重庆市不同大气污染水平地区学龄儿童呼吸系统症状及肺功能的比较

Comparison of respiratory symptoms and pulmonary functions among school-age children in areas with different levels of air pollution in Chongqing

[目的]比较重庆市主城区不同大气污染水平地区的学龄儿童呼吸系统健康的差异。[方法]根据2010—2015年重庆市环保局网站的空气污染指数选取重庆市主城区污染区和清洁区。按照整群抽样的方法,随机选择分别位于清洁区、污染区的2所小学3~4年级的儿童,共487人为研究对象,进行肺功能检测,采用美国流行病学标准问卷(AST-DLD-78-C)对儿童呼吸系统疾病和症状发生情况进行调查。[结果]污染区环境大气污染物PM_(10)、PM_(2.5)在4个季节的平均浓度和年平均浓度均高于清洁区(P<0.05),污染区NOX在春、冬季和年平均浓度高于清洁区(P<0.05),污染区SO_2冬季浓度高于清洁区(P<0.05)。清洁区和污染区调查对象的男女比例分别为1.11∶1与1∶1.16。两区在家庭月收入、家庭采暖方式、厨房排烟系统、养猫/狗/鸟、房屋1年内装修等情况上的差异具有统计学意义(P<0.05)。运用单因素非条件logistic回归模型控制年龄、厨房排烟系统、家庭月收入等混杂因素后,污染区儿童感冒时咯痰(OR=2.54;95%CI:1.64~3.94)、支气管炎(OR=2.05;95%CI:1.18~3.55)的危险性仍高于清洁区儿童(P<0.05)。清洁区女童和男童的用力肺活量、1 s用力呼气容积均高于污染区(P<0.05)。多因素非条件logistic回归分析显示,污染区儿童感冒时咳痰(OR=2.63;95%CI:1.69~4.09),支气管炎(OR=2.19;95%CI:1.26~3.83)发生率高于清洁区(P<0.05)。[结论]重庆市污染区学龄儿童呼吸系统疾病及症状的发生率高于清洁区,肺功能水平有差异,证明大气污染对儿童呼吸系统健康可能带来了一定影响。

[Objective] To compare respiratory health among school-age children in areas with different air pollution levels in Chongqing.[Methods] Pollution area and clean area of Chongqing were defined by air pollution index （API） from the website of local environmental protection agency from 2010 to 2015. Using a cluster sampling method, we recruited a total of 487 children from Grade 3 and 4 in two primary schools in each study area. Children＇s pulmonary functions were examined. The incidences of respiratory diseases and symptoms were determined using a standard respiratory disease questionnaire （ATS-DLD-78-C）.[Results] The pollution area showed higher average concentrations of PM10 and PM2.5 than the clean area in four seasons and whole year （P 〈 0.05）. In spring, winter, and whole year, the average concentrations of NOX in the pollution area were higher than those in the clean area （P 〈 0.05）. The concentration of SO2 in the pollution area was higher than that in the clean area in winter （P 〈 0.05）. The ratios of male to female were 1.11：1 and 1：1.16 in the clean area and the pollution area, respectively. Two areas showed significant differences in family monthly income, home heating mode, kitchen ventilation system, keeping pets, and housing renovation within one year （P 〈 0.05）. The results of single factor unconditional logistic regression analysis displayed higher risks of persistent coughing up phlegm （OR=2.54; 95%CI：1.64-3.94） and bronchitis （OR=2.05; 95%CI：1.18-3.55） for the children in the pollution area than those in the clean area after controlling confounding factors such as age, kitchen ventilation system, and family monthly income （P 〈 0.05）. Forced vital capacity （FVC） and forced expiratory volume in one second （FEV1） of both girls and boys in the clean area were higher than those in the pollution area （P 〈 0.05）. Multivariate non-conditional logistic regression result showed higher risks of coughing up phlegm （OR=2.63; 95%CI：1.69-4.09） and bronchitis （OR=2.19; 95%CI：1.26-3.83） for the children in the pollution area than those in the clean area （P 〈 0.05）.[Conclusion] The incidences of respiratory diseases and symptoms in school-age children were higher in the pollution area than those in the clean area of Chongqing, and there are differences in pulmonary function in dicators, indicating that air pollution may affect children＇s respiratory health.