昼夜温差对乌鲁木齐市慢性肾脏病日住院人次影响的时间序列分析  

Time series analysis of the effect of diurnal temperature range on daily inpatients with chronic kidney disease in Urumqi

作　　者：吴瑞凯 张莹[2] 杨浩峰[2] 马龙[1] 苏德奇[1] WU Ruikai;ZHANG Ying;YANG Haofeng;MA Long;SU Deqi(School of Public Health,Xinjiang Medical University,Urumqi 830011,China;Urumqi Center for Disease Control and Prevention,Urumqi 830023,China)

机构地区：[1]新疆医科大学公共卫生学院,乌鲁木齐830011 [2]乌鲁木齐市疾病预防控制中心,乌鲁木齐830023

出　　处：《医学新知》2024年第2期137-148,共12页New Medicine

摘　　要：目的探讨昼夜温差(diurnal temperature range,DTR)影响慢性肾脏病(chronic kidney diseases,CKD)日住院人次的影响。方法收集2019年1月1日至2020年12月31日乌鲁木齐市4所三甲医院、4所二甲医院、1所一甲医院CKD日住院人次数据,同期气象及污染物数据来自于乌鲁木齐市主城区的6个国控监测点,采用分布滞后非线性模型,控制星期几效应、假期效应、长期时间趋势及其它因素,分析DTR与CKD日住院人次的关系。结果CKD日住院人次与DTR(滞后0~21 d)的暴露-反应曲线呈“N”形,CKD患者住院风险随DTR的升高呈先上升后下降趋势。低度和高度DTR对CKD患者住院的影响存在一定的滞后效应,中度DTR对住院影响较小;DTR=5℃时,单日效应出现在第3天[RR=1.081,95%CI(1.020,1.145),P<0.05],最大效应出现在第21天[RR=1.090,95%CI(1.014,1.173),P<0.05];高度DTR=14℃(P_(95))时,单日效应出现在第4天[RR=1.086,95%CI(1.007,1.172),P<0.05],最大效应出现在第5天[RR=1.089,95%CI(1.009,1.176),P<0.05],累积滞后均暂未发现有统计学差异。男性和年龄<65岁的CKD患者更易受到DTR的影响,寒冷季节和四季更替时DTR变化对CKD患者住院的影响更大。结论男性与<65岁CKD患者更易受到DTR的影响,在寒冷季节和四季交替DTR变化时更应重点保护易感人群免受DTR的影响。Objective To investigate the influence of diurnal temperature range(DTR)on the daily hospitalization with chronic kidney diseases(CKD).Methods CKD daily inpatient data of four Grade III hospitals,four Grade II hospitals and one Grade I hospital in Urumqi were collected from January 1,2019 to December 31,2020.Meteorological and pollutant data during the same period were collected from six state-controlled monitoring points in the main urban area of Urumqi.A distributed lag no-linear model(DLNM)was used to analyze the relationship between DTR and daily inpatients in CKD,controlling for day of the week effect,holiday effect,long-term trend and other factors,analyzing the relationship between DTR and CKD daily hospitalization.Results The expose-response curves of the number of patients admitted to CKD daily and DTR(with a lag of 0-21 days)showed an"N"shape,and the hospitalization risk of CKD patients increased first and then decreased with the increase of DTR.The influence of low and high DTR on hospitalization of CKD patients has a certain lag effect,while the influence of moderate DTR on hospitalization is small.DTR=5℃,the single-day effect appeared on day 3[RR=1.081,95%CI(1.020,1.145),P<0.05],and the maximum effect appeared on day 21[RR=1.090,95%CI(1.014,1.173),P<0.05];the single-day effect of altitude DTR=14℃(P_(95))occurred on day 4[RR=1.086,95%CI(1.007,1.172),P<0.05],and the largest effect occurred on day 5[RR=1.089,95%CI(1.009,1.176),P<0.05],and no statistical difference was found in cumulative lag.The results of stratified analysis by gender,age and season showed that males and CKD patients<65 years old were more susceptible to DTR,and the change of DTR in cold season and four seasons had a greater impact on hospitalization of CKD patients.Conclusion Men and patients<65 years of age with CKD are more susceptible to DTR,the focus should be more on protecting the susceptible population from DTR during the cold season and the change in DTR at the turn of seasons.

关 键 词：昼夜温差 慢性肾脏病 分布滞后非线性模型 日住院人次 时间序列分析 

分 类 号：R692[医药卫生—泌尿科学]