吸烟与室内空气污染的交互作用对慢性阻塞性肺部疾病影响的分析

Interaction between smoking and indoor air pollution on chronic obstructive pulmonary diseases

目的 了解浙江省桐乡地区慢性阻塞性肺部疾病（COPD）患病率，分析吸烟与室内空气污染交互作用对COPD患病的影响。方法 随机抽取桐乡市崇福、洲泉、高桥、石门、乌镇5个乡镇所有30-79岁人群进行问卷、体格检查和肺功能检测。以第一秒用力肺活量最大值/肺活量最大值（FEV1max/FVCmax）≤0.7确诊为COPD，运用logistic回归模型分析吸烟、室内空气污染与COPD的关系，评价吸烟与室内空气污染之间的相乘交互作用；采用引入Andersson等编制的Excel表计算相加交互作用。结果 桐乡市COPD总患病率为6.6%，调整年龄、文化程度、职业、婚姻、年收入、BMI、腰臀比等因素后，多因素logistic回归分析发现：男性人群中目前已戒烟人群、开始吸烟年龄〈25岁人群患COPD危险性高；女性人群中吸烟量每天〈15 g、吸烟时吸入口腔或咽喉部相对于从不吸烟人群，患COPD危险性均上升。交互作用分析显示：使用柴/炭/煤、煤饼、煤球等做饭燃料与当前或曾经经常吸烟存在相乘交互作用，女性人群做饭时未使用烟囱或排烟装置与当前或曾经经常吸烟存在相加交互作用。结论 桐乡地区COPD患病率接近全国平均水平，女性吸烟人群患COPD的危险性高于男性，居民通过改善厨房通风条件及排烟设施，使用清洁能源煤气、天然气、电做饭，积极控烟将有利于预防COPD的发生。

Objective To investigate the prevalence of chronic obstructive pulmonary diseases （COPD） in Tongxiang, Zhejiang province, and analyze the interaction between smoking and indoor air pollution on COPD. Methods Townships of Chongfu, Zhouquan, Gaoqiao, Shimen, Wuzhen were randomly selected from Tongxiang. All the local people aged 30-79 years were asked to receive questionnaire survey, physical examination and pulmonary function testing. FEV1max/FVC max≤0.7 was the criterion of COPD diagnosis. Logistic regression model was used to analyze the relationship between smoking/indoor air pollution and COPD, multiplied interaction between smoking and indoor air pollution was evaluated, Excel table prepared by Andersson et al. was used to calculate the adding interaction. Results The overall prevalence of COPD was 6.6%, and adjusted for age, educational level, occupation, marriage, income level, BMI, waist-to-hip and other factors, multivariate logistic regression analysis showed that males who had quit smoking, started smoking at age of 〈25 years had a high risk of COPD; females who smoked every day 〈15 g, inhaled smoke into mouth or throat had high risk of COPD. Interaction analysis showed that using fuel of firewood/charcoal/coal, briquettes for cooking and regular smoking had multiplied interaction on COPD. Use no chimney or exhaust system in cooking and regular smoking had adding interaction in females. Conclusion The prevalence of COPD in Tongxiang was close to the national average level. Female smokers had higher risk for COPD than male smokers. Improving kitchen ventilation, using natural gas or fuel gas for cooking and active tobacco control would facilitate the prevention of COPD.