特应性皮炎对生命早期颗粒物暴露与儿童过敏性鼻炎发生风险关联的效应修饰作用  

Modification of allergic dermatitis on the associations between early-life exposure to size-specific particulate matter and childhood allergic rhinitis

作　　者：唐浩然 张玲[1,2] 张云权 吴传莎 Tang Haoran;Zhang Ling;Zhang Yunquan;Wu Chuansha(Department of Environmental Hygiene and Occupational Medicine,School of Public Health,Wuhan University of Science and Technology,Wuhan 430065,China;Hubei Province Key Laboratory of Occupational Hazard Identification and Control,Wuhan University of Science and Technology,Wuhan 430065,China;Department of Epidemiology and Biostatistics,School of Public Health,Wuhan University of Science and Technology,Wuhan 430065,China)

机构地区：[1]武汉科技大学医学部公共卫生学院环境卫生与职业医学系,武汉430065 [2]武汉科技大学职业危害识别与控制湖北省重点实验室,武汉430065 [3]武汉科技大学医学部公共卫生学院流行病与卫生统计学系,武汉430065

出　　处：《中华预防医学杂志》2024年第6期830-838,共9页Chinese Journal of Preventive Medicine

基　　金：湖北省自然科学基金(2022CFB701);国家自然科学基金(81861138005)。

摘　　要：本研究评估特应性皮炎在颗粒物暴露与学龄前儿童过敏性鼻炎发生风险关联中的效应修饰作用。采用横断面研究的设计,通过问卷调查的方式于2019年6月至2020年6月在中国7个城市的幼儿园收集了共计28408名3~6岁学龄前儿童有关过敏性鼻炎和特应性皮炎的信息。运用一种成熟的基于机器学习的时空模型以1 km的空间分辨率水平估算不同城市儿童生命早期、孕期和出生后第1年PM_(1)、PM_(2.5)和PM_(10)暴露水平。采用多水平logistic回归和暴露反应关系相结合的方法定量评估特应性皮炎作为效应修饰因子是否会改变不同粒径颗粒物暴露与儿童过敏性鼻炎发生风险的关联。结果显示,在28408名儿童中,男孩为14803名(52.1%),女孩为13605名(47.9%);年龄范围是3.1~6.8岁、(4.9±0.9)岁,其中患过敏性鼻炎的儿童为3586名(12.6%)。在总人群中,母乳喂养持续时间大于6个月的儿童为17832名(62.8%),父母有过敏史的为769名(2.7%)。母亲教育水平为大学及以上的儿童为21548名(75.9%)。有被动吸烟暴露的儿童为7338名(29.6%)。生命早期PM_(1)(9.8μg/m^(3))、PM_(2.5)(14.9μg/m^(3))和PM_(10)(37.7μg/m^(3))每增加一个四分位区间(IQR)浓度,儿童过敏性鼻炎调整后的OR值在特应性皮炎儿童中高于无特应性皮炎儿童中对应的OR值[PM_(1):OR=1.45,95%CI(1.26,1.66)vs.OR=1.33,95%CI(1.20,1.47);PM_(2.5):OR=1.38,95%CI(1.23,1.56)vs.OR=1.32,95%CI(1.21,1.45);PM_(10):OR=1.56,95%CI(1.31,1.86)vs.OR=1.46,95%CI(1.28,1.67)]。特应性皮炎与不同粒径PM暴露对儿童过敏性鼻炎的交互作用差异有显著的统计学意义(Z值=19.4,交互作用P值均<0.001)。在孕期和出生后第1年也观察到了类似的结果,且剂量反应关系的结果与logistic回归的结果具有一致性。综上,作为过敏性疾病进程重要环节的特应性皮炎可能会修饰大气颗粒物暴露与儿童过敏性鼻炎发生风险的关联。提示患特应性皮炎的儿童更应重�To evaluate the modification of allergic dermatitis on the association between PM exposure and allergic rhinitis in preschool children.This cross-sectional study was based on a questionnaire conducted between June 2019 and June 2020 to caregivers of children aged 3 to 6 years in the kindergartens of 7 Chinese cities to collect information on allergic rhinitis and allergic dermatitis.A mature machine learning-based space-time extremely randomized trees model was applied to estimate early-life,prenatal,and first-year exposure of PM_(1),PM_(2.5) and PM_(10) at 1 km×1 km resolution.A combination of multilevel logistic regression and restricted cubic spline functions was used to quantitatively assess whether allergic dermatitis modifies the associations between size-specific PM exposure and the risk of childhood allergic rhinitis.The results showed that out of 28408 children,14803(52.1%)were boys and 13605(47.9%)were girls;the age of children ranged from 3.1 to 6.8 years,with a mean age of(4.9±0.9)years,of which 3586(12.6%)were diagnosed with allergic rhinitis.Among all children,17832(62.8%)were breastfed for more than 6 months and 769(2.7%)had parental history of atopy.A total of 21548 children(75.9%)had a mother with an educational level of university or above and 7338(29.6%)had passive household cigarette smoke exposure.The adjusted ORs for childhood allergic rhinitis among the children with allergic dermatitis as per interquartile range(IQR)increase in early-life PM_(1)(9.8μg/m^(3)),PM_(2.5)(14.9μg/m^(3))and PM_(10)(37.7μg/m^(3))were significantly higher than the corresponding ORs among the children without allergic dermatitis[OR:1.45,95%CI(1.26,1.66)vs.1.33,95%CI(1.20,1.47),for PM_(1);OR:1.38,95%CI(1.23,1.56)vs.1.32,95%CI(1.21,1.45),for PM_(2.5);OR:1.56,95%CI(1.31,1.86)vs.1.46,95%CI(1.28,1.67),for PM_(10)].The interactions between allergic dermatitis and size-specific PM exposure on childhood allergic rhinitis were statistically significant(Z value=19.4,all P for interaction<0.001).The similar patterns were

关 键 词：亚微米颗粒物 细颗粒物 特应性皮炎 过敏性鼻炎 效应修饰作用 

分 类 号：R758.2[医药卫生—皮肤病学与性病学] R765.21[医药卫生—临床医学]