大气可吸入性颗粒物暴露与儿童哮喘显著关联:基于22篇观察性研究的Meta分析  

Association between inhalable particulate matter and asthma in children : a meta-analysis based on 22 observational studies

作　　者：张娟娟[1] 汪东海[1] 代继宏[2] 

机构地区：[1]重庆医科大学附属儿童医院儿童发育与疾病教育部重点实验室,重庆400014 [2]重庆医科大学附属儿童医院呼吸中心,重庆400014

出　　处：《中国循证儿科杂志》2015年第5期337-344,共8页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的定量分析大气可吸入性颗粒物（PM2.5,PM10）暴露对儿童哮喘发病风险的影响。方法计算机检索Pub Med、EMBASE、Cochrane图书馆、Ovid、中国生物医学文献数据库、中国知网和万方数据库,检索时间均为建库至2014年11月,同时手工检索相关杂志,纳入可吸入性颗粒物暴露与儿童哮喘关联的观察性研究文献。采用NOS和AHRQ量表进行文献偏倚评价。以可吸入性颗粒物浓度每升高10μg·m-3与儿童哮喘发病风险关联强度的OR及其95%CI作为效应量,按急性效应和慢性效应分别行Meta分析,进一步按PM2.5和PM10行亚组分析。采用Rev Man 5.3和Stata 12.0软件分别行异质性分析及发表偏倚检验,根据异质性分析结果采用相应的效应模型合并效应值。结果 31篇文献进入Meta分析,队列研究10篇,横断面研究12篇,病例交叉研究8篇,时间序列研究2篇。122篇文献报道了可吸入性颗粒物对儿童哮喘发病风险的慢性效应,文献间具异质性,随机效应模型的Meta分析结果显示,合并OR=1.10（95%CI：1.03~1.17）,即大气PM2.5或PM10浓度每上升10μg·m-3,儿童哮喘的发病风险升高10%,亚组分析显示,PM2.5和PM10的合并OR值分别为1.08（95%CI：1.02~1.15）和1.10（95%CI：1.01~1.20）。29篇文献报道了可吸入性颗粒物对儿童哮喘发病风险的急性效应,文献间具异质性,随机效应模型的Meta分析结果显示,合并OR=1.05（95%CI：1.02~1.08）,即大气PM2.5或PM10浓度每上升10μg·m-3,儿童哮喘的发病风险升高5%;亚组分析显示,PM2.5和PM10的合并OR值分别为1.06（95%CI：1.02~1.10）和1.05（95%CI：1.02~1.08）。3Egger直线回归法发表偏倚检验显示,急性效应不存在发表偏倚,慢性效应存在发表偏倚。结论 PM2.5和PM10水平与儿童哮喘发病风险的急性和慢性效应存在显著关联。Objective To quantitatively estimate the association between particulate matter with asthma in children.Methods Pub Med,EMBASE,Ovid,Cochrane Library,CBM,CNKI and Wanfang database were searched up to November 2014,and additional studies were manual screened. Observational studies assessing the association between inhalable particulate matter（ PM2. 5,PM10） and risk of childhood asthma were included. The quality of the literatures was evaluated by the Newcastle Ottawa Scale and AHRQ. The adjusted effect sizes and corresponding 95% CI for asthma attack corresponding to a 10 μg·m-3increment in exposure to inhalable particulate matter were investigated and conducted to identify the acute and chronic effects. Furthermore,subgroup analysis was conducted by the sizes of inhalable particulate matter. Rev Man 5. 3 and Stata 12. 0 software were used to perform heterogeneity analysis and the test of publication bias. The pooled effect was conducted on the basis of effect model. Results Thirty-one studies were identified,including 10 cohort studies,12 cross-sectional studies,8 case-crossover studies and 2 timeseries studies. 1Twenty-two literatures reported the chronic effects of exposure to inhalable particles on childhood asthma,which exhibited heterogeneity（ P 0. 001,I2= 72%）. The pooled effect sizes of odds ratio based on random effect model were 1. 10（ 95% CI： 1. 03-1. 17）,which indicated that the incidence of pediatric asthma increased 10% by a weighted average of adjusted OR for a 10 μg·m-3increase in inhalable particles. In subgroup analysis,the combined odds ratios of PM2. 5 and PM10 were 1.08（ 95% CI： 1. 02-1. 15） and 1. 0（ 95% CI： 1. 01-1. 20） respectively. 2 Nine literatures reported the acute effects of exposure to inhalable particles on childhood asthma. The pooled effect sizes were 1. 05（ 95% CI： 1. 02- 1. 08）,which indicated that the incidence of pediatric asthma increased 5% by a weighted average of for a 10 μg · m-3increment of adjusted OR in inhalable particles. In subgr

关 键 词：可吸入性颗粒物 儿童 哮喘 系统评价 META分析 

分 类 号：R725.6[医药卫生—儿科] R-03[医药卫生—临床医学]