张家口市大气颗粒物PM_(2.5)、PM_(10)浓度与慢性阻塞性肺疾病住院人次的关系研究
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摘要
目的:研究张家口市大气颗粒物对慢性阻塞性肺疾病(COPD)的影响,并分析大气颗粒物对不同特征人群的影响。方法:从张家口市医保办公室获取张家口市2013年1月1日-2015年12月31日两家三甲医院COPD患者的住院病历资料,从中国环境监测总站网站获取大气污染物的监测数据,从张家口市气象局获取气象资料。建立广义相加模型(GAM),在控制长期趋势、星期几效应和温湿度影响后,应用条件Logitic回归方法评估PM_(2.5)、PM_(10)对COPD住院人次的影响。根据患者不同特征(性别、年龄、季节)进行分层分析,评估颗粒物污染的高危人群。结果:研究纳入两家三甲医院,共1984例住院COPD患者,其中男性患者1258例(63.4%)、女性患者726例(36.6%),≥75岁患者678例(34.2%),60~75岁患者936例(47.2%)、芨60岁患者370例(18.6%)。2013-2015年PM_(2.5)、PM_(10)年均浓度分别为[(36.54±20.34)μg/m~3、(84.37±52.54)μg/m~3],[(34.50±27.08)μg/m~3、(78.43±69.78)μg/m~3],[(32.04±21.35)μg/m~3、(75.46±50.02)μg/m~3],两者在移动平均滞后3d时,对COPD的影响最大,即PM_(2.5)每增加10μg/m~3,COPD住院人次增加1.90%(95%CI:1.002-1.033,P<0.05),PM_(10)每增加10μg/m~3,COPD住院人次增加2.10%(95%CI:1.005-1.045,P<0.05)。分层分析结果显示:PM_(2.5)、PM_(10)每升高10μg/m~3,女性COPD患者住院人次增加1.09%、1.14%,差异具有统计学意义(P<0.05);≥75岁患者,COPD住院人次增加1.03%、0.99%,差异具有统计学意义(P<0.05);而年龄芨60岁、60~75岁、男性以及季节分层分析中,PM_(2.5)、PM_(10)浓度与COPD住院人次无统计学意义(P>0.05)。结论:颗粒物污染会增加COPD住院率,≥75岁的老年患者及女性患者更敏感。
Objective: To study the effects of airborne particulate matter on chronic obstructive pulmonary disease(COPD) in Zhangjiakou city, and to analyze the effects of airborne particulate matter on population with different characteristics. Methods: The inpatient records of COPD patients in 2 top three hospitals in Zhangjiakou city from January 1, 2013 to December 31, 2015 were obtained from Zhangjiakou medical insurance office; air pollution monitoring data were obtained from the China environmental monitoring station website; meteorological data were obtained from Zhangjiakou Meteorological Bureau. A generalized additive model(GAM) was established, and after controlling long-term trends, week effects, and temperature and humidity effects, the conditional Logitic regression method was used to assess the effect of PM_(2.5) and PM_(10) on the number of inpatients of COPD. Based on different characteristics of the patients(sex, age, season), stratified analyses were performed to assess high-risk population of particulate contamination. Results: A total of 1984 inpatients with COPD from 2 top three hospitals were enrolled in this study, among them, there were 1258 male patients(63.4%), 726 female patients(36.6%), 678 patients over 75(34.2%), 936 patients over 60~75(47.2%), and 370 patients(18.6%) below 60 years old. The yearly average concentration of PM_(2.5) and PM_(10) from 2013 to 2015 years was [(36.54±20.34)μg/m~3,(84.37±52.54)μg/m~3], [(34.50±27.08)μg/m~3,(78.43±69.78)μg/m~3], [(32.04±21.35)μg/m~3,(75.46±50.02)μg/m~3]; the effect of both on COPD was the greatest when they moved average lags 3 d, that was to say, with an increase of per 10 μg/m~3 of PM_(2.5), the number of inpatients with COPD was increased by 1.90%(95%CI:1.002-1.033, P<0.05), with an increase of per 10 μg/m~3 of PM_(10), the number of inpatients with COPD was increased by 2.10%(95%CI:1.005-1.045, P<0.05). The results of stratified analysis showed that PM_(2.5) and PM_(10) was increased by per 10 μg/m~3, and the number of female inpatients with COPD was increased by 1.09% and 1.14%, the difference was statistically significant(P<0.05). For more than 75 years old patients, the number of inpatients with COPD was increased by 1.03%and 0.99%, the difference was statistically significant(P<0.05). But for the patients below 60, 60~75 years old, men and the seasonal stratification analysis, there were not statistical significance in PM_(2.5) and PM_(10) concentrations and the number of inpatients with COPD(P>0.05). Conclusion: Particulate matter contamination can increases hospitalizations of COPD,and the patients over 75 and female patients are more sensitive to it.
Objective: To study the effects of airborne particulate matter on chronic obstructive pulmonary disease(COPD) in Zhangjiakou city, and to analyze the effects of airborne particulate matter on population with different characteristics. Methods: The inpatient records of COPD patients in 2 top three hospitals in Zhangjiakou city from January 1, 2013 to December 31, 2015 were obtained from Zhangjiakou medical insurance office; air pollution monitoring data were obtained from the China environmental monitoring station website; meteorological data were obtained from Zhangjiakou Meteorological Bureau. A generalized additive model(GAM) was established, and after controlling long-term trends, week effects, and temperature and humidity effects, the conditional Logitic regression method was used to assess the effect of PM_(2.5) and PM_(10) on the number of inpatients of COPD. Based on different characteristics of the patients(sex, age, season), stratified analyses were performed to assess high-risk population of particulate contamination. Results: A total of 1984 inpatients with COPD from 2 top three hospitals were enrolled in this study, among them, there were 1258 male patients(63.4%), 726 female patients(36.6%), 678 patients over 75(34.2%), 936 patients over 60~75(47.2%), and 370 patients(18.6%) below 60 years old. The yearly average concentration of PM_(2.5) and PM_(10) from 2013 to 2015 years was [(36.54±20.34)μg/m~3,(84.37±52.54)μg/m~3], [(34.50±27.08)μg/m~3,(78.43±69.78)μg/m~3], [(32.04±21.35)μg/m~3,(75.46±50.02)μg/m~3]; the effect of both on COPD was the greatest when they moved average lags 3 d, that was to say, with an increase of per 10 μg/m~3 of PM_(2.5), the number of inpatients with COPD was increased by 1.90%(95%CI:1.002-1.033, P<0.05), with an increase of per 10 μg/m~3 of PM_(10), the number of inpatients with COPD was increased by 2.10%(95%CI:1.005-1.045, P<0.05). The results of stratified analysis showed that PM_(2.5) and PM_(10) was increased by per 10 μg/m~3, and the number of female inpatients with COPD was increased by 1.09% and 1.14%, the difference was statistically significant(P<0.05). For more than 75 years old patients, the number of inpatients with COPD was increased by 1.03%and 0.99%, the difference was statistically significant(P<0.05). But for the patients below 60, 60~75 years old, men and the seasonal stratification analysis, there were not statistical significance in PM_(2.5) and PM_(10) concentrations and the number of inpatients with COPD(P>0.05). Conclusion: Particulate matter contamination can increases hospitalizations of COPD,and the patients over 75 and female patients are more sensitive to it.
引文
[1]Fernandes L,Mesquita AM.The success and safety profile of sputum induction in patients with chronic obstructive pulmonary disease:An Indian experience[J].Indian J Tuberc,2017,64(3):201-205
[2]Zhou M,Wang H,Zhu J,et al.Cause-specific mortality for 240causes in China during 1990-2013:a systematic subnational analysis for the global burden of disease study 2013[J].Lancet,2016,387(10015):251-272
[3]MonsóE.Microbiome in chronic obstructive pulmonary disease[J].Ann Transl Med,2017,5(12):251
[4]Hogg JC,ParéPD,Hackett TL.The Contribution of Small Airway Obstruction to the Pathogenesis of Chronic Obstructive Pulmonary Disease[J].Physiol Rev,2017,97(2):529-552
[5]Engel M,Endesfelder D,Schloter-Hai B,et al.Influence of lung CT changes in chronic obstructive pulmonary disease(COPD)on the human lung microbiome[J].PLo S One,2017,12(7):e0180859
[6]Antus B,Drozdovszky O,Barta I.Assessment of exhaled carbon monoxide in exacerbations of chronic obstructive pulmonary disease[J].Physiol Int,2016,103(2):211-219
[7]Jouneau S,Dres M,Guerder A,et al.Management of acute exacerbations of chronic obstructive pulmonary disease?(COPD).Guidelines from the Sociétéde pneumologie de langue fran aise(summary)[J].Rev Mal Respir,2017,34(4):282-322
[8]Torres-Sánchez I,Cruz-Ramírez R,Cabrera-Martos I,et al.Results of Physiotherapy Treatments in Exacerbations of Chronic Obstructive Pulmonary Disease:A Systematic Review[J].Physiother Can,2017,69(2):122-132
[9]Dong YH,Alcusky M,Maio V,et al.Evidence of potential bias in a comparison ofβblockers and calcium channel blockers in patients with chronic obstructive pulmonary disease and acute coronary syndrome:results of a multinational study[J].BMJ Open,2017,7(3):e012997
[10]Xie W,Li G,Zhao D,et al.Relationship between fine particulate air pollution and ischaemic heart disease morbidity and mortality[J].Heart,2015,101(4):257-263
[11]Kim HJ,Choi MG,Park MK,et al.Predictive and Prognostic Biomarkers of Respiratory Diseases due to Particulate Matter Exposure[J].J Cancer Prev,2017,22(1):6-15
[12]Li G,Huang J,Xu G,et al.The short term burden of ambient fine?particulate matter on chronic obstructive pulmonary disease?in Ningbo,China[J].Environ Health,2017,16(1):54
[13]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264Chronic Obstructive Pulmonary Disease Committee,Respiratory Society,Chinese Medical Association.Guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease(revised edition 2013)[J].Chinese Journal of Tuberculosis and Respiratory Diseases,2013,36(4):255-264
[14]冀翠华,王式功,尹岭,等.广义相加模型在创伤急诊人次与气象要素时间序列相关分析中的应用[J].兰州大学学报(自然科学版),2015,51(5):671-675Ji Cui-hua,Wang Shi-gong,Yin Ling,et al.Application of generalized additive models in the analysis of the relationship between daily trauma emergency department visit number and meteorological factors:a time-series analysis[J].Journal of Lanzhou University(Natural Sciences),2015,51(5):671-675
[15]Fiordelisi A,Piscitelli P,Trimarco B,et al.The mechanisms of air pollution and particulate matter in cardiovascular diseases[J].Heart Fail Rev,2017,22(3):337-347
[16]Marchini T,Wolf D,Michel NA,et al.Acute exposure to?air pollution particulate matter aggravates experimental myocardial infarction in mice by potentiating cytokine secretion from lung macrophages[J].Basic Res Cardiol,2016,111(4):44
[17]Happo MS,Salonen RO,Halinen AI,et al.Dose and time dependency of in ammatory responses in themouse lung to urban air coarse,fine,and ultra fine particles from six European cities[J].Inhal Toxicol,2007,19(3):227-246
[18]Lv J,Chen W,Sun D,et al.Gender-specific association between tobacco smoking and central obesity among 0.5 million Chinese people:the China kadoorie biobank study[J].PLo S One,2015,10(4):e0124586
[19]Pope CA,Bhatnagar A,Mc Cracken JP,et al.Exposure to Fine Particulate Air Pollution Is Associated With Endothelial Injury and Systemic Inflammation[J].Circ Res,2016,119(11):1204-1214
[20]Cevallos VM,Díaz V,Sirois CM.Particulate matter air pollution from the city of Quito,Ecuador,activates inflammatory signaling pathways in vitro[J].Innate Immun,2017,23(4):392-400
[21]Calderón-Garcidue?as L,de la Monte SM.Apolipoprotein E4,Gender,Body Mass Index,Inflammation,Insulin Resistance,and Air Pollution Interactions:Recipe for Alzheimer's Disease Development in Mexico City Young Females[J].J Alzheimers Dis,2017,58(3):613-630
[22]Ramanathan M Jr,London NR Jr,Tharakan A,et al.Airborne Particulate Matter Induces Nonallergic Eosinophilic Sinonasal Inflammation in Mice[J].Am J Respir Cell Mol Biol,2017,57(1):59-65
[23]Malig BJ,Green S,Basu R,et al.Coarse particles and respiratory emergency department visits in California[J].Am J Epidemiol,2013,178(1):58-69
[24]翟文慧,黄志刚,路晶凯,等.北京市大气细颗粒污染物与老年呼吸系统疾病急诊就医关系的病例交叉研究[J].现代生物医学进展,2015,15(8):1461-1464Zhai Wen-hui,Huang Zhi-gang,Lu Jing-kai,et al.Association between Particulate Matters in the Ambient air Pollution and Hospital Emergency Treatment for Elderly Respiratory Diseases in Beijing:A Case Crossover Study[J].Progress in Modern Biomedicine,2015,15(8):1461-1464
[25]Pinault L,van Donkelaar A,Martin RV.Exposure to fine particulate matter air pollution in Canada[J].Health Rep,2017,28(3):9-16
[26]Zhang Q,Luo Q,Yuan X,et al.Atmospheric particulate matter 2.5promotes the migration and invasion of hepatocellular carcinoma cells[J].Oncol Lett,2017,13(5):3445-3450
[27]Bell ML,Son JY,Peng RD,et al.Ambient PM2.5and risk of hospital admissions:do risks differ for men and women[J].Epidemiology,2015,26(4):575-579
[28]陈建鸿,詹开宇,张冬梅,等.老年COPD疾病进展与机体调节性T细胞的关系分析[J].现代生物医学进展,2016,16(28):5543-5545,5471Chen Jian-hong,Zhan Kai-yu,Zhang Dong-mei,et al.The Relationship between Disease Progression and Regulatory T cells in Elderly patients with COPD[J].Progress in Modern Biomedicine,2016,16(28):5543-5545,5471
[29]Mesquita SR,van Drooge BL,Dall'Osto M,et al.Toxic potential of organic constituents of submicron particulate matter(PM1)in an urban road site(Barcelona)[J].Environ Sci Pollut Res Int,2017,24(18):15406-15415
[30]Tomczak A,Miller AB,Weichenthal SA,et al.Long-term exposure to fine particulate matter air pollution and the risk of lung cancer among participants of the Canadian National Breast Screening Study[J].Int J Cancer,2016,139(9):1958-1966
[2]Zhou M,Wang H,Zhu J,et al.Cause-specific mortality for 240causes in China during 1990-2013:a systematic subnational analysis for the global burden of disease study 2013[J].Lancet,2016,387(10015):251-272
[3]MonsóE.Microbiome in chronic obstructive pulmonary disease[J].Ann Transl Med,2017,5(12):251
[4]Hogg JC,ParéPD,Hackett TL.The Contribution of Small Airway Obstruction to the Pathogenesis of Chronic Obstructive Pulmonary Disease[J].Physiol Rev,2017,97(2):529-552
[5]Engel M,Endesfelder D,Schloter-Hai B,et al.Influence of lung CT changes in chronic obstructive pulmonary disease(COPD)on the human lung microbiome[J].PLo S One,2017,12(7):e0180859
[6]Antus B,Drozdovszky O,Barta I.Assessment of exhaled carbon monoxide in exacerbations of chronic obstructive pulmonary disease[J].Physiol Int,2016,103(2):211-219
[7]Jouneau S,Dres M,Guerder A,et al.Management of acute exacerbations of chronic obstructive pulmonary disease?(COPD).Guidelines from the Sociétéde pneumologie de langue fran aise(summary)[J].Rev Mal Respir,2017,34(4):282-322
[8]Torres-Sánchez I,Cruz-Ramírez R,Cabrera-Martos I,et al.Results of Physiotherapy Treatments in Exacerbations of Chronic Obstructive Pulmonary Disease:A Systematic Review[J].Physiother Can,2017,69(2):122-132
[9]Dong YH,Alcusky M,Maio V,et al.Evidence of potential bias in a comparison ofβblockers and calcium channel blockers in patients with chronic obstructive pulmonary disease and acute coronary syndrome:results of a multinational study[J].BMJ Open,2017,7(3):e012997
[10]Xie W,Li G,Zhao D,et al.Relationship between fine particulate air pollution and ischaemic heart disease morbidity and mortality[J].Heart,2015,101(4):257-263
[11]Kim HJ,Choi MG,Park MK,et al.Predictive and Prognostic Biomarkers of Respiratory Diseases due to Particulate Matter Exposure[J].J Cancer Prev,2017,22(1):6-15
[12]Li G,Huang J,Xu G,et al.The short term burden of ambient fine?particulate matter on chronic obstructive pulmonary disease?in Ningbo,China[J].Environ Health,2017,16(1):54
[13]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264Chronic Obstructive Pulmonary Disease Committee,Respiratory Society,Chinese Medical Association.Guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease(revised edition 2013)[J].Chinese Journal of Tuberculosis and Respiratory Diseases,2013,36(4):255-264
[14]冀翠华,王式功,尹岭,等.广义相加模型在创伤急诊人次与气象要素时间序列相关分析中的应用[J].兰州大学学报(自然科学版),2015,51(5):671-675Ji Cui-hua,Wang Shi-gong,Yin Ling,et al.Application of generalized additive models in the analysis of the relationship between daily trauma emergency department visit number and meteorological factors:a time-series analysis[J].Journal of Lanzhou University(Natural Sciences),2015,51(5):671-675
[15]Fiordelisi A,Piscitelli P,Trimarco B,et al.The mechanisms of air pollution and particulate matter in cardiovascular diseases[J].Heart Fail Rev,2017,22(3):337-347
[16]Marchini T,Wolf D,Michel NA,et al.Acute exposure to?air pollution particulate matter aggravates experimental myocardial infarction in mice by potentiating cytokine secretion from lung macrophages[J].Basic Res Cardiol,2016,111(4):44
[17]Happo MS,Salonen RO,Halinen AI,et al.Dose and time dependency of in ammatory responses in themouse lung to urban air coarse,fine,and ultra fine particles from six European cities[J].Inhal Toxicol,2007,19(3):227-246
[18]Lv J,Chen W,Sun D,et al.Gender-specific association between tobacco smoking and central obesity among 0.5 million Chinese people:the China kadoorie biobank study[J].PLo S One,2015,10(4):e0124586
[19]Pope CA,Bhatnagar A,Mc Cracken JP,et al.Exposure to Fine Particulate Air Pollution Is Associated With Endothelial Injury and Systemic Inflammation[J].Circ Res,2016,119(11):1204-1214
[20]Cevallos VM,Díaz V,Sirois CM.Particulate matter air pollution from the city of Quito,Ecuador,activates inflammatory signaling pathways in vitro[J].Innate Immun,2017,23(4):392-400
[21]Calderón-Garcidue?as L,de la Monte SM.Apolipoprotein E4,Gender,Body Mass Index,Inflammation,Insulin Resistance,and Air Pollution Interactions:Recipe for Alzheimer's Disease Development in Mexico City Young Females[J].J Alzheimers Dis,2017,58(3):613-630
[22]Ramanathan M Jr,London NR Jr,Tharakan A,et al.Airborne Particulate Matter Induces Nonallergic Eosinophilic Sinonasal Inflammation in Mice[J].Am J Respir Cell Mol Biol,2017,57(1):59-65
[23]Malig BJ,Green S,Basu R,et al.Coarse particles and respiratory emergency department visits in California[J].Am J Epidemiol,2013,178(1):58-69
[24]翟文慧,黄志刚,路晶凯,等.北京市大气细颗粒污染物与老年呼吸系统疾病急诊就医关系的病例交叉研究[J].现代生物医学进展,2015,15(8):1461-1464Zhai Wen-hui,Huang Zhi-gang,Lu Jing-kai,et al.Association between Particulate Matters in the Ambient air Pollution and Hospital Emergency Treatment for Elderly Respiratory Diseases in Beijing:A Case Crossover Study[J].Progress in Modern Biomedicine,2015,15(8):1461-1464
[25]Pinault L,van Donkelaar A,Martin RV.Exposure to fine particulate matter air pollution in Canada[J].Health Rep,2017,28(3):9-16
[26]Zhang Q,Luo Q,Yuan X,et al.Atmospheric particulate matter 2.5promotes the migration and invasion of hepatocellular carcinoma cells[J].Oncol Lett,2017,13(5):3445-3450
[27]Bell ML,Son JY,Peng RD,et al.Ambient PM2.5and risk of hospital admissions:do risks differ for men and women[J].Epidemiology,2015,26(4):575-579
[28]陈建鸿,詹开宇,张冬梅,等.老年COPD疾病进展与机体调节性T细胞的关系分析[J].现代生物医学进展,2016,16(28):5543-5545,5471Chen Jian-hong,Zhan Kai-yu,Zhang Dong-mei,et al.The Relationship between Disease Progression and Regulatory T cells in Elderly patients with COPD[J].Progress in Modern Biomedicine,2016,16(28):5543-5545,5471
[29]Mesquita SR,van Drooge BL,Dall'Osto M,et al.Toxic potential of organic constituents of submicron particulate matter(PM1)in an urban road site(Barcelona)[J].Environ Sci Pollut Res Int,2017,24(18):15406-15415
[30]Tomczak A,Miller AB,Weichenthal SA,et al.Long-term exposure to fine particulate matter air pollution and the risk of lung cancer among participants of the Canadian National Breast Screening Study[J].Int J Cancer,2016,139(9):1958-1966