基于混合暴露模型的空气污染物与肺结节进展关联研究  

Association study between mixed air pollutant exposure and progression of pulmonary nodules

作　　者：徐瑞宁 张心悦 陈劼 石逸秋 刘可夫[2] 王莉娜[1] XU Ruining;ZHANG Xinyue;CHEN Jie;SHI Yiqiu;LIU Kefu;WANG Lina(Department of Epidemiology&Biostatistics,School of Public Health,Southeast University,Nanjing 210009,China;Department of Radiology,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Gusu School,Nanjing Medical University,Suzhou 215008,China)

机构地区：[1]东南大学公共卫生学院流行病与卫生统计学系,南京210009 [2]南京医科大学附属苏州医院放射科,南京医科大学姑苏学院,苏州市立医院,苏州215008

出　　处：《中华疾病控制杂志》2025年第1期61-66,共6页Chinese Journal of Disease Control & Prevention

基　　金：江苏省研究生科研与实践创新计划(SJCX23_0095);南京医科大学姑苏学院科研项目(GSKY20210209)。

摘　　要：目的 探讨单一空气污染物和混合污染物暴露与肺结节进展的关联。方法 选取体检人群中肺结节患者作为研究对象,根据中国环境监测总站数据,计算体检前1年空气污染物平均日暴露浓度,随访每年肺结节直径变化情况。采用广义估计方程,基于分位数的g计算(quantile g-computation,QgC)模型和贝叶斯核机器回归(Bayesian kernel machine regression,BKMR)模型,探究空气污染物单独和混合暴露对肺结节直径变化量的影响。结果 最终纳入785例肺结节患者,广义估计方程分析结果表明,二氧化氮(nitrogen dioxide,NO_(2))、细颗粒物(fine particulate matter,PM_(2.5))、可吸入颗粒物(inhalable particulate mattert,PM_(10))暴露水平每增加1个四分位距(interquartile range,IQR),肺结节患者结节直径年变化量分别为0.30 mm、0.51 mm及0.32 mm。QgC模型结果显示,空气混合污染物水平每增加1个IQR,肺结节直径平均增加0.50 mm(95%CI:0.09 mm~0.91 mm)。BKMR模型结果表明,PM_(2.5)是影响结节进展的重要变量,且二者之间存在剂量-反应关系。结论 空气污染物混合暴露与肺结节直径年变化量的增加有关,PM_(2.5)是混合污染物中影响肺结节直径的最重要组分。Objective To explore the single and mixed exposure effects of air pollutants on the progression of pulmonary nodules.Methods Individuals identified with pulmonary nodules in the medical examination were included.The average daily exposure concentrations of air pollutants in the year before the physical examination were estimated using the data from environmental monitoring stations and the diameters of pulmonary nodules were followed up each year.Generalized estimating equation models,quantile g-computation models(QgC) and bayesian kernel machine regression models(BKMR) were used to estimate the effects of air pollutants exposure singly and mixed on the annual change in pulmonary nodule diameter.Results A total of 785 individuals with pulmonary nodules were finally included in the study.The results of the generalized estimating equation analysis showed that for per interquartile range(IQR) increment in exposure levels of NO_2,PM_(2.5),and PM_(10),the annual increases in nodule diameter were 0.30 mm,0.51 mm,and 0.32 mm,respectively.The results of the QgC model showed that per IQR increment in exposure levels of the mixed pollutants,the annual increases in nodule diameter were 0.50 mm(95% CI:0.09 mm-0.91 mm).The BKMR model suggested that PM_(2.5) was an important factor influencing nodule progression and a dose-response relationship was observed between them.Conclusions Air pollutants are associated with increased changes in pulmonary nodule diameter,and PM_(2.5) is the most important component of the mixed pollutants affecting nodule diameter.

关 键 词：肺结节 空气污染物 贝叶斯核机器回归 分位数g计算 

分 类 号：R122[医药卫生—环境卫生学]