中山市居室内被动吸烟对儿童哮喘及哮喘样症状的影响
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摘要
目的探讨中山市居室内被动吸烟对儿童哮喘及哮喘样症状的影响。方法于2016年3—7月在中山市城区采用随机整群抽样方法抽取小学和初中各5所,共有效调查11 611名儿童,采用国际统一的标准问卷[美国胸科协会制定的标准呼吸卫生调查表(ATS)]调查所选学生的哮喘及哮喘样症状及家庭室内被动吸烟等情况,分析被动吸烟对儿童哮喘和哮喘样症状的影响。结果中山市儿童的持续咳嗽、持续咯痰、喘鸣、哮喘和哮喘现患的检出率分别为2.85%(331/11 611),1.20%(139/11 611),6.93%(805/11 611),5.70%(662/11 611)和1.46%(169/11 611),有30.9%(3 588/11 611)的儿童暴露于二手烟。室内被动吸烟、母亲吸烟、母亲妊娠期被动吸烟和两岁前被动吸烟均对儿童哮喘和哮喘样症状有不同程度的影响(P<0.05);家庭成员每日吸烟量≥5支的儿童哮喘现患率(OR=3.66,95%CI:1.68~8.01)和喘鸣发生率(OR=1.76,95%CI:1.04~2.97)均高于非吸烟组,差异均有统计学意义(P<0.05)。多因素非条件logistic回归分析显示,两岁前被动吸烟是儿童哮喘及哮喘样症状的危险因素(OR值为1.51~2.03),室内被动吸烟是儿童持续咯痰的危险因素(OR=1.61,95%CI:1.11~2.35),均有统计学意义(P<0.05)。结论中山市室内被动吸烟是儿童哮喘及哮喘样症状的危险因素,尤其是两岁前被动吸烟。
Objective To explore the effects of indoor passive smoking on asthma and asthma-related symptoms in children in Zhongshan. Methods From March to July in 2016, a total of 11 611 children from five primary schools and junior high schools in downtown of Zhongshan were chosen with a random cluster sampling method. The ATS questionnaire of the international standard questionnaire was used to investigate the asthma and asthma-like symptoms of the selected students and family indoor passive smoking and so on, to analyze the impact of second hand smoke exposure on children with asthma and asthma-like symptoms. Results The prevalence rates of persistent cough, persistent expectoration, wheezing, asthma and asthmatoid systems in children were 2.85%, 1.20%, 6.93%, 5.70% and 1.46%, respectively. 30.9% of children were exposed to secondhand smoke.Univariate analysis showed that the indoor passive smoking, mother smoking, passive smoking during pregnancy and children≤2-year old exposed to passive smoking were all the risk factors of asthma and asthma-like symptoms in children(P<0.05).The indoor smoking amount was correlated with the wheezing and asthma in children. With the increase of smoking, the risk of illness increased(OR=1.76-3.66, P<0.05). Multivariate logistic regression analysis showed that children ≤2-year old exposed to passive smoking was a risk factor for persistent expectoration in children(OR=1.61, 95%CI: 1.11-2.35). Both children with asthma and asthma-like symptoms were significantly more likely to have passive smoking(OR=1.51-2.03). Conclusion Indoor passive smoking is a risk factor for children suffering from asthma and asthma-like symptoms and passive smoking is more dangerous for children≤2-year old.
Objective To explore the effects of indoor passive smoking on asthma and asthma-related symptoms in children in Zhongshan. Methods From March to July in 2016, a total of 11 611 children from five primary schools and junior high schools in downtown of Zhongshan were chosen with a random cluster sampling method. The ATS questionnaire of the international standard questionnaire was used to investigate the asthma and asthma-like symptoms of the selected students and family indoor passive smoking and so on, to analyze the impact of second hand smoke exposure on children with asthma and asthma-like symptoms. Results The prevalence rates of persistent cough, persistent expectoration, wheezing, asthma and asthmatoid systems in children were 2.85%, 1.20%, 6.93%, 5.70% and 1.46%, respectively. 30.9% of children were exposed to secondhand smoke.Univariate analysis showed that the indoor passive smoking, mother smoking, passive smoking during pregnancy and children≤2-year old exposed to passive smoking were all the risk factors of asthma and asthma-like symptoms in children(P<0.05).The indoor smoking amount was correlated with the wheezing and asthma in children. With the increase of smoking, the risk of illness increased(OR=1.76-3.66, P<0.05). Multivariate logistic regression analysis showed that children ≤2-year old exposed to passive smoking was a risk factor for persistent expectoration in children(OR=1.61, 95%CI: 1.11-2.35). Both children with asthma and asthma-like symptoms were significantly more likely to have passive smoking(OR=1.51-2.03). Conclusion Indoor passive smoking is a risk factor for children suffering from asthma and asthma-like symptoms and passive smoking is more dangerous for children≤2-year old.
引文
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[14]卫生部履行《烟草控制框架公约》领导小组办公室.2007年中国控制吸烟报告[J].中国健康教育,2008,24(12):935-939.
[15]杨金月,傅茂笋,田欢,等.山东省鄄城县学生家长吸烟与被动吸烟现况及认知态度分析[J].中国卫生事业管理,2016,33(6):460-463.
[16]孙秉玺,黄佩娣,赵梦珠,等.广州、佛山两地学龄期儿童家庭二手烟暴露及自我保护行为调查研究[J].中国儿童保健杂志,2016,24(6):649-652.
[17]周秀芳,毛芬.婴幼儿过敏性哮喘危险因素logistic回归分析[J].中国煤炭工业医学杂志,2015,18(9):1484-1488.
[18]王雪梅,王玲.2005—2014年中国儿童哮喘与过敏体质、家族史、被动吸烟病例对照研究的meta分析[J].中国妇幼保健,2017,32(6):1351-1354.
[19]Awasthi S,Gupta S,Maurya N,et al.Environmental risk factors for persistent asthma in lucknow[J].Indian J Pediat,2012,79:1311-1317.
[20]钮春瑾.婴幼儿呼吸系统健康的家庭室内环境影响因素研究[D].上海:复旦大学,2012.
[21]Goren AI,Hellmann S.Respiratory conditions among schoolchildren and their relationship to environmental tobacco smoke and other combustion products[J].Arch Environ Health,1995,50:112.
[22]Burney PG,Chinn S,Rona RJ.Has the prevalence of asthma increased in children?Evidence from the national study of health and growth1973-86[J].BMJ,1990,300:1306.
[23]杨宏,曹廷容,杨军.环境性吸烟与儿童呼吸健康[J].中国医药导报,2013,10(22):27-29.
[2]冯庆春,元熙哲.儿童哮喘的调查分析及应对[J].吉林医学,2017,38(1):165-168.
[3]郑燕冰.东莞市0~14岁小儿哮喘的横断面研究及因素分析[J].中国妇幼卫生杂志,2017,8(2):26-28.
[4]Bai J,Jing Z,Shen KL,et al.Current trends of the prevalence of childhood asthma in three Chinese cities:a multicenter epidemiological survey[J].Biomed Environ Sci,2010,23:453-457.
[5]王晗.住宅室内环境对儿童哮喘的健康风险评估[D].重庆:重庆大学,2016.
[6]招轩娜,吴斌.支气管哮喘发病危险因素的研究进展[J].广东医学院学报,2014,32(5):703-705.
[7]李万伟,任彩玲,李晓红,等.儿童哮喘危险因素的病例对照研究[J].环境与健康杂志,2014,31(2):137-139.
[8]王滨.研究室内空气污染对儿童呼吸系统的影响[J].世界最新医学信息文摘,2017,17(49):157.
[9]吴辰辰,刘艺哲,陈丽茹,等.家养宠物和肥胖对儿童哮喘及哮喘样症状的交互效应[J].中国卫生统计,2015,32(2):295-297.
[10]Dong GH,Ren WH,Wang D,et al.Exposure to secondhand tobacco smoke enhances respiratory symptoms and responses to animals in8 819 children in kindergarten:results from 25 districts in northeast China[J].Respiration,2011,81:179-185.
[11]Kanchongkittiphon W,Mendell MJ,Gaffin JM,et al.Indoor environmental exposures and exacerbation of asthma:an update to the 2000review by the institute of medicine[J].Environ Health Perspect,2015,123:6.
[12]张林媛,张亚玮,孙耀峰,等.北京市郊区儿童哮喘病影响因素病例对照研究[J].中国公共卫生,2010,26(10):1226-1228.
[13]董蔚,周莹,苏雯,等.上海城郊儿童婴幼儿期多因素暴露与日后哮喘发病相关性研究[J].临床儿科杂志,2012,30(12):1139-1143.
[14]卫生部履行《烟草控制框架公约》领导小组办公室.2007年中国控制吸烟报告[J].中国健康教育,2008,24(12):935-939.
[15]杨金月,傅茂笋,田欢,等.山东省鄄城县学生家长吸烟与被动吸烟现况及认知态度分析[J].中国卫生事业管理,2016,33(6):460-463.
[16]孙秉玺,黄佩娣,赵梦珠,等.广州、佛山两地学龄期儿童家庭二手烟暴露及自我保护行为调查研究[J].中国儿童保健杂志,2016,24(6):649-652.
[17]周秀芳,毛芬.婴幼儿过敏性哮喘危险因素logistic回归分析[J].中国煤炭工业医学杂志,2015,18(9):1484-1488.
[18]王雪梅,王玲.2005—2014年中国儿童哮喘与过敏体质、家族史、被动吸烟病例对照研究的meta分析[J].中国妇幼保健,2017,32(6):1351-1354.
[19]Awasthi S,Gupta S,Maurya N,et al.Environmental risk factors for persistent asthma in lucknow[J].Indian J Pediat,2012,79:1311-1317.
[20]钮春瑾.婴幼儿呼吸系统健康的家庭室内环境影响因素研究[D].上海:复旦大学,2012.
[21]Goren AI,Hellmann S.Respiratory conditions among schoolchildren and their relationship to environmental tobacco smoke and other combustion products[J].Arch Environ Health,1995,50:112.
[22]Burney PG,Chinn S,Rona RJ.Has the prevalence of asthma increased in children?Evidence from the national study of health and growth1973-86[J].BMJ,1990,300:1306.
[23]杨宏,曹廷容,杨军.环境性吸烟与儿童呼吸健康[J].中国医药导报,2013,10(22):27-29.