空气污染物与脑梗死发生情况的病例交叉研究
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摘要
目的采用病例交叉研究设计,分析空气污染物对脑梗死发生情况的影响。方法收集2014-01-01至2016-12-31宁波市3家三级甲等医院(宁波市医疗中心李惠利医院、宁波市第一医院和宁波市第二医院)所有诊断为脑梗死的就诊记录(ICD10编码I63),及宁波市环境监测中心的空气污染物数据、宁波市气象局的气温数据。采用单向回顾性1∶3配对病例交叉研究设计,建立单污染物和多污染物模型条件Logistic回归分析,并对性别进行亚组分析。结果 2014-01-01至2016-12-31宁波市3家三级甲等医院共计诊断脑梗死22 837人次,其中男10 968人次(占48.03%),女7 540人次(占33.02%),男女比例为1.45∶1,性别缺失4 329人次(占18.95%)。单污染物模型结果显示:NO_2、CO浓度是发生脑梗死的影响因素[OR=1.001,95%CI(1.000,1.003),P=0.034;OR=0.794,95%CI(0.723,0.873),P<0.001];性别亚组分析发现,NO_2、O_3浓度是男性发生脑梗死的影响因素[OR=1.003,95%CI(1.001,1.004),P=0.011;OR=0.999,95%CI(0.998,1.000),P=0.033],NO_2、CO浓度是女性发生脑梗死的影响因素[OR=1.002,95%CI(1.000,1.005),P=0.046;OR=0.826,95%CI(0.704,0.968),P=0.018]。多污染物模型结果显示:PM10、NO_2、CO浓度是发生脑梗死的影响因素[OR=1.001,95%CI(1.000,1.002),P=0.019;OR=1.004,95%CI(1.002,1.006),P<0.001;OR=0.564,95%CI(0.490,0.650),P<0.001];性别亚组分析发现,PM10、NO_2、O_3、CO浓度是男性发生脑梗死的影响因素[OR=1.002,95%CI(1.001,1.004),P=0.004;OR=1.004,P<0.001];NO_2、CO浓度是女性发生脑梗死的影响因素[OR=1.006,95%CI(1.003,1.009),P<0.001;OR=0.609,95%CI(0.480,0.773),P<0.001]。结论在一定条件下,空气中的PM10、NO_2浓度是发生脑梗死的危险因素,CO浓度是发生脑梗死的保护因素;部分空气污染物对脑梗死发生情况的影响存在性别差异。
Objective To explore the effects of air pollutants on the incidence of cerebral infarction using a casecrossover design.Methods Data of visits for cerebral infarction (ICD10 I63) were collected from three grade A tertiary hospitals (Ningbo City Medical Treatment Center Lihuili Hospital,Ningbo First Hospital,and Ningbo NO.2 Hospital).Air pollutants data were obtained from Environment Monitoring Center of Ningbo.Data concerning temperature stemmed from Ningbo Meteorological Bureau.All the aforementioned data cover a three-year period from January 1,2014 to December 31,2016.Based on a one-way retrospective 1∶3 case-crossover design,single pollutant and multi-pollutant (conditional Logistic regression)models combined with sex subgroup analysis were used.Results A total of 22 837 visits were enrolled,except the data concerning sex of 4 329 (18.95%) were missed,the other cases[10 968 males (48.03%)and 7 540 (33.02%)females,with a male-to-female ratio of 1.45∶1] were included in the sex subgroup analysis.Single-pollutant analyses showed that NO_2and CO levels appeared to be the associated factors for cerebral infarction[OR=1.001,95%CI (1.000,1.003),P=0.034;OR=0.794,95%CI (0.723,0.873),P<0.001].When sex was considered as a stratification variable,NO_2 and O_3 levels were found to be the associated factors for cerebral infarction in males[OR=1.003,95%CI (1.001,1.004),P=0.011;OR=0.999,95%CI (0.998,1.000),P=0.033],and NO_2 and CO levels were identified to be the associated factors for cerebral infarction in females[OR=1.002,95%CI (1.000,1.005),P=0.046;OR=0.826,95%CI (0.704,0.968),P=0.018].Multi-pollutant analyses revealed that PM10,NO_2 and CO levels were associated factors for cerebral infarction[OR=1.001,95%CI (1.000,1.002),P=0.019;OR=1.004,95%CI (1.002,1.006),P<0.001;OR=0.564,95%CI (0.490,0.650),P<0.001];PM10,NO_2,O_3 and CO levels were associated factors for cerebral infarction in males[OR=1.002,95%CI (1.001,1.004),P=0.004;OR=1.004,95%CI (1.001,1.007),P=0.004;OR=0.999,95%CI (0.998,0.999),P=0.001;OR=0.580,95%CI (0.474,0.708),P<0.001],and NO_2 and CO levels were associated factors for cerebral infarction in females[OR=1.006,95%CI (1.003,1.009),P<0.001;OR=0.609,95%CI (0.480,0.773),P<0.001]when sex was considered as a stratification variable.Conclusion Under certain conditions,PM10 and NO_2 levels might be the risk factors and CO level a protective factor associated with cerebral infarction,there might be gender differences in the effects of some air pollutants on cerebral infarction.
Objective To explore the effects of air pollutants on the incidence of cerebral infarction using a casecrossover design.Methods Data of visits for cerebral infarction (ICD10 I63) were collected from three grade A tertiary hospitals (Ningbo City Medical Treatment Center Lihuili Hospital,Ningbo First Hospital,and Ningbo NO.2 Hospital).Air pollutants data were obtained from Environment Monitoring Center of Ningbo.Data concerning temperature stemmed from Ningbo Meteorological Bureau.All the aforementioned data cover a three-year period from January 1,2014 to December 31,2016.Based on a one-way retrospective 1∶3 case-crossover design,single pollutant and multi-pollutant (conditional Logistic regression)models combined with sex subgroup analysis were used.Results A total of 22 837 visits were enrolled,except the data concerning sex of 4 329 (18.95%) were missed,the other cases[10 968 males (48.03%)and 7 540 (33.02%)females,with a male-to-female ratio of 1.45∶1] were included in the sex subgroup analysis.Single-pollutant analyses showed that NO_2and CO levels appeared to be the associated factors for cerebral infarction[OR=1.001,95%CI (1.000,1.003),P=0.034;OR=0.794,95%CI (0.723,0.873),P<0.001].When sex was considered as a stratification variable,NO_2 and O_3 levels were found to be the associated factors for cerebral infarction in males[OR=1.003,95%CI (1.001,1.004),P=0.011;OR=0.999,95%CI (0.998,1.000),P=0.033],and NO_2 and CO levels were identified to be the associated factors for cerebral infarction in females[OR=1.002,95%CI (1.000,1.005),P=0.046;OR=0.826,95%CI (0.704,0.968),P=0.018].Multi-pollutant analyses revealed that PM10,NO_2 and CO levels were associated factors for cerebral infarction[OR=1.001,95%CI (1.000,1.002),P=0.019;OR=1.004,95%CI (1.002,1.006),P<0.001;OR=0.564,95%CI (0.490,0.650),P<0.001];PM10,NO_2,O_3 and CO levels were associated factors for cerebral infarction in males[OR=1.002,95%CI (1.001,1.004),P=0.004;OR=1.004,95%CI (1.001,1.007),P=0.004;OR=0.999,95%CI (0.998,0.999),P=0.001;OR=0.580,95%CI (0.474,0.708),P<0.001],and NO_2 and CO levels were associated factors for cerebral infarction in females[OR=1.006,95%CI (1.003,1.009),P<0.001;OR=0.609,95%CI (0.480,0.773),P<0.001]when sex was considered as a stratification variable.Conclusion Under certain conditions,PM10 and NO_2 levels might be the risk factors and CO level a protective factor associated with cerebral infarction,there might be gender differences in the effects of some air pollutants on cerebral infarction.
引文
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[14]LI H,XIN X.Nitrogen dioxide NO2 pollution as a potential risk factor for developing vascular dementia and its synaptic mechanisms[J].Chemosphere,2013,92(1):52-58.DOI:10.1016/j.chemosphere.2013.02.061.
[15]MAHESWARAN R,PEARSON T,BEEVERS S D,et al.Outdoor air pollution,subtypes and severity of ischemic strokea small-area level ecological study[J].Int J Health Geogr,2014,13(1):1-9.DOI:10.1186/1476-072X-13-23.
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[2]王陇德,王金环,彭斌,等.《中国脑卒中防治报告2016》概要[J].中国脑血管病杂志,2017,14(4):217-244.DOI:10.3969/j.issn.1672-5921.2017.04.010.WANG L D,WANG J H,PENG B,et al.Summary of Chinese stroke prevention report 2016[J].Chinese Journal of Cerebrovascular Diseases,2017,14(4):217-244.DOI:10.3969/j.issn.1672-5921.2017.04.010.
[3]司圣喜,史典,何世娇,等.脑卒中的疾病负担及生存分析[J].世界最新医学信息文摘,2017,17(21):3-4.SI S X,SHI D,HE S J,et al.Disease burden and survival analysis of stroke[J].World Latest Medicine Information,2017,17(21):3-4.
[4]胡以松.病例交叉研究[J].中华疾病控制杂志,2001,5(4):341-343.DOI:10.3969/j.issn.1674-3679.2001.04.019.HU Y S.Case-crossover study[J].Chinese Journal of Disease,2001,5(4):341-343.DOI:10.3969/j.issn.1674-3679.2001.04.019.
[5]彭晓武,余松林,相红,等.用SAS程序整理病例交叉设计资料[J].中国卫生统计,2012,29(1):135-138.DOI:10.3969/j.issn.1002-3674.2012.01.046.PENG X W,YU S L,XIANG H,et al.Using SAS procedure to organize case cross design data[J].Chinese Journal of Health Statistics,2012,29(1):135-138.DOI:10.3969/j.issn.1002-3674.2012.01.046.
[6]于晓牧.logistic回归多重共线性诊断方法的研究[D].大连:大连医科大学,2010.YU X M.Study on diagnostic methods of multicollinearity in logistic regression[D].Dalian:Dalian Medical University,2010.
[7]刘红玉,房伟.缺血性脑卒中发病机制的研究进展[J].中国现代医生,2010,48(25):11-12.DOI:10.3969/j.issn.1673-9701.2010.25.005.LIU H Y,FANG W.Research progress on the pathogenesis of ischemic stroke[J].China Modern Doctor,2010,48(25):11-12.DOI:10.3969/j.issn.1673-9701.2010.25.005.
[8]刘建平.缺血性脑卒中易感基因与环境因素交互作用的分子流行病学研究[D].武汉:华中科技大学,2008.LIU J P.A molecular epidemiological study of gene polymorphisms and environmental factors associated with ischemic stroke[J].Wuhan:Huazhong University of Science and Technology,2008.
[9]王雪茵,胡永华.脑卒中病因流行病学的家系研究[J].中华流行病学杂志,2013,34(6):647-649.DOI:10.3760/cma.j.issn.0254-6450.2013.06.026.WANG X Y,HU Y H.Family-based studies on the etiological epidemiology of stroke[J].Chinese Journal of Epidemiology,2 0 1 3,3 4(6):6 4 7-6 4 9.D O I:1 0.3 7 6 0/c m a.j.issn.0254-6450.2013.06.026.
[10]张政,詹思延.病例交叉设计[J].中华流行病学杂志,2001,22(4):304-306.DOI:10.3760/j.issn:0254-6450.2001.04.022.ZHANG Z,ZHAN S Y.Case-crossover design[J].Chinese Journal of Epidemiology,2001,22(4):304-306.DOI:10.3760/j.issn:0254-6450.2001.04.022.
[11]孙刚,党玉兰.脑卒中的性别差异[J].国际老年医学杂志,2016,37(4):191-192.DOI:10.3969/j.issn.1674-7593.2016.04.013.SUN G,DANG Y L.Gender differences of stroke[J].International Journal of Geriatrics,2016,37(4):191-192.DOI:10.3969/j.issn.1674-7593.2016.04.013.
[12]周煜,李秀央,陈坤,等.大气颗粒物与居民脑卒中发作或死亡之间关系的Meta分析[J].中华流行病学杂志,2010,31(11):1300-1305.DOI:10.3760/cma.j.issn.0254-6450.2010.11.023.ZHOU Y,LI X Y,CHEN K,et al.Association between air particulate matter and stroke attack or mortality:a metaanalysis[J].Chinese Journal of Epidemiology,2010,31(11):1300-1305.DOI:10.3760/cma.j.issn.0254-6450.2010.11.023.
[13]俞晓波.大气颗粒物短期暴露与脑卒中发作关系的Meta分析[D].杭州:浙江大学,2014.YU X B.Short-term effects of particulate matter on stroke attack:meta-regression and meta-analyses[D].Hangzhou:Zhejiang University,2014.
[14]LI H,XIN X.Nitrogen dioxide NO2 pollution as a potential risk factor for developing vascular dementia and its synaptic mechanisms[J].Chemosphere,2013,92(1):52-58.DOI:10.1016/j.chemosphere.2013.02.061.
[15]MAHESWARAN R,PEARSON T,BEEVERS S D,et al.Outdoor air pollution,subtypes and severity of ischemic strokea small-area level ecological study[J].Int J Health Geogr,2014,13(1):1-9.DOI:10.1186/1476-072X-13-23.
[16]ZHU N,LI H,HAN M,et al.Environmental nitrogen dioxide(NO2)exposure influences development and progression of ischemic stroke[J].Toxicol Lett,2012,214(2):120-130.DOI:10.1016/j.toxlet.2012.08.021.
[17]胥丽霞,杨改清,李彩霞,等.臭氧治疗脑梗死的研究现状[J].中国实用神经疾病杂志,2015,18(1):125-127.DOI:10.3969/j.issn.1673-5110.2015.01.081.XU L X,YANG G Q,LI C X,et al.Current status of ozone therapy for cerebral infarction[J].Chinese Journal of Practical Nervous Diseases,2015,18(1):125-127.DOI:10.3969/j.issn.1673-5110.2015.01.081.
[18]ZEYNALOV E,DORéS.Low doses of carbon monoxide protect against experimental focalbrain ischemia[J].Neurotox Res,2009,15(2):133-137.DOI:10.1007/s12640-009-9014-4.
[19]田婷,石正洪.胆红素抗氧化系统与缺血性脑卒中的关系[J].中国康复理论与实践,2015,21(10):1178-1181.DOI:10.3969/j.issn.1006-9771.2015.10.012.TIAN T,SHI Z H.Relationship between antioxidant system of bilirubin and ischemic stroke(review)[J].Chinese Journal of Rehabilitation Theory and Practice,2015,21(10):1178-1181.DOI:10.3969/j.issn.1006-9771.2015.10.012.
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