大气气态污染物对农村结核分枝杆菌潜伏感染者肺结核发病的影响  

Impact of gaseous air pollutants on the risk of incident active pulmonary tuberculosis among rural people with latent tuberculosis infection

作　　者：田思帆 郭同磊 陈晨[3] 张彬 辛赫男 杜江[2] 曹雪芳 冯博轩 何翼君 何勇鹏 王大宽 刘自森 闫娇霞 沈玲羽 邸元植 陈彦宵 金奇[2] 段伟焘 高磊[2] 高旭 Tian Sifan;Guo Tonglei;Chen Chen;Zhang Bin;Xin Henan;Du Jiang;Cao Xuefang;Feng Boxuan;He Yijun;He Yongpeng;Wang Dakuan;Liu Zisen;Yan Jiaoxia;Shen Lingyu;Di Yuanzhi;Chen Yanxiao;Jin Qi;Duan Weitao;Gao Lei;Gao Xu(Department of Occupational and Environmental Health Sciences,School of Public Health,Peking University,Beijing 100191,China;Institute of Pathogen Biology,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Key Laboratory of Environment and Population Health/National Institute of Environmental Health,Chinese Center for Disease Control and Prevention,Beijing 100021,China;Center for Diseases Control and Prevention of Zhongmu,Zhengzhou,Henan Province,Zhengzhou 451450,China;College of Public Health,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]北京大学公共卫生学院劳动卫生与环境卫生学系,北京100191 [2]中国医学科学院病原生物学研究所,北京100730 [3]中国疾病预防控制中心环境与人群健康重点实验室/中国疾病预防控制中心环境与健康相关产品安全所,北京100021 [4]河南省郑州市中牟县疾病预防控制中心,郑州451450 [5]郑州大学公共卫生学院,郑州450001

出　　处：《中国防痨杂志》2024年第6期654-663,共10页Chinese Journal of Antituberculosis

基　　金：国家自然科学基金(82304098,42305196,82373647);科技基础资源调查专项(2023FY100603)。

摘　　要：目的:探讨主要大气气态污染物对农村地区处于结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)状态的成年人群肺结核发病的影响。方法:本研究基于2013—2018年在农村地区开展的一项多中心、前瞻性结核分枝杆菌潜伏感染队列(LATENTTB-NSTM),对3866例基线LTBI者季度随访5年,收集新发活动性肺结核病例,根据居住地点和时间匹配气态污染物浓度,利用含时依协变量的Cox比例风险模型分别估计二氧化硫(SO_(2))、二氧化氮(NO_(2))、臭氧(O3)和一氧化碳(CO)与研究人群及不同年龄段、性别、受教育程度、家庭收入和生活方式等亚组新发活动性肺结核发病风险之间的关联。结果:3866例LTBI者,随访中发现新发活动性肺结核58例。6个月的SO_(2)和CO暴露水平分别每增加10μg/m^(3)和100μg/m^(3),活动性肺结核发病风险分别增加81.0%(HR=1.810,95%CI:1.153~2.843)和19.6%(HR=1.196,95%CI:1.031~1.388)。SO_(2)和CO暴露与活动性肺结核发病风险间的关联在老年人群和吸烟人群中更强,但差异均无统计学意义(交互作用P值均>0.05)。结论:大气气态污染物尤其是SO_(2)和CO暴露可引起农村地区LTBI者活动性肺结核发病风险升高,大气气态污染的治理对肺结核的控制具有不可忽视的意义。Objective:To investigate the influence of primary atmospheric gaseous pollutants on the incidence of active pulmonary tuberculosis among adults in rural areas with latent tuberculosis infection(LTBI).Methods:This study utilized a multicenter,longitudinal cohort of rural residents with LTBI(LATENTTB-NSTM),spanning from 2013 to 2018,comprising 3866 participants who were monitored quarterly over five years to document new cases of active pulmonary tuberculosis.Concentrations of atmospheric gaseous pollutants such as sulfur dioxide(SO_(2)),nitrogen dioxide(NO_(2)),ozone(O3),and carbon monoxide(CO)were precisely matched to the residential locations and periods under review.The association between exposure levels and the emergence of active tuberculosis was analyzed using time-dependent Cox proportional hazards models,stratified by age,sex,educational attainment,family income,and lifestyle factors.Results:Among 3866 individuals diagnosed with latent tuberculosis infection,surveillance identified 58 new cases of active pulmonary tuberculosis.Incremental exposures to SO_(2) and CO by 10μg/m^(3) and 100μg/m^(3),respectively,over a six-month period were associated with a respective 81.0%(HR=1.810,95%CI:1.153-2.843)and 19.6%(HR=1.196,95%CI:1.031-1.388)increase in the risk of developing active tuberculosis.Notably,these associations appeared more pronounced among older adults and smokers,though the differences did not reach statistical significance(interaction P-values>0.05).Conclusion:Exposure to atmospheric gaseous pollutants,particularly SO_(2) and CO,is associated with a heightened risk of developing active pulmonary tuberculosis among individuals with LTBI in rural settings.The management of air quality,therefore,plays a crucial role in the strategic control of tuberculosis.

关 键 词：结核 肺 感染 空气污染物 因素分析 统计学 

分 类 号：R521[医药卫生—内科学]