空气污染物与脑梗死发生情况的病例交叉研究  

Air Pollutants and Cerebral Infarction:a Case-crossover Study

作　　者：李宁[1] 纪威[1] 俞延峰[1] 韩航涛 樊明锁[1] 张良[1] LI Ning;JI Wei;YU Yanfeng;HAN Hangtao;FAN Mingsuo;ZHANG Liang(Institute of Big Data for Public Health,Ningbo Municipal Center for Disease Control and Prevention,Ningbo 315010,China)

机构地区：[1]浙江省宁波市疾病预防控制中心公共卫生大数据研究所,315010

出　　处：《中国全科医学》2018年第29期3551-3556,共6页Chinese General Practice

摘　　要：目的采用病例交叉研究设计,分析空气污染物对脑梗死发生情况的影响。方法收集2014-01-01至2016-12-31宁波市3家三级甲等医院(宁波市医疗中心李惠利医院、宁波市第一医院和宁波市第二医院)所有诊断为脑梗死的就诊记录(ICD10编码I63),及宁波市环境监测中心的空气污染物数据、宁波市气象局的气温数据。采用单向回顾性1∶3配对病例交叉研究设计,建立单污染物和多污染物模型条件Logistic回归分析,并对性别进行亚组分析。结果 2014-01-01至2016-12-31宁波市3家三级甲等医院共计诊断脑梗死22 837人次,其中男10 968人次(占48.03%),女7 540人次(占33.02%),男女比例为1.45∶1,性别缺失4 329人次(占18.95%)。单污染物模型结果显示:NO_2、CO浓度是发生脑梗死的影响因素[OR=1.001,95%CI(1.000,1.003),P=0.034;OR=0.794,95%CI(0.723,0.873),P<0.001];性别亚组分析发现,NO_2、O_3浓度是男性发生脑梗死的影响因素[OR=1.003,95%CI(1.001,1.004),P=0.011;OR=0.999,95%CI(0.998,1.000),P=0.033],NO_2、CO浓度是女性发生脑梗死的影响因素[OR=1.002,95%CI(1.000,1.005),P=0.046;OR=0.826,95%CI(0.704,0.968),P=0.018]。多污染物模型结果显示:PM10、NO_2、CO浓度是发生脑梗死的影响因素[OR=1.001,95%CI(1.000,1.002),P=0.019;OR=1.004,95%CI(1.002,1.006),P<0.001;OR=0.564,95%CI(0.490,0.650),P<0.001];性别亚组分析发现,PM10、NO_2、O_3、CO浓度是男性发生脑梗死的影响因素[OR=1.002,95%CI(1.001,1.004),P=0.004;OR=1.004,P<0.001];NO_2、CO浓度是女性发生脑梗死的影响因素[OR=1.006,95%CI(1.003,1.009),P<0.001;OR=0.609,95%CI(0.480,0.773),P<0.001]。结论在一定条件下,空气中的PM10、NO_2浓度是发生脑梗死的危险因素,CO浓度是发生脑梗死的保护因素;部分空气污染物对脑梗死发生情况的影响存在性别差异。Objective To explore the effects of air pollutants on the incidence of cerebral infarction using a casecrossover design.Methods Data of visits for cerebral infarction(ICD10 I 63)were collected from three grade A tertiary hospitals(Ningbo City Medical Treatment Center Lihuili Hospital,Ningbo First Hospital,and Ningbo NO.2 Hospital).Air pollutants data were obtained from Environment Monitoring Center of Ningbo.Data concerning temperature stemmed from Ningbo Meteorological Bureau.All the aforementioned data cover a three-year period from January 1,2014 to December 31,2016.Based on a one-way retrospective 1∶3 case-crossover design,single pollutant and multi-pollutant(conditional Logistic regression)models combined with sex subgroup analysis were used.Results A total of 22 837 visits were enrolled,except the data concerning sex of 4 329(18.95%)were missed,the other cases〔10 968 males(48.03%)and 7 540(33.02%)females,with a male-to-female ratio of 1.45∶1〕were included in the sex subgroup analysis.Single-pollutant analyses showed that NO2 and CO levels appeared to be the associated factors for cerebral infarction〔OR=1.001,95%CI(1.000,1.003),P=0.034;OR=0.794,95%CI(0.723,0.873),P<0.001〕.When sex was considered as a stratification variable,NO2 and O3 levels were found to be the associated factors for cerebral infarction in males〔OR=1.003,95%CI(1.001,1.004),P=0.011;OR=0.999,95%CI(0.998,1.000),P=0.033〕,and NO2 and CO levels were identified to be the associated factors for cerebral infarction in females〔OR=1.002,95%CI(1.000,1.005),P=0.046;OR=0.826,95%CI(0.704,0.968),P=0.018〕.Multi-pollutant analyses revealed that PM10,NO2 and CO levels were associated factors for cerebral infarction〔OR=1.001,95%CI(1.000,1.002),P=0.019;OR=1.004,95%CI(1.002,1.006),P<0.001;OR=0.564,95%CI(0.490,0.650),P<0.001〕;PM10,NO2,O3 and CO levels were associated factors for cerebral infarction in males〔OR=1.002,95%CI(1.001,1.004),P=0.004;OR=1.004,95%CI(1.001,1.007),P=0.004;OR=0.999,95%CI(0.998,0.999),P=0.001;OR=0.580,95%CI(0.474,0.7

关 键 词：脑卒中 空气污染物 影响因素分析 病例交叉研究 

分 类 号：R743[医药卫生—神经病学与精神病学]