海南地区空气污染物暴露对妊娠不良结局的影响研究

发布时间：2018-06-20 10:38

本文选题：NO_2 + PM_(10)　；参考：《华中科技大学》2013年博士论文

【摘要】：目的：分析海南地区出生缺陷的基本情况、影响因素及变化趋势，研究孕期空气污染物暴露与出生缺陷、早产以及低出生体重等妊娠不良结局的关系，探讨降低出生缺陷、早产和低出生体重等妊娠不良结局的预防策略，为公共卫生决策提供科学依据。方法：1.利用海南省2000～2010年以医院为基础的出生缺陷监测资料，对海南地区出生缺陷总发生率、发生顺位、城乡的发生率、围产儿性别的发生率等特征进行描述；采用Poisson回归法对出生缺陷发生率的城乡差异、性别差异和在孕母年龄上的差异进行分析，了解海南地区出生缺陷的一般影响因素；利用海口、三亚两市2009～2011年的空气污染资料和出生登记资料，采用成组设计的病例-对照研究法，采用t检验和logistic回归法，分析孕期不同阶段空气污染物暴露与出生缺陷的关系； 2.利用海口市2009～2011年的空气污染资料、气象资料及出生登记系统的活产儿早产、低出生体重等出生情况资料，采用Poisson广义相加模型进行时间序列分析，研究空气污染物暴露与早产和低出生体重的关系。结果：1.2001～2010年海南省出生缺陷总发生率99.13/万，低于全国平均水平；出生缺陷发生率城市低于农村(IRR=0.765，95%CI：0.715-0.819，P0.001)；男性围产儿高于女性围产儿(IRR=1.092，95%CI：1.021-1.169，P=0.010)；出生缺陷发生率与孕母年龄相关，20岁年龄组和≥35岁年龄组发病率较高，且组间没有差异(P0.05)，其次为20～25岁年龄组(IRR=0.816，95%CI：0.701-0.949，P=0.008)、25～30岁(IRR=0.761，95%CI：0.655-0.883，P0.001)及30～35岁年龄组(IRR=0.731，95%CI：0.623-0.858，P0.001)。 2.孕早期空气污染物PM_(10)的暴露对出生缺陷有不良影响。海口市多污染物logistic回归调整模型结果显示，在控制了一般因素和另外两种污染物的影响后，妊娠第2月(OR=1.039，95%CI：1.016-1.063，P=0.001)与第3月(OR=1.066，95%CI：1.043-1.090，P0.001)空气中PM_(10)的暴露对出生缺陷的总发生率有不良影响。三亚市多污染物logistic回归调整模型结果显示，妊娠第3月(OR=1.025，95%CI：1.006-1.044，P=0.009)空气中PM_(10)的暴露对出生缺陷总发生率有不良影响。海口市空气污染物暴露与先天性心脏病和唇腭裂的关系研究显示，海口市孕早期空气中PM_(10)的暴露为先天性心脏病的影响因素(OR=1.103，95%CI：1.023-1.190，P=0.011)。而所研究的三种污染物孕早期对婴儿唇腭裂发生的影响无统计学意义。 3.海口市大气主要污染物PM_(10)和SO_2浓度水平对早产发生率有不利影响，全污染物模型拟合分析结果显示，PM_(10)污染物滞后当天对新生儿日早产数影响的相对危险度为1.016(95%CI：1.003-1.030，P0.05)；SO_2污染物累积6天对新生儿日早产数影响的相对危险度为1.141(95%CI：1.039-1.242，P0.05)；大气主要污染物PM_(10)对低出生体重发生率有不利影响，PM_(10)污染物滞后1天对新生儿日低出生体重数影响的相对危险度为1.024(95%CI：1.011-1.038，P0.05)；累积6天对新生儿日低出生体重数影响的相对危险度为1.064(95%CI：1.042-1.087，P0.05)。结论：孕早期空气污染物PM_(10)的暴露是出生缺陷和先天性心脏病的危险因素；大气主要污染物SO_2和PM_(10)的浓度水平与早产率发生有关，，PM_(10)浓度水平与新生儿低出生体重率发生有关；一级预防是控制和减少妊娠不良结局最具成本效益的预防措施，要考虑探讨医疗保健部门与环境监控与保护部门联动的预防机制，努力发挥一级预防的效力。
[Abstract]:Objective: to analyze the basic conditions, influencing factors and trends of birth defects in Hainan, to study the relationship between the exposure of air pollutants and birth defects, preterm birth and low birth weight, and to explore the prevention strategies for reducing the adverse outcomes of pregnancy, such as birth defects, preterm birth and low birth weight, and to make public health decisions. Provide a scientific basis.
Methods: 1. the birth defect monitoring data based on the hospital in Hainan province for 2000~2010 years was used to describe the total incidence of birth defects in Hainan, the occurrence of birth defects, the incidence of urban and rural areas and the incidence of perinatal sex, and the difference in the incidence of birth defects, gender differences and the year of pregnant mother by the Poisson regression method. The difference in age was analyzed in order to understand the general factors of birth defects in Hainan area. Using the data of air pollution and birth registration in two cities of Haikou, Sanya, and 2009~2011 years, a group designed case control study was used, and t test and logistic regression were used to analyze the exposure of air pollutants and birth defects at different stages of pregnancy. The relationship of depression;
2. the relationship between air pollution exposure and premature birth and low birth weight was studied by using the data of air pollution in Haikou for 2009~2011 years, the data of birth registration system and birth registration system, such as premature birth, low birth weight, and other birth data. The Poisson generalized additive model was used to analyze the time series.
Results: the total incidence of birth defects in Hainan province from 1.2001 to 2010 was 99.13/ million, which was lower than the national average; the incidence of birth defects in cities was lower than that in rural areas (IRR=0.765,95%CI:0.715-0.819, P0.001); male perinatal infants were higher than female perinatal infants (IRR=1.092,95%CI:1.021-1.169, P= 0.010), and the incidence of birth defects was related to the age of pregnant women, 20 The incidence of the age group and the age group over 35 years was higher, and there was no difference between the groups (P0.05), followed by 20~25 year old age group (IRR=0.816,95%CI:0.701-0.949, P=0.008), 25~30 years (IRR=0.761,95%CI:0.655-0.883, P0.001) and 30~35 year old age group (IRR=0.731,95%CI: 0.623-0.858, P0.001).
The exposure to air pollutants PM_ (10) in the early 2. pregnancies had adverse effects on birth defects. The Haikou multi pollutant logistic regression model showed that after the control of the general factors and the effects of the other two pollutants, second months of pregnancy (OR=1.039,95%CI:1.016-1.063, P=0.001) and third months (OR=1.066,95%CI:1.043-1.090, P0.001) air The exposure of PM_ (10) had adverse effects on the total incidence of birth defects. The Sanya multi pollutant logistic regression model showed that the exposure to PM_ (10) in the air of third months of pregnancy (OR=1.025,95%CI:1.006-1.044, P=0.009) had adverse effects on the total incidence of birth defects. Air pollutants were exposed to congenital heart disease and congenital heart disease in Haikou. The study of the relationship between cleft lip and palate shows that the exposure of PM_ (10) in the early stage of pregnancy in Haikou is an influential factor of congenital heart disease (OR=1.103,95%CI:1.023-1.190, P=0.011). The effect of the early pregnancy of the three kinds of pollutants on cleft lip and palate in infants is not statistically significant.
3. the level of PM_ (10) and SO_2 concentration of main pollutants in Haikou had adverse effects on the incidence of premature birth. The result of the model fitting analysis showed that the relative risk was 1.016 (95%CI:1.003-1.030, P0.05) for the daily premature birth of newborns with PM_ (10), and SO_2 pollutants accumulated for 6 days of neonatal daily preterm birth. The relative risk was 1.141 (95%CI:1.039-1.242, P0.05), and the main pollutant PM_ (10) had an adverse effect on the incidence of low birth weight. The relative risk of the PM_ (10) pollutant lag 1 days to the neonatal daily low birth weight was 1.024 (95%CI:1.011-1.038, P0.05), and the cumulative 6 days for the neonatal daily low birth weight. The relative risk of noise was 1.064 (95%CI:1.042-1.087, P0.05).
Conclusion: exposure to air pollutants PM_ (10) in the early pregnancy is a risk factor for birth defects and congenital heart disease. The concentration level of SO_2 and PM_ (10) of major air pollutants is related to the incidence of premature birth. The concentration level of PM_ (10) is related to the incidence of low birth weight of the newborn; primary prevention is the most effective control and reduction of bad pregnancy outcome. The preventive measures for this benefit should consider the preventive mechanism of linkage between the medical care department and the environmental monitoring and protection department, so as to exert the effectiveness of primary prevention.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R114

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