized cases, meteorological and air pollution data. In order to the average temperature as temperature, relative humidity or humidity, the concentration of N02 or NO2, the concentration of SO2 referred to as SO2, the concentration of PM10 PM10. using the descriptive statistical analysis of the data distribution, a general additive, distributed lag the nonlinear model is studied. Statistical analysis was completed by R software. The results were collected in 108991 cases, including 67640 cases of Guangzhou, Harbin 41351 cases, 83060 cases were ischemic stroke, a The relationship between ischemic stroke and 25931 cases of.1. and meteorological factors of stroke (1). The influence of air temperature in Guangzhou were 23 C (50th) and Harbin 7 (50th) stroke admission number as the reference value, we found that in Guangzhou, when the temperature is 7 degrees centigrade (1th), HSr Rose RR:1.251 (95%CI:1.109-1.412); in Harbin, when the temperature is 27 degrees centigrade (75th), HSr decreased, RR:0.54 (95%CI:0.448-0.650). In Guangzhou, when the temperature is 31 degrees centigrade (99th), ISr increased, RR:1.089 (95%CI:1.022-1.162). (2) the effect of relative humidity. Humidity respectively in Guangzhou 79% (50th) and Harbin 68% humidity (50th) stroke admission number as the reference value, found that the relative humidity and the two hemorrhagic stroke risk was not significantly correlated. In Guangzhou, when the humidity is 97% (99th), ISr decreased, RR:0.913 (95%CI:0.866-0.963); in Harbin, when the humidity is 29% (1th), ISr decreased RR:0.851 (95%CI:0.779-0.929 ).(3)姘旀俯宸�鐨勫奖鍝�.鍒嗗埆浠ュ箍宸炴皵娓╁樊8鈩，

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