大气污染与耳鼻咽喉急性疾病发病的时间序列分析  

Time-series analysis of association between air pollutants and the incidence of acute diseases of otorhinolaryngology

作　　者：方许哲 朱瑾[2] 滕尧树[2] 张槿 曾黎[3] 慈军[4] 陈志凌[5] FANG Xuzhe;ZHU Jin;TENG Yaoshu;ZHANG Jin;ZENG Li;CI Jun;CHEN Zhiling(不详;The Fourth Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou 310053,China)

机构地区：[1]浙江中医药大学第四临床医学院,杭州310053 [2]杭州市第一人民医院耳鼻咽喉科 [3]杭州市第三人民医院耳鼻咽喉科 [4]杭州市红十字会医院耳鼻咽喉科 [5]杭州市中医院耳鼻咽喉科

出　　处：《浙江医学》2024年第10期1087-1092,共6页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2021KY239)。

摘　　要：目的分析大气污染与耳鼻咽喉急性疾病发病的关系。方法回顾性收集2013至2018年杭州市主城区4家大型三级综合性医院(杭州市第一人民医院、浙江省中西医结合医院、杭州市中医院、杭州市第三人民医院)耳鼻咽喉急性疾病(包括急性扁桃体炎、急性会厌炎、急性喉炎、急性鼻-鼻窦炎、急性中耳炎)的门急诊量,并获取同时期该地区大气污染及气象参数数据。采用R统计软件建立广义相加模型,研究不同大气污染物浓度对耳鼻咽喉急性疾病门急诊量的影响,根据季节、年龄分层分析研究不同大气污染物浓度与门急诊量的关系。结果2013至2018年杭州市主城区耳鼻咽喉急性疾病门急诊总量333254人次,日均门急诊量为152人次。颗粒污染物(PM2.5、PM10)日均浓度每增加10μg/m^(3),在滞后第4天时对耳鼻咽喉急性疾病门急诊量的影响效应最大;气态污染物(SO2、NO2)日均浓度每增加10μg/m^(3),分别在滞后第4天、滞后第6天效应最大。单大气污染物模型中:年龄分层分析显示,在就诊的不同年龄亚组中,5~14岁年龄亚组中各大气污染物浓度与门急诊量的相关性最为明显,PM2.5、PM10、SO2、NO2浓度每升高10μg/m^(3),其效应排序为:NO2>SO2>PM10>PM2.5,RR值分别1.07(95%CI:1.05~1.09)、1.05(95%CI:1.03~1.07)、1.04(95%CI:1.02~1.05)、1.03(95%CI:1.02~1.05);季节分层分析显示,冷季(11月至4月)中大气污染物对耳鼻咽喉急性疾病门急诊量增加的影响强于暖季(5月至10月)(P<0.05)。在双大气污染物模型中,大气双污染物与耳鼻咽喉急性疾病门急诊量的相关性均有统计学意义(均P<0.05)。结论2013至2018年杭州市主城区大气污染物浓度升高与人群耳鼻咽喉急性疾病门急诊量增加相关,且具有滞后效应。耳鼻咽喉急性疾病的发病冷季效应强于暖季,5~14岁儿童的影响效应最为显著。这对制定耳鼻咽喉急性疾病的防治策略有重要参考价值。Objective To analyze the relationship between air pollutants and the incidence of acute diseases of otorhinolaryngology.Methods The outpatient and emergency volume of acute diseases of otolaryngology,including acute tonsillitis,acute epiglottitis,acute laryngitis,acute rhinitis and nasal sinusitis,and acute otitis media in four large tertiary general hospitals in the main urban area of Hangzhou(Hangzhou First People's Hospital,Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine,Hangzhou Hospital of Traditional Chinese Medicine,and Hangzhou Third People's Hospital)was collected during 2013-2018,and data on atmospheric pollution and meteorological parameters in the area during the same period were obtained.R statistical software was used to establish a generalized additive model to study the effects of different air pollutant concentrations on the outpatient and emergency volume of acute otolaryngological diseases,and the relationship between different air pollutant concentrations and daily outpatient and emergency volume in different subgroups stratified by season and age was analyzed.Results The total number of outpatient and emergency visits for acute otolaryngology diseases in the main urban area of Hangzhou during 2013-2018 was 333,254,and the average daily number of outpatient and emergency visits was 152.For every 10μg/m^(3)increase in the average daily concentration of particulate pollutants(PM2.5,PM10),the effect on the number of outpatient and emergency visits for acute otorhinolaryngological diseases was the greatest on the 4th day of lag(Lag 4),while for every 10μg/m^(3)increase in the average daily concentration of gaseous pollutants(SO2,NO2),the effect on the number of outpatient and emergency visits was the greatest on the 4th and 6th days of lag(Lag 4 and Lag 6,respectively).In the single-pollutant model:Age-stratified analysis showed that the correlation between the concentration of each air pollutant and the volume of emergency and outpatient visits was most significantly se

关 键 词：大气污染 耳鼻咽喉急性疾病 时间序列分析 广义相加模型 

分 类 号：R76[医药卫生—耳鼻咽喉科] X51[医药卫生—临床医学]