广州市气象因素对胎膜早破影响的病例交叉研究

Impact of meteorological factors on premature rupture of membranes in Guangzhou,China:A case-crossover study

目的探讨广州市气象因素对孕妇胎膜早破的影响。方法应用时间分层病例交叉设计,拟合条件Logistic回归模型和广义相加模型(generalized additive model,GAM),分析不同季节各气象因素对胎膜早破的影响。进行(0~5)d的滞后分析和多因素模型分析,计算各气象因素每增加1个单位,胎膜早破风险增加的比值比。结果在春季,气温日较差(DTR)在lag1 d对胎膜早破的影响具有统计学意义,每增加1℃,胎膜早破风险增加4.4%(95%CI:1.2%~7.7%);风速在lag0 d对胎膜早破的影响有统计学意义,每增加1 m/s,胎膜早破风险增加14.0%(95%CI:0.6%~29.1%)。在夏季,DTR在lag4 d对胎膜早破的影响有统计学意义,每增加1℃,胎膜早破风险增加4.7%(95%CI:0.3%~9.3%);日均气温在lag0 d对胎膜早破的影响最大,日均气温每增加1℃,胎膜早破的风险增加18.3%(95%CI:9.2%~28.1%)。秋季各气象因素的升高并不增加胎膜早破的发生风险。在冬季,相对湿度在lag5 d对胎膜早破的影响有统计学意义,相对湿度每增加1%,胎膜早破风险增加1.8%(95%CI:0.7%~3.0%);日均气压在lag5 d对胎膜早破的影响有统计学意义,气压每增加1 hPa,胎膜早破风险增加3.2%(95%CI:0.7%~5.8%);日均风速在lag1 d对胎膜早破的影响有统计学意义,风速每增加1 m/s,胎膜早破风险增加10.5%(95%CI:0.3%~21.7%)。结论广州市春季DTR和风速、夏季的气温和DTR、冬季的湿度、气压和风速的增加会导致胎膜早破风险增加,值得关注。

Objective To investigate the impact of meteorological factors on premature rupture of membranes(PROM)in Guangzhou,China.Methods The fitting conditional logistic regression model and the generalized additive model were used to investigate the impact of meteorological factors on PROM in different seasons based on time-stratified case-crossover study.The(0-5)-day cross-lagged regression analysis and the multivariate model analysis were used to calculate the odds ratio of the increased risk of PROM for every 1 unit increase in each meteorological factor.Results In spring,diurnal temperature range(DTR)had a significant impact on the risk of PROM on lag1 d,and for every 1℃increase in DTR,the risk of PROM was increased by 4.4%(95%CI:1.2%-7.7%);wind speed had a significant impact on the risk of PROM on lag0 d,and for every 1 m/s increase in wind speed,the risk of PROM was increased by 14.0%(95%CI:0.6%-29.1%).In summer,DTR had a significant impact on the risk of PROM on lag4 d,and for every 1℃increase in DTR,the risk of PROM was increased by 4.7%(95%CI:0.3%-9.3%);daily mean temperature had the greatest impact on the risk of PROM on lag0 d,and for every 1℃increase in daily mean temperature,the risk of PROM was increased by 18.3%(95%CI:9.2%-28.1%).In autumn,the increase in meteorological factors did not increase the risk of PROM.In winter,relative humidity(RH)had a significant impact on the risk of PROM on lag5 d,and for every 1%increase in RH.the risk of PROM was increased by 1.8%(95%CI:0.7%-3.0%);daily mean pressure had a significant impact on the risk of PROM on lag5 d,and for every 1 hPa increase in daily mean pressure,the risk of PROM was increased by 3.2%(95%CI:0.7%-5.8%);daily mean wind speed had a significant impact on the risk of PROM on lag1 d,and for every 1 m/s increase in daily mean wind speed,the risk of PROM was increased by 10.5%(95%CI:0.3%-21.7%).Conclusion The increases in DRT and daily mean wind speed in spring,DRT and daily mean temperature in summer,and RH,daily mean wind speed,and daily mean pressure in winter may increase the risk of PROM in Guangzhou,which should be taken seriously in clinical practice.