PM10长期暴露与中国北方城市居民慢性支气管炎发病风险的回顾性队列研究  

Long-term exposure to PM10 and risk of chronic bronchitis of residents in northern China: A retrospective cohort study

作　　者：咸平 闫梦璠 李耀妍 张利文[1] 陈曦[1] 董光辉[2] 刘亚民[3] 陈杰[4] 王彤[5] 赵宝新[6] 汤乃军[1] XIAN Ping;YAN Meng-fan;LI Yao-yan;ZHANG Li-wen;CHEN Xi;DONG Guang-hui;LIU Ya-min;CHEN Jie;WANG Tong;ZHAO Bao-xin;TANG Nai-jun(School of Public Health,Tianjin Medical University,Tianjin Key Laboratory of Environment,Nutrition,and Public Health,Center for International Collaborative Research on Environment,Nutrition and Public Health,Tianjin 300070,China;School of Public Health,Sun Yat-sen University,Guangzhou,Guangdong 510080,China;School of Medicine and Life Sciences,Shandong Academy of Medical Sciences,Jinan,Shandong 250062,China;School of Public Health,China Medical University,Shenyang,Liaoning 110122,China;School of Public Health,Shanxi Medical University,Taiyuan,Shanxi 030001,China;Taiyuan Center for Disease Control and Prevention,Taiyuan,Shanxi 030001,China)

机构地区：[1]天津医科大学公共卫生学院,天津市环境营养与人群健康重点实验室,环境营养与人群健康国际联合研究中心,天津300070 [2]中山大学公共卫生学院,广东广州510080 [3]山东省医学科学院医学与生命科学学院,山东济南250062 [4]中国医科大学公共卫生学院,辽宁沈阳110122 [5]山西医科大学公共卫生学院,山西太原030001 [6]太原市疾病预防控制中心,山西太原030001

出　　处：《环境与职业医学》2020年第2期95-102,共8页Journal of Environmental and Occupational Medicine

基　　金：国家重点研发计划(2017YFC0211600,2017YFC0211605,2017YFC0211704);国家环境保护部环保公益性行业科研项目(200709048).

摘　　要：[背景]大气颗粒物污染已经成为威胁人类健康的主要因素之一,在心血管疾病和呼吸系统疾病的发生发展过程中起到重要作用。慢性支气管炎(CB)是一种常见的呼吸道疾病,大多并发肺气肿及肺心病,严重影响患者的生活质量,给家庭和社会带来了巨大经济负担。而有关颗粒物长期高暴露对CB影响的研究仍然有限。[目的]研究高浓度PM10长期暴露与居民CB发病风险的关联。[方法]采用回顾性队列研究方法,于1998—2009年对中国北方四城市(日照、天津、沈阳、太原)的37915名符合纳入标准的居民进行调查研究。采用问卷调查的方法获得人口学、生活方式、疾病史等信息,由研究对象自述CB患病情况。PM10浓度来源于各城市环境空气质量国控监测站点,以从纳入队列至CB发病期间内PM10的年平均浓度作为暴露估计值,运用Cox比例风险回归模型估计发病风险比(HR)及其95%可信区间(CI),并分析性别、年龄、体质量指数(BMI)、受教育程度、经济、吸烟以及户外锻炼等因素与PM10暴露的交互作用。[结果]平均随访11.78年,其中CB新发病例354人,累计发病率为9.3‰。研究对象基线年龄为(44.09±13.87)岁,BMI为(22.64±2.95)kg·m-2。调整年龄、性别、BMI、生活方式、CB家族史等混杂因素后,PM10每增加10μg·m-3,发生CB的HR(95%CI)为1.616(1.546~1.688)。分层分析中,PM10与CB发病关联在不同年龄、BMI、受教育程度、锻炼状态者间差异有统计学意义(均P交互<0.05);与年龄<45岁[HR(95%CI):1.324(1.252~1.401)]、BMI<24 kg·m-2[HR(95%CI):1.553(1.477~1.634)]、受教育程度低[HR(95%CI):1.582(1.502~1.667)]、户外锻炼不活跃[HR(95%CI):1.489(1.407~1.576)]的人群相比,年龄≥45岁[HR(95%CI):1.888(1.787~1.996)]、BMI≥24 kg·m-2[HR(95%CI):1.825(1.673~1.992)]、受教育程度高[HR(95%CI):1.753(1.614~1.904)]、户外锻炼活跃[HR(95%CI):1.800(1.687~1.920)]的人群与PM10暴露的交互作用更强。在敏感�[Background]Air particulate matter pollution has become one of the main factors threatening human health,playing an important role in the occurrence and development of cardiovascular diseases and respiratory diseases.Chronic bronchitis(CB)is a common respiratory disease,most of which are complicated with emphysema and cor pulmonale,and seriously affects the quality of life in patients and poses huge economic burden to families and society.There are limited studies on the long-term exposure to particulate matters and CB.[Objective]This study aims to assess the association between long-time exposure to high concentrations of PM10 and the risk of CB of residents.[Methods]A retrospective cohort study was conducted among 37915 residents in four cities in northern China,including Rizhao,Tianjin,Shenyang,and Taiyuan,from 1998 to 2009.Questionnaire survey was used to obtain demography,lifestyle,disease history,and selfreported CB.PM10 concentrations were sourced from the national monitoring sites of ambient air quality in each city.With the annual average concentration of PM10 from the time of inclusion into the cohort to the time of CB onset as exposure estimate,Cox proportional risk regression model was used to estimate the hazard ratio(HR)and 95%confidence interval(CI),and to examine the interaction of PM10 exposure with gender,age,body mass index(BMI),education,income,smoking,outdoor exercise,and other factors.[Results]With a mean follow-up of 11.78 years,354 new cases of CB were reported,and the cumulative incidence was 9.3‰.The baseline age of the study subjects was(44.09±13.87)years,and the baseline body mass index was(22.64±2.95)kg·m-2.After adjusting for age,gender,BMI,lifestyle,CB family history,and other confounding factors,the HR(95%CI)of CB was 1.616(1.546-1.688)for every 10μg·m-3 increase of PM10.The stratified analysis results showed significant associations between PM10 and CB incidence across different age,BMI,education,and exercise groups(Pinteraction<0.05);and compared with the age group<45 year

关 键 词：空气污染 颗粒物 慢性支气管炎 发病 队列研究 

分 类 号：X513[环境科学与工程—环境工程] R562.21[医药卫生—呼吸系统]