沈阳市大气污染物PM_(2.5)、PM_(10)、SO_(2)、NO_(2)浓度对呼吸系统疾病严重程度的影响

Effects of PM_(2.5),PM_(10),SO_(2),and NO_(2) concentrations on severity of respiratory diseases in Shenyang

目的 观察沈阳市主要大气污染物PM_(2.5)、PM_(10)、SO_(2)、NO_(2)浓度对呼吸系统疾病严重程度的影响。方法 收集2016年1月—2017年12月中国医科大学附属第四医院第二呼吸内科HIS系统录入的病历资料2 690份,诊断为呼吸系统疾病重症1 705例,于沈阳市环境研究所获得同期大气污染物PM_(2.5)、PM_(10)、SO_(2)、NO_(2)浓度,分析呼吸系统疾病严重程度与大气污染物浓度之间的相关性;采用基于Poisson分布的广义相加模型(GAM),分析沈阳市主要大气污染物PM_(2.5)、PM_(10)、SO_(2)、NO_(2)单污染物及双污染物对呼吸系统疾病重症的影响,以及呼吸系统疾病重症例数随污染物浓度改变的滞后效应;计算在最佳滞后时间下,当污染物浓度增加10μg/m^(3)时呼吸系统疾病重症的超额危险度(ER值)及其95%置信区间(CI)。结果 呼吸系统疾病严重程度与PM_(2.5)、PM_(10)、SO_(2)、NO_(2)浓度均呈正相关关系(r分别为0.629、0.617、0.703、0.637,P均<0.05)。单污染物模型分析结果显示,PM_(2.5)、PM_(10)、SO_(2)、NO_(2)影响呼吸系统疾病重症的ER值及95%CI分别为1.31(1.21~1.43)、1.29(1.18~1.41)、2.94(2.75~3.14)、5.23(4.91~5.61),P均<0.05。PM_(2.5)和NO_(2)影响呼吸系统疾病重症例数的效应在延迟累积2天(Lag01)达到最大值,PM_(10)在延迟累积5天(Lag04)达到最大值,SO_(2)在延迟累积4天(Lag03)达到最大值;在最佳滞后时间下,PM_(2.5)、PM_(10)、SO_(2)和NO_(2)的浓度每增加10μg/m^(3),对应的呼吸系统疾病重症患者例数增加1.31%(ER=0.96,95%CI:1.21~1.43)、1.29%(ER=0.39,95%CI:1.18~1.41)、2.94%(ER=0.39,95%CI:0.28~0.31)、5.26%(ER=0.39,95%CI:0.49~0.56),P均<0.05。双污染物模型分析结果显示,PM_(2.5)+SO_(2)影响呼吸系统疾病重症的ER值及95%CI为3.53(3.24~3.76),PM_(10)+SO_(2)为2.46(2.23~2.70),PM_(2.5)+NO_(2)为5.02(4.46~5.56),PM_(10)+NO_(2)为3.99(3.50~4.44),SO_(2)+NO_(2)为3.34(3.06~3.62),P均<0.01。结论 沈阳市主要大气污染物PM_(10)、PM_(2.5)、SO_(2)和NO_(2)浓度升高均可导致呼吸系统疾病患者病情加重,且病情严重程度相对于污染物浓度的改变存在滞后效应,PM_(2.5)联合NO_(2)对呼吸系统疾病严重程度的影响最大。

Objective To observe the influence of PM_(2.5),PM_(10),S0_(2),and NO_(2) concentrations on the severity of respiratory diseases in Shenyang.Methods Totally 2 690 medical records were collected from the second respiratory department of the Fourth Affiliated Hospital of China Medical University from January 2016 to December 31^(st) 2017,and1 705 cases were diagnosed as severe respiratory diseases.The concentrations of atmospheric pollutants(PM_(2.5),PM_(10),S0_(2),NO_(2)) in the same year were obtained from Shenyang Institute of Environment.The correlation between the severity of respiratory diseases and the concentration of air pollutants was analyzed.The generalized additive model(GAM) based on Poisson distribution was used to analyze the influence of single and double pollutants of PM_(2.5),PM_(10),SO_(2) and NO_(2) on the severity of respiratory diseases in Shenyang,and the lag effect of the number of severe respiratory diseases with the change of pollutant concentration.The excess risk(ER value) and 95% confidence interval(CI) of severe respiratory disease were calculated when pollutant concentration increased by 10 μg/m~3 under the optimal lag time.Results The number of patients with severe respiratory diseases was positively correlated with PM_(2.5),PM_(10),SO_(2),and NO_(2)(R=0.629,0.617,0.703,0.637,all P<0.05).Analysis results of single pollutant model showed that the ER values and 95% CI of PM_(2.5),PM_(10),SO_(2) and NO_(2) affecting severe respiratory diseases were 1.31(1.21-1.43),1.29(1.18-1.41),2.94(2.75-3.14),and 5.23(4.91-5.61),respectively(all P<0.05).The effect of PM_(2.5) and NO_(2) on the number of patients with sewere respiratory diseases reached the maximum value in delayed accumulation of 2 days(Lag01),PM_(10) reached the maximum value in delayed accumulation of 5 days(Lag04),and SO_(2) reached the maximum value in delayed accumulation of 4 days(Lag03).Under the optimal lag time,the number of patients with severe respiratory diseases increased by 1.31%(ER=0.96,95% CI:1.21-1.43) and 1.29%(ER=0.39,95% CI:1.18-1.41),2.94%(ER=0.39,95% CI:0.28-0.31),5.26%(ER=0.39,95% CI:0.49-0.56),respectively(all P<0.05).The analysis results of dual pollutant model showed that the ER values and 95% CI were 3.53(3.24-3.76) for PM_(2.5)+SO_(2) affecting the severity of respiratory diseases,2.46(2.23-2.70) for PM_(10)+SO_(2),5.02(4.46-5.56) for PM_(2.5)+NO_(2),3.99(3.50-4.44) for PM_(10)+NO_(2),and 3.34(3.06-3.62) for SO_(2)+NO_(2)(all P<0.01).Conclusions The increased concentrations of major air pollutants PM_(10),PM_(2.5),SO_(2) and NO_(2) in Shenyang can lead to an increase in the number of patients with severe respiratory diseases,and the disease severity has a lag effect with the change of pollutant concentration.PM_(2.5) combined with NO_(2) has the greatest impact on the severity of respiratory diseases.