2014-2015年合肥市空气污染物与某儿童医院0-14岁儿童上呼吸道感染日门诊量的时间序列研究

发布时间：2018-06-02 04:11

本文选题：空气污染物 + 儿童　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的研究2014-2015年合肥市空气污染物,如可吸入颗粒物(Particulate matter,PM10)、细颗粒物(Fine particulate matter,PM2.5)、二氧化硫(Sulfur dioxide,SO2)、二氧化氮(Nitrogen dioxide,NO2)、一氧化碳(Carbon monoxide,CO)、臭氧(Ozone,O3)与0-14岁儿童上呼吸道感染(Upper respiratory tract infection,URTI)(以下简称上感)日门诊量之间的关系,并发现敏感人群。方法1.收集2014-2015年合肥市某儿童医院儿童上感的逐日门诊资料,年龄为0-14岁,包括儿童的性别、出生日期、年龄以及世界卫生组织国际疾病分类(International classification of diseases 10th Revision,ICD-10)编码。根据儿童的性别和年龄分为不同的亚组:(1)男童和女童;(2)0-4岁、5-9岁和10-14岁。2014-2015年的空气污染物逐日监测资料从合肥市环境监测中心站获得,包括24-小时PM10、PM2.5、SO2、NO2、CO浓度资料和1-小时O3浓度资料。同时从合肥市气象局收集2014-2015年的逐日气象监测数据,包括每日的平均气温(°C)、平均气压(hpa)、平均相对湿度(%)、风速(m/s)和降水(mm)。2.使用时间序列分析方法中的广义相加模型(Generalized additive model,GAM),控制长期趋势、季节性、星期几效应(Day of the week,DOW)、法定节假日和气象因素的混杂效应,定量分析2014-2015年合肥市空气污染物PM10、PM2.5、SO2、NO2、O3、CO浓度与0-14岁儿童上感日门诊量的关系及滞后效应,并发现敏感人群。结果1.单污染物模型中,PM10、PM2.5、SO2、NO2、CO对儿童上感总日门诊量的影响均有统计学意义(P0.05),滞后效应分别在lag3、lag06、lag06、lag06、lag06最明显,浓度每升高10μg/m3,儿童上感总日门诊量分别增加0.15%(0.07%~0.23%)、0.38%(0.17%~0.60%)、2.92%(1.88%~3.97%)、4.47%(3.69%~5.25%)、0.05%(0.02%~0.08%)。全污染物模型1和模型2中,在调整了其他空气污染物的影响后,仅NO2对儿童上感总日门诊量的影响有统计学意义(P0.05),NO2浓度每上升10μg/m3,儿童上感总日门诊量分别增加4.72%(3.76%~5.69%)和4.70%(3.76%~5.65%)。2.本研究中PM10、PM2.5、SO2、NO2、O3和CO对女童比对男童的滞后效应要强。PM10、PM2.5、SO2、NO2、O3和CO每上升10μg/m3,男童上感日门诊量分别增加0.14%(0.03%~0.24%)、0.29%(0.02%~0.57%)、2.46%(1.13%~3.82%)、4.32%(3.32%~5.33%)、0.02%(-0.22%~0.26%)、0.05%(0.02%~0.08%)。女童上感日门诊量分别增加0.17%(0.05%~0.30%)、0.53%(0.19%~0.87%)、3.69%(2.04%~5.37%)、4.67%(3.45%~5.90%)、0.22%(-0.07%~0.52%)、0.06%(0.01%~0.10%)。3.本研究中PM10、PM2.5、SO2、NO2、O3和CO对5岁以上儿童的滞后效应较强,对5岁以下儿童的滞后效应较弱。结论1.短期暴露于空气污染物可能与儿童上感日门诊量的增加有关,本研究中NO2是影响0-14岁儿童上感日门诊量的主要空气污染物。2.PM10、PM2.5、SO2、NO2、O3和CO对女童比对男童的滞后效应要强。3.PM10、PM2.5、SO2、NO2、O3和CO对5岁以上儿童的滞后效应较5岁以下儿童强。目的探讨2015-2016年合肥市空气污染物对儿童肺功能指标及其发育的影响,为控制空气污染以及保护儿童肺功能发育提供理论依据,并制定相应的防治措施。方法根据《国家空气污染对人群健康影响监测项目工作手册》,合肥市将包河区和瑶海区列为国家监测点。对2015-2016年合肥市瑶海区和包河区环境监测站点的空气污染水平进行分析,瑶海区PM10、PM2.5、SO2、NO2、O3、CO的浓度均高于包河区,且差异均有统计学意义(P0.05)。选择包河区为清洁区,瑶海区为污染区,在两区各随机选择1所小学,采用随机整群抽样的方法,抽取两个小学三年级的儿童作为调查对象,对其进行问卷调查和肺功能测试,2015年和2016年各进行一次肺功能测试。结果1.包河区和瑶海区共纳入研究对象245和234人,完成两年肺功能测试及问卷调查分别为240人和230人,再排除患过敏性鼻炎、肺炎、哮喘、气管炎或支气管炎以及居住年限不足2年的儿童,清洁区和污染区的有效应答人数分别为236人和227人,总有效应答率分别为96.33%和97.01%。2.2015年,瑶海区男童最大呼气中期流速(MMEF,The maximum mid-expiratory flow rate或FEF25~75,Mid-forced expiratory flow)和75%用力肺活量时的呼气流速(FEF75)的实测值均显著低于包河区(t=2.473,P=0.014;t=2.407,P=0.017)。2016年,瑶海区男童25%用力肺活量时的呼气流速(FEF25)显著低于包河区(t=2.231,P=0.027);瑶海区女童用力肺活量(FVC,forced vital capacity)显著高于包河区(t=-2.424,P=0.016),呼气峰值流量(PEF,Peak expiratory flow)和FEF25显著低于包河区(t=3.937,P=0.000;t=4.298,P=0.000)。3.调整了年龄、身高、体重后,2015年,瑶海区男童MMEF的预测值低于包河区。2016年,瑶海区男童FVC、第1秒用力呼气容积(FEV1,Forced expiratory volume in 1 second)、MMEF、FEF75均低于包河区。4.瑶海区儿童肺功能指标的增长量均低于包河区。另外,除瑶海区和包河区男童FVC、包河区FEV1增长量高于女童外,其余指标均是女童高于男童。5.在控制了各种影响因素后,空气污染暴露对儿童FVC、PEF、MMEF、FEF25均有显著影响(P0.05),其中瑶海区儿童的PEF和FEF25的异常率明显高于包河区(OR=2.809,P0.05;OR=3.052,P0.05)。结论1.合肥市瑶海区儿童PEF、MMEF、FEF25、FEF75均低于包河区,提示儿童肺功能下降可能与空气污染物有关。2.瑶海区儿童肺功能指标的增长量均低于包河区,表明儿童肺功能的增长发育可能受到空气污染物的影响。3.空气污染物可能是儿童肺功能指标异常的危险因素。
[Abstract]:Objective to study air pollutants in Hefei city for 2014-2015 years, such as Particulate matter (PM10), fine particles (Fine particulate matter, PM2.5), sulfur dioxide (Sulfur dioxide, SO2), nitrogen dioxide (Nitrogen dioxide), carbon monoxide, ozone, and 0-14 year old children's upper respiratory tract infection. Espiratory tract infection, URTI) (hereinafter referred to as the sense) the relationship between the day out-patient volume, and found the sensitive population. Method 1. collected 2014-2015 years of children's Hospital in Hefei city children's day by day outpatient data, age 0-14 years old, including children's sex, birth date, age and WHO International Classification of diseases (Internationa L classification of Diseases 10th Revision, ICD-10) coding. According to the sex and age of children, it is divided into different subgroups: (1) boys and girls; (2) the daily monitoring data of air pollutants for 0-4, 5-9 and 10-14 years old are obtained from the Hefei environmental monitoring center station, including 24- hours PM10, PM2.5, SO2, concentration data and Hourly O3 concentration data. At the same time, the daily meteorological monitoring data of 2014-2015 years were collected from the Hefei Meteorological Bureau, including daily average temperature (C), average pressure (HPA), average relative humidity (%), wind speed (m/s) and precipitation (mm).2. use time series analysis method (Generalized additive model, GAM), to control the long-term trend. The seasonal, Day of the week (DOW), the mixed effect of the statutory holidays and meteorological factors, the quantitative analysis of the relationship and lag effect of the air pollutants in Hefei City, PM10, PM2.5, SO2, NO2, O3, CO concentration and 0-14 year old children, and the sensitive population in the 1. single pollutant model. The effects of O2 and CO on the total daily outpatient service of children were statistically significant (P0.05). The lag effect was the most obvious in Lag3, lag06, lag06, lag06, lag06, and the concentration increased by 10 u g/m3, and the total daily outpatient quantity of children increased by 0.15% (0.07%~0.23%), 0.38% (0.17%~ 0.60%), 2.92% (1.88%~3.97%), 4.47% (1.88%~3.97%), 0.05%. In model 1 and model 2, after adjusting the effects of other air pollutants, only NO2 had a statistically significant effect on the total daily outpatient service of children (P0.05), the concentration of NO2 increased by 10 g/m3, and the total daily outpatient outpatient volume increased by 4.72% (3.76%~5.69%) and 4.70% (3.76%~5.65%).2. in the study of PM10, PM2.5, SO2, NO2, O3, and the girls' ratio. The lag effect on boys was strong.PM10, PM2.5, SO2, NO2, O3 and CO were up 10 mu each, and the boys' daily outpatient volume increased by 0.14% (0.03%~0.24%), 0.29% (0.02%~0.57%), 2.46% (1.13%~3.82%), 4.32% (3.32%~5.33%), 0.02% (-0.22%~0.26%), 0.05% (0.53%), 0.53% (0.53%), 0.53%, respectively. 3.69% (2.04%~5.37%), 4.67% (3.45%~5.90%), 0.22% (-0.07%~0.52%), 0.06% (0.01%~0.10%).3. in this study, PM10, PM2.5, SO2, NO2, O3 and CO are stronger for children over 5 years of age, and the lag effect is weaker for children under 5 years of age. Conclusion 1. short-term exposure to air pollutants may be related to the increase of the outpatient outpatient dose of children. NO2 is the main air pollutant.2.PM10, PM2.5, SO2, NO2, O3 and CO which affect the day outpatient quantity of 0-14 year old children, which are stronger.3.PM10, PM2.5, SO2, NO2, the lag effect on children over 5 years old is stronger than that of children under the age of 5. The influence of its development provides a theoretical basis for controlling air pollution and protecting children's lung function development, and formulates corresponding prevention and control measures. According to the working manual of the national air pollution monitoring project for the population health, Hefei has listed the Baohe district and Yaohai district as the national monitoring point for the Yaohai District of Hefei and the Baohe River in 2015-2016 years. The air pollution level of the district environmental monitoring station is analyzed. The concentration of PM10, PM2.5, SO2, NO2, O3 and CO in Yaohai district is higher than that of Baohe District, and the difference is statistically significant (P0.05). In the Baohe District, the clean area is a clean area, and the Yaohai District is a polluted area. In the two district, 1 primary schools are selected randomly, and two primary schools are selected for three years by random cluster sampling. A questionnaire survey and lung function test were carried out for the children of the class, and the lung function tests were conducted in 2015 and 2016. Results 1. people and 234 people were included in the 1. Baohe and Yaohai areas. The lung function test and questionnaire survey were performed for 240 and 230 people for two years, and then the allergic rhinitis, pneumonia, asthma, and gas were excluded. The effective responses of children with tracheitis or bronchitis and less than 2 years of residence were 236 and 227 in clean and polluted areas, respectively, and the total effective response rate was 96.33% and 97.01%.2.2015 years respectively. The maximum expiratory flow rate (MMEF, The maximum mid-expiratory flow rate or FEF25~75, Mid-forced expiratory flow) for boys in Yaohai district. The measured values of expiratory flow velocity (FEF75) at the 75% forced vital capacity were significantly lower than that in the Baohe region (t=2.473, P=0.014; t=2.407, P=0.017).2016. The expiratory flow rate (FEF25) of 25% forced lung capacity in Yaohai boys was significantly lower than that in the Baohe area (t=2.231, P=0.027), and the forced vital capacity (FVC, forced vital) of the girls in Yaohai was significantly higher than that of the Baohe district. (t=-2.424, P=0.016), the peak expiratory flow (PEF, Peak expiratory flow) and FEF25 are significantly lower than the Baohe district (t=3.937, P=0.000; t=4.298, P=0.000).3. adjusted the age, height and weight. In 2015, the prediction value of the Yaohai District boys was lower than that of the Baohe District, the boy in Yaohai District, the first second forced expiratory volume. In 1 second), MMEF, FEF75 were lower than that of Baohe District of.4. Yaohai District of Baohe district. Besides, the growth of FEV1 in Yaohai and Baohe district was higher than that of girls, and the rest of the other indicators were that children were higher than boys'.5. in control of various factors, and air pollution was exposed to FVC, PEF, MMEF, FE. There were significant effects of F25 (P0.05). The abnormal rate of PEF and FEF25 in children in Yaohai was significantly higher than that in Baohe district (OR=2.809, P0.05; OR=3.052, P0.05). Conclusion 1. children in Yaohai District of Hefei city are PEF, MMEF, FEF25, and FEF75 are lower than the Baohe District, suggesting that the decline of lung function in children can be related to the increase of air pollutants in Yaohai district. The growth and development of lung function in children may be affected by air pollutants..3. air pollutants may be a risk factor for abnormal pulmonary function in children.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.6

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