郑州市大气污染与精神疾病日门诊量的关系  

Relationship between air pollution and daily psychiatric outpatient visits in Zhengzhou

作　　者：孔德琪 王炎 黄慧敏 马宁怡 千孟丹 李亚[2,3] KONG Deqi;WANG Yan;HUANG Huimin;MA Ningyi;QIAN Mengdan;LI Ya(The First Clinical Medical College,Henan University of Chinese Medicine,Zhengzhou,Henan 450046,China;Henan Key Laboratory of Chinese Medicine for Respiratory Disease/Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan&Education Ministry of P.R.China,Henan University of Chinese Medicine,Zhengzhou,Henan 450046,China;Respiratory Pharmacological Laboratory of Chinese Medicine/Henan Key Laboratory of Chinese Medicine for the Prevention and Treatment of Respiratory Disease,The First Affiliated Hospital,Henan University of Chinese Medicine,Zhengzhou,Henan 450000,China)

机构地区：[1]河南中医药大学第一临床医学院,河南郑州450046 [2]河南中医药大学河南省中医药防治呼吸病重点实验室/呼吸疾病中医药防治省部共建协同创新中心,河南郑州450046 [3]河南中医药大学第一附属医院中药药理(呼吸)实验室/河南省呼吸病防治中医药重点实验室,河南郑州450000

出　　处：《环境与职业医学》2023年第12期1370-1378,共9页Journal of Environmental and Occupational Medicine

基　　金：国家自然科学基金面上项目(82274495,82074403);河南省中医药科学研究专项课题(20-21ZY1019);河南省特色骨干学科中医学学科建设项目(STG-ZYXKY-2020014)。

摘　　要：[背景]精神疾病严重威胁人类健康,有研究表明大气污染与精神疾病的发生有关,但其研究结果并不一致。[目的]本研究以郑州地区为例,探究大气污染暴露对精神疾病的潜在影响。[方法]收集2013年10月28日至2019年8月28日期间河南中医药大学第一附属医院临床心理科门诊患者就诊资料与同期空气质量数据,利用分布滞后非线性模型(DLNM)评估大气污染物暴露与日门诊就诊量之间的暴露-滞后效应,并根据性别(男、女)、年龄(<18岁、18~59岁和>59岁)、季节(春、夏、秋、冬)以及疾病种类(抑郁症、焦虑症)分层分析。[结果]研究共纳入有效精神疾病门诊确诊病历112986人次,其中女性、18~59岁、春季以及抑郁症就诊人群在各相应亚组中占比最多。总门诊量单日滞后风险结果表明,PM_(2.5)、PM_(10)、SO_(2)及NO_(2)均显著增加了精神疾病的门诊就诊风险。其中单日滞后风险峰值分别为:PM_(2.5)(RR=1.0016,95%CI:1.0011~1.0022)、PM_(10)(RR=1.0012,95%CI:1.0001~1.0022)、SO_(2)(RR=1.0060,95%CI:1.0002~1.0117)和NO_(2)(RR=1.0144,95%CI:1.0100~1.0187);累积滞后风险峰值分别为:PM_(2.5)(CumRR=1.0274,95%CI:1.0158~1.0392)、PM_(10)(CumRR=1.0124,95%CI:1.0044~1.0205)、SO_(2)(CumRR=1.0214,95%CI:1.0009~1.0423)和NO_(2)(CumRR=1.0613,95%CI:1.0460~1.0770)。亚组分析结果显示,大气污染暴露对女性、18~59岁人群的影响更为显著,冬季受大气污染的影响高于其他季节,其中PM_(2.5)(RR=1.0022,95%CI:1.0006~1.0037)、PM_(10)(RR=1.0015,95%CI:1.0003~1.0027)、SO_(2)(RR=1.0082,95%CI:1.0016~1.0148)及NO_(2)(RR=1.0156,95%CI:1.0106~1.0206)暴露增加了女性精神疾病的门诊就诊风险,PM_(2.5)(RR=1.0018,95%CI:1.0011~1.0024)、PM_(10)(RR=1.0012,95%CI:1.0001~1.0023)及NO_(2)(RR=1.0142,95%CI:1.0095~1.0189)增加18~59岁人群就诊风险,冬季PM_(2.5)(RR=1.0043,95%CI:1.0001~1.0085)、PM_(10)(RR=1.0038,95%CI:1.0007~1.0069)及NO_(2)(RR=1.0215,95%CI:1.0117~1.0313)增加了精神疾病门诊就诊风�[Background]Psychiatric diseases are a serious threat to human health.Studies have shown an association between ambient air pollution and psychiatric diseases,yet the results are inconsistent.[Objective]To explore the potential effects of air pollution exposure on psychiatric diseases using Zhengzhou City as an example.[Methods]Outpatient consultation data of the Clinical Psychology Clinic at The First Affiliated Hospital of Henan University of Traditional Chinese Medicine as well as air quality data between 28 October 2013 and 28 August 2019 were collected.The exposure-lag effect between air pollutant exposure and daily outpatient visits was assessed using a distribution lag nonlinear model(DLNM),and subgroup analyses were conducted including sex(male and female),age(<18,18-59,and>59 years),season(spring,summer,autumn,and winter),and types of diseases(depression and anxiety).[Results]A total of 112986 valid confirmed outpatient visit records for psychiatric diseases were collected.The largest proportions of visits in each subgroup were females,18-59 years old,spring,and depression.The results of one-day lagged risk of total outpatient visits showed that PM_(2.5),PM_(10),SO_(2),and NO_(2)all significantly associated with an increased risk of psychiatric outpatient visits.The one-day lagged risk peaks were:PM_(2.5)(RR=1.0016,95%CI:1.0011,1.0022),PM_(10)(RR=1.0012,95%CI:1.0001,1.0022),SO_(2)(RR=1.0060,95%CI:1.0002,1.0117),and NO_(2)(RR=1.0144,95%CI:1.0100,1.0187).The cumulative lagged risk peaks were:PM_(2.5)(CumRR=1.0274,95%CI:1.0158,1.0392),PM_(10)(CumRR=1.0124,95%CI:1.0044,1.0205),SO_(2)(CumRR=1.0214,95%CI:1.0009,1.0423),and NO_(2)(CumRR=1.0613,95%CI:1.0460,1.0770).The results of subgroup analysis showed more significant impacts of air pollution exposure on females and people aged 18-59 years,and in winter.To be specific,PM_(2.5)(RR=1.0022,95%CI:1.0006,1.0037),PM_(10)(RR=1.0015,95%CI:1.0003,1.0027),SO_(2)(RR=1.0082,95%CI:1.0016,1.0148),and NO_(2)(RR=1.0156,95%CI:1.0106,1.0206)exposures associated with an increas

关 键 词：大气污染物 精神疾病 非线性滞后分布模型 相对风险值 性别 年龄 季节 

分 类 号：R12[医药卫生—环境卫生学]