济南市空气污染物对小学生病症率及肺功能的影响研究

发布时间：2019-04-01 20:27

【摘要】：研究目的流行病学相关研究提示,儿童呼吸系统疾病患病率、症状发生率以及肺功能降低均与大气污染物存在一定的相关性。本研究选择在济南市空气污染较重的区域(历城区)背景下,开展空气污染物与小学生健康状况的连续性监测,评估高浓度空气污染情况下的小学生病症率以及肺功能的健康效应,旨在初步探索严重空气污染情况下小学生健康影响的变化趋势与显著特征,为今后的相关研究奠定基础,同时依据研究结果,提出针对性的措施与建议,为本地空气污染影响下的低年龄段人群(儿童)的健康干预、健康管理提供基础依据,指导学生和家长做好个人的防护与保护,减少健康损失。研究方法选取济南市空气污染相对较重的历城区(重工业、化工企业区较多)作为本项研究的实施区域,选择历城区内空气质量环保监测站点——宝胜电缆监测点2公里范围内的一所小学学校作为研究现场,对该校三至五年级的所有在校学生开展连续性监测。本次调查为自愿性参加,调查对象签署知情同意书,最终纳入研究者共计614人。本项研究采用重复性测量设计调查小学生每周疾病、症状出现情况与空气污染的相关性,采用现况研究设计评估小学生肺功能与空气污染的相关性。小学生每周疾病和症状出现情况采用自行设计的调查问卷于每周五下午由班级辅导员集中收集本班级内学生从本周六开始至周五期间的健康状况,调查问卷由学生家长和学生本人共同完成填写。问卷调查时间范围为2014年11月15日~12月26日,共计6周。在问卷调查开始前和结束时,分别开展一次小学生肺功能检测,检测对象均为意愿参与问卷调查者,采用分层整群随机抽样方法,分别从三年级、四年级、五年级各抽取一个班级开展肺功能检测,累计检测小学生149人。肺功能检测指标包括用力肺活量(FVC)、1秒用力呼气量(FEV1)、呼气流速峰值(PEF)、25%FVC时的用力呼气流量(V25/PEF75)、75%FVC时的用力呼气流量(V75/PEF25)。同时收集空气质量环保监测站点宝胜电缆监测点2014年11月1日~12月31日期间的细颗粒物(PM_2.5)、可吸入颗粒物(PM_10)、一氧化碳(CO)、二氧化氮(NO_2)、二氧化硫(SO_2)以及臭氧(O_3)六种污染物日均浓度数据以及同期济南市日均温度和相对湿度数据。描述性分析研究对象的基本特征和研究期间的空气污染物时间分布特征,计算小学生连续性测量期间每周的疾病患病率、症状出现率,比较各周疾病患病率和症状出现率的差异,分析每周疾病患病率和症状出现率与每周六种空气污染物浓度的相关性,评估空气污染物浓度升高时的疾病与症状发生风险;比较小学生两次短时间内不同空气污染暴露浓度下的肺功能各项指标差异,同时按照性别、年龄分层,进一步分析不同空气污染暴露情况下的短期肺功能变化效应。结果连续监测结果分析显示,呼吸系统疾病中以急性鼻咽炎(普通感冒)、气管炎/扁桃体炎的患病率最高,监测的症状中,咽喉和鼻腔部位的症状发生率最高,其中咳嗽和流鼻涕是主要症状。SO_2浓度的升高,会引起总疾病、呼吸系统疾病以及普通感冒患病风险的增高,此外,PM_10、SO_2以及NO_2还会加剧过敏性鼻炎的患病风险;PM_10、SO_2以及NO_2浓度的升高会引起总症状、咽喉部位(咳嗽、咳痰)以及鼻腔部位(流鼻涕、鼻塞、打喷嚏)等症状发生率的增高,此外,SO_2浓度的升高,还会引起眼睛部位(眼睛疼、红、痒)症状发生率的增高;CO和03浓度的变化对小学生疾病患病率和症状发生率的影响均无统计学意义。肺功能检测结果显示,PM_2.5和NO_2浓度的降低会引起小学生FVC和FEV1肺功能指标的显著升高,然而并未发现各项肺功能指标与其他污染物浓度的变化存在显著相关性。结论PM_10、SO_2以及NO_2浓度的升高会导致济南市历城区小学生呼吸系统疾病患病率和症状发生率的显著增多,其中SO_2对疾病患病率和症状发生率的影响最为强烈。推断历城区小学生可能对周围空气中的PM_2.5、NO_2尤其是SO_2更敏感,受到的不利影响也更严重。此外,空气污染物浓度的升高还会导致济南市历城区小学生肺功能相关指标的显著降低,按性别分层后,发现PM_2.5和NO_2浓度的降低会引起小学生FVC和FEV1肺功能指标的显著升高;按年级分层后,发现PM2.5和NO2浓度的降低会引起三年级学生FVC、FEV1和V75肺功能指标的显著升高,而对于四、五年级的学生来说,仅发现FVC和V25两项肺功能指标显著升高。推断空气污染物对低年龄段的健康影响更为明显。
[Abstract]:The epidemiological study of the aim of the study indicated that the prevalence of respiratory diseases, the incidence of symptoms and the decrease of the function of the lung were related to the atmospheric pollutants. In this study, under the background of the heavy air pollution in Jinan (Licheng District), the continuous monitoring of the air pollutants and the health status of the primary school students is carried out, and the disease rate of the primary school students and the health effects of the lung function under the condition of high concentration of air pollution are evaluated. The aim of this paper is to explore the changing trend and characteristics of the health impact of primary school students in the condition of severe air pollution, to lay the foundation for the future research, and to put forward some measures and suggestions based on the results of the research. To provide the basic basis for the health intervention and health management of the low-age group (children) under the influence of local air pollution, to guide the students and the parents to protect and protect the individual, and to reduce the health loss. According to the research method, the relatively heavy urban area of Jinan (heavy industry and chemical enterprise area) is selected as the implementation area of this study, and a primary school in the range of 2 km of the air quality environmental protection monitoring station point _ Baosheng cable monitoring point in the Licheng District is selected as the study site. Continuity monitoring of all school students in the three to fifth grades of the school. The survey was voluntary, and the investigation object signed the informed consent form, which was finally included in the total of 614 investigators. In this study, the correlation between the weekly disease, the occurrence of symptoms and air pollution was investigated by using the repetitive measurement and design, and the correlation between the pulmonary function and the air pollution of the primary school students was assessed by the current research and design. A self-designed questionnaire was used to collect the health status of the students in the class from the beginning of Saturday to Friday in the afternoon of each Friday afternoon, and the questionnaire was completed by the student parents and the students themselves. The time of the survey was from November 15 to December 26,2014 for a total of 6 weeks. At the beginning and end of the questionnaire, a primary school student's lung function test was carried out. The test subjects were willing to participate in the questionnaire. The stratified cluster random sampling method was adopted to carry out the lung function test from the third grade, the fourth grade and the fifth grade respectively. A total of 149 primary school pupils were detected. The lung function test indicators included forced vital capacity (FVC),1 second forced expiratory volume (FEV1), peak expiratory flow rate (PEF), forced expiratory flow at 25% FVC (V25/ PEF75), and forced expiratory flow at 75% FVC (V75/ PEF25). At the same time, collect fine particulate matter (PM _ 2.5), fine particulate matter (PM _ 10), carbon monoxide (CO), nitrogen dioxide (NO _ 2), The daily daily concentration data of sulfur dioxide (SO _ 2) and ozone (O _ 3) and the daily average daily temperature and relative humidity data of Jinan city. The basic characteristics of the study object and the characteristics of the time distribution of air pollutants during the study were analyzed in a descriptive way. The prevalence of the disease and the rate of occurrence of the symptoms were calculated during the continuous measurement of the primary school pupils, and the prevalence of the disease and the rate of the occurrence of the symptoms were compared. analyzing the correlation between the occurrence rate of the weekly disease and the occurrence rate of the symptom and the concentration of the air pollutants on each Saturday, and evaluating the risk of the disease and the symptom when the concentration of the air pollutants is increased; and comparing the difference of the indexes of the lung function under the different air pollution exposure concentration in the primary school for two times, At the same time, the effects of short-term lung function changes in different air pollution exposures were further analyzed by gender and age stratification. Results The results of continuous monitoring show that the prevalence of acute nasopharyngitis (common cold), trachitis/ tonsillitis is the highest in the respiratory system, and the symptoms of the throat and the nasal cavity are the highest in the monitoring symptoms, and the cough and the runny nose are the main symptoms. The increase of the concentration of SO _ 2 can raise the risk of general diseases, respiratory diseases and common cold. In addition, PM _ 10, SO _ 2 and NO _ 2 can increase the risk of allergic rhinitis. The increase of PM _ 10, SO _ 2 and NO _ 2 can cause total symptoms and throat part (cough, The incidence of the symptoms such as cough and phlegm and the nasal part (nose, nose, sneezing) increased, and the increase of the concentration of SO _ 2 can also cause the incidence of the symptoms of the eyes (the eyes, the red and the itchy) to increase. The changes of CO and 03 concentration had no significant effect on the prevalence of disease and the incidence of symptoms in primary school students. The results of lung function test showed that the decrease of the concentration of PM _ 2.5 and NO _ 2 could cause a significant increase in the function of FVC and FEV1 in primary school students. Conclusion The increase of the concentration of PM _ 10, SO _ 2 and NO _ 2 can lead to a significant increase in the incidence of respiratory diseases and symptoms of primary school students in Licheng District of Jinan, and the effect of SO _ 2 on the prevalence of disease and the incidence of symptoms is the most intense. It is concluded that primary school students in Licheng District may be more sensitive to PM _ 2.5, NO _ 2, especially SO _ 2, in the surrounding air. In addition, the increase of the air pollutant concentration can also lead to a significant decrease of the pulmonary function related index of primary school students in Licheng District of Jinan. After the sex stratification, the decrease of the concentration of PM _ 2.5 and NO _ 2 will cause a significant increase in the function index of FVC and FEV1 of primary school students; after the grade is layered, A decrease in the concentration of PM2.5 and NO2 was found to cause a significant increase in FVC, FEV1, and V75 lung function in the third grade, whereas for students in the fourth and fifth grades, only two pulmonary function indicators of FVC and V25 were found to be significantly elevated. It is concluded that the effect of air pollutant on the health of low age group is more obvious.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R179

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