上海市浦东新区不同空气污染区小学生肺功能变化分析
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摘要
目的探索上海市浦东新区不同空气污染区小学生肺功能变化情况。方法在上海市浦东新区内城区和郊区共选择4所小学,每所学校4年级随机抽取1个班共145名小学生为研究对象,分别在2017年9月、12月和2018年3月、6月检测小学生肺功能4次,同时收集城区和郊区学校附近环境空气质量监测站细颗粒物(PM_(2.5))、可吸入颗粒物(PM_(10))、二氧化硫(SO_2)、二氧化氮(NO_2)、臭氧(O_3)和一氧化碳(CO)的1 h平均浓度;采用t检验、方差分析以及卡方检验比较组间差异,用重复测量方差分析比较城区和郊区小学生肺功能变化趋势。结果环境监测数据显示,2017年9月,城区SO_2、O_3和CO污染物浓度显著低于郊区(P<0.01),而NO_2浓度显著高于郊区(P<0.01);2017年12月,城区PM_(10)、SO_2、NO_2、O_3污染物浓度显著高于郊区(P<0.01),CO污染物浓度显著低于郊区(P<0.01);2018年3月,城区PM_(10)、SO_2、NO_2、CO污染物浓度显著高于郊区(P<0.01);2018年6月,城区PM_(2.5)、PM_(10)、SO_2、NO_2、CO污染物浓度显著高于郊区(P<0.01)。145名小学生中,共132名(91.0%)完成了全4次肺功能检测,城区和郊区学生在身高、体重和性别上差异无统计学意义(P>0.05),郊区学生第4次用力肺活量(FVC)和第1次第1 s用力呼气量(FEV1)、呼气流量峰值(PEF)高于城区学生(P<0.01);城区和郊区学生肺功能差异具有统计学意义,城区小学生肺功能FVC指标低于郊区小学生(P<0.05),FEV1和FEV1/FVC呈现随时间变化的趋势(均P<0.01),且呈线性降低(均P<0.01),PEF存在时间和地区的交互作用(P<0.01)。边际轮廓图显示,郊区学生FVC指标呈上升趋势,但差异无统计学意义,FEV1和FEV1/FVC指标呈下降趋势,且郊区学生后3次检测结果显著低于第1次(P<0.05),PEF指标受地域和时间的交互影响,且城区第1次结果显著低于后3次(均P<0.01)。结论 2017和2018年上海市浦东新区城区空气质量比郊区差,城区小学生肺功能FVC比郊区小学生差,并且由于冬季大气污染较重,肺功能指标部分出现下降趋势。
[Objective] To explore the changes in lung function of primary school students in different air pollution areas in Pudong New Area of Shanghai.[Methods]Four primary schools were selected in the urban and suburban areas of Pudong New Area in Shanghai.One class from fourth grade was randomly selected from each school,and total 145 pupils were selected as research objects.Their lung functions were examined once in September,December in 2017 and March,June in 2018,respectively.Meanwhile,the data of 1-hour average concentration of particulate matter(PM_(2.5)),inhalable particulate matter(PM_(10)),sulfur dioxide(SO_2),nitrogen dioxide(NO_2),ozone(O_3)and carbon monoxide(CO)at environment monitoring stations near urban and suburban schools were collected respectively.T-test,variance analysis and chi-square test were used to compare the differences between groups,and repeated measurement variance analysis was used to compare the trend of pupils'pulmonary function in urban and suburban areas.[Results]Environmental monitoring data showed that,in September of 2017,the concentrations of SO_2,O_3and CO in urban areas were significantly lower than those in the suburbs(P<0.01),while the concentration of NO_2was significantly higher than that in the suburbs(P<0.01).In December of 2017,the concentrations of PM_(10),SO_2,NO_2 and O_3 in urban areas were significantly higher than those in the suburbs(P<0.01),while the concentration of CO was significantly lower than that in the su burbs(P<0.01).In March of 2018,the concentrations of PM_(10),SO_2,NO_2and CO i n urban areas were significantly higher than those in the suburbs(P<0.01).In June of 20 18,the concentrations of PM_(2.5),PM_(10),SO_2,NO_2and CO in urban areas were significantly higher than those in the suburbs(P<0.01).Among 145 pupils,132(91.0%)completed all four lung function tests,and there were no statistically significant differences in height,weight and gender between urban and suburban students(P>0.05).The forced vital capacity(FVC)at the forth test,the first forced expiratory volume(FEV_1)and peak expiratory flow(PEF)at the first test among suburban students were higher than those among urban students(P<0.01).The difference in lung function was statistically significant between urban and suburban students.The FVC of lung function in urban students was lower than that in suburban students(P<0.05).FEV1 and FEV_1/FVC changed with time(both P<0.01),showing a linear downward trend(both P<0.01),and PEF presented time and region interaction(P<0.01).The marginal mean plots showed an upward trend in FVC of suburban students,but the difference was not statistically significant.The decreased trend was observed in FEV_1and FEV1/FVC,and the results of the last three examinations were significantly lower than the results of the first exa mination in suburban students(P<0.01or P<0.05).PEF was interacted by region and time,and the results of the first examination were significantly lower than the results of the last three examinations in urban students(all P<0.01).[Conclusion]In 2017 and 2018,the air quality of urban area is worse than that of the suburbs in Pudong New Area of Shanghai.FVC of the primary school students in the urban is worse than that in suburbs.Moreover,some lung function indicators show a downward trend due to the heavy air pollution in winter.
[Objective] To explore the changes in lung function of primary school students in different air pollution areas in Pudong New Area of Shanghai.[Methods]Four primary schools were selected in the urban and suburban areas of Pudong New Area in Shanghai.One class from fourth grade was randomly selected from each school,and total 145 pupils were selected as research objects.Their lung functions were examined once in September,December in 2017 and March,June in 2018,respectively.Meanwhile,the data of 1-hour average concentration of particulate matter(PM_(2.5)),inhalable particulate matter(PM_(10)),sulfur dioxide(SO_2),nitrogen dioxide(NO_2),ozone(O_3)and carbon monoxide(CO)at environment monitoring stations near urban and suburban schools were collected respectively.T-test,variance analysis and chi-square test were used to compare the differences between groups,and repeated measurement variance analysis was used to compare the trend of pupils'pulmonary function in urban and suburban areas.[Results]Environmental monitoring data showed that,in September of 2017,the concentrations of SO_2,O_3and CO in urban areas were significantly lower than those in the suburbs(P<0.01),while the concentration of NO_2was significantly higher than that in the suburbs(P<0.01).In December of 2017,the concentrations of PM_(10),SO_2,NO_2 and O_3 in urban areas were significantly higher than those in the suburbs(P<0.01),while the concentration of CO was significantly lower than that in the su burbs(P<0.01).In March of 2018,the concentrations of PM_(10),SO_2,NO_2and CO i n urban areas were significantly higher than those in the suburbs(P<0.01).In June of 20 18,the concentrations of PM_(2.5),PM_(10),SO_2,NO_2and CO in urban areas were significantly higher than those in the suburbs(P<0.01).Among 145 pupils,132(91.0%)completed all four lung function tests,and there were no statistically significant differences in height,weight and gender between urban and suburban students(P>0.05).The forced vital capacity(FVC)at the forth test,the first forced expiratory volume(FEV_1)and peak expiratory flow(PEF)at the first test among suburban students were higher than those among urban students(P<0.01).The difference in lung function was statistically significant between urban and suburban students.The FVC of lung function in urban students was lower than that in suburban students(P<0.05).FEV1 and FEV_1/FVC changed with time(both P<0.01),showing a linear downward trend(both P<0.01),and PEF presented time and region interaction(P<0.01).The marginal mean plots showed an upward trend in FVC of suburban students,but the difference was not statistically significant.The decreased trend was observed in FEV_1and FEV1/FVC,and the results of the last three examinations were significantly lower than the results of the first exa mination in suburban students(P<0.01or P<0.05).PEF was interacted by region and time,and the results of the first examination were significantly lower than the results of the last three examinations in urban students(all P<0.01).[Conclusion]In 2017 and 2018,the air quality of urban area is worse than that of the suburbs in Pudong New Area of Shanghai.FVC of the primary school students in the urban is worse than that in suburbs.Moreover,some lung function indicators show a downward trend due to the heavy air pollution in winter.
引文
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[14]伍燕珍,张金良,赵秀阁,等.我国大气污染与儿童呼吸系统疾病和症状的关系[J].环境与健康杂志,2009,26(6):471-477.
[15]张莉君,郭常义,许慧慧,等.上海市冬季雾霾期两校小学生肺功能变化分析[J].环境与职业医学,2015,32(5):409-414.
[16]郑劲平.肺功能测定临床应用[J].继续医学教育,2006,20(2):67-71.
[2]曲亮,李孟良,高佳佳,等.机动车排放污染的速度-加速度耦合影响分析[J].中国环境科学,2006,26(4):390-394.
[3]贺克斌,霍红,王岐东,等.城市轻型车实际道路瞬态排放的特征[J].中国环境科学,2006,26(4):390-394.
[4]CHEN CC,YANG CY.Effects of ambient air pollution exposure on frequency of hospital admissions for appendicitis in Taipei,Taiwan[J].J Toxicol Environ Health A,2018,81(17):854-860.
[5]ESCARNILLA-NUNEZ MC,BARRAZA-Villarreal A,HERNANDEZ-CADENA L,et al.Traffic-related air pollution and respiratory symptoms among asthmatic children,resident in Mexico City:the EVA cohort study[J/OL].Respir Res,2008,9:74.[2018-09-10].https://respiratoryresearch.biomedcentral.com/articles/10.1186/1465-9921-9-74.DOI:10.1186/1465-9921-9-74.
[6]SAMOLI E,ATKINSON RW,ANALITIS A,et al.Associations of short-term exposure to traffic-related air pollution with cardiovascular andrespiratory hospital admissions in London,UK[J].Occup Environ Med,2016,73(5):300-307.
[7]张皓,邬宇芬,黄剑峰,等.儿童肺功能检测及评估专家共识[J].临床儿科杂志,2014,32(2):104-114.
[8]中华人民共和国生态环境部.环境空气质量标准:GB 3095-2012[S].环境空气质量标准[S].北京:中国环境科学出版社,2012.
[9]FRANKLIN BA,BROOK R,ARDEN POPE C 3rd.Air pollution and cardiovascular disease[J].Curr Probl Cardiol,2015,40(5):207-238.
[10]DANYSH HE,MITCHELL LE,ZHANG K,et al.Traffic-related air pollution and the incidence of childhood central nervous system tumors:Texas,2001-2009[J].Pediatr Blood Cancer,2015,62(9):1572-1578.
[11]ASHLEY-MARTIN J,LAVIGNE E,ARBUCKLR TE,et al.Air Pollution During Pregnancy and Cord Blood Immune System Biomarkers[J].J Occup Environ Med,2016,58(10):979-986.
[12]BRUGHA R,GRIGG J.Urban air pollution and respiratory infections[J].Paediatr Respir Rev,2014,15(2):194-199.
[13]张莹,邵毅,王式功,等.北京市空气污染物对呼吸系统疾病门诊人数的影响[J].中国环境科学,2014,34(9):2401-2407.
[14]伍燕珍,张金良,赵秀阁,等.我国大气污染与儿童呼吸系统疾病和症状的关系[J].环境与健康杂志,2009,26(6):471-477.
[15]张莉君,郭常义,许慧慧,等.上海市冬季雾霾期两校小学生肺功能变化分析[J].环境与职业医学,2015,32(5):409-414.
[16]郑劲平.肺功能测定临床应用[J].继续医学教育,2006,20(2):67-71.