大气NO_(X)和NO_(2)急性暴露与儿童呼吸系统疾病门诊量的关联研究

Correlation between atmospheric nitrogen oxides and nitrogen dioxide acute exposure and outpatient visits of pediatric respiratory diseases

目的分析交通相关大气污染物氮氧化物(NO_(X))和二氧化氮(NO_(2))急性暴露与儿童呼吸系统疾病门诊量的关联。方法收集2015—2020年首都医科大学附属北京儿童医院呼吸系统疾病门诊就诊资料,通过北京大学医学部设置的监测点收集NO_(X)、NO_(2)及其他共存大气污染物资料;采用时间分层的病例交叉设计建立条件logistic回归模型分析NO_(X)和NO_(2)急性暴露与儿童呼吸系统疾病门诊量的关联。结果2015—2020年首都医科大学附属北京儿童医院0~14岁儿童呼吸系统疾病日门诊量M(Q_(R))为571(554)人次,其中上呼吸道感染、支气管炎和肺炎的日门诊量M(Q_(R))分别为265(282)、143(178)和128(120)人次。大气NO_(X)和NO_(2)的日均浓度M(Q_(R))分别为67.8(50.7)和49.3(30.7)μg/m^(3)。NO_(X)和NO_(2)急性暴露对儿童呼吸系统疾病的滞后效应均在累积滞后0~7 d时最大。NO_(X)每升高一个Q_(R)浓度,上呼吸道感染、支气管炎和肺炎门诊就诊的超额风险分别为6.87%(95%CI:6.37%~7.38%)、7.25%(95%CI:6.51%~7.99%)和5.51%(95%CI:4.69%~6.33%);NO_(2)每升高一个Q_(R)浓度,上呼吸道感染、支气管炎和肺炎门诊就诊的超额风险分别为5.71%(95%CI:5.12%~6.31%)、5.32%(95%CI:4.51%~6.14%)和4.83%(95%CI:3.91%~5.75%);对>5岁儿童的呼吸系统疾病门诊量影响更为明显。结论交通相关大气污染物NO_(X)和NO_(2)急性暴露可能导致儿童呼吸系统疾病门诊量增加。

Objective To examine the association between acute exposure to traffic-related air pollutants(TRAP)NO_(X)and NO_(2)and outpatient visits of pediatric respiratory diseases.Methods Data regarding outpatient visits to Department of Respiratory Diseases of Beijing Children’s Hospital from 2015 to 2020 were collected,and the concentrations of nitrogen oxides(NO_(X)),nitrogen dioxide(NO_(2))and other TRAP were collected from the surveillance sites assigned by the Peking University Health Science Center.A time-stratified case-crossover design was employed,and a conditional logistic regression model was created to examine the association between NO_(X)and NO_(2)acute exposure and outpatient visits of pediatric respiratory diseases.Results The daily mean outpatient visits of pediatric respiratory diseases were 571(interquartile range,554)person-times among children at ages of 0 to 14 years in Beijing Children’s Hospital from 2015 to2020,and the daily mean outpatient visits for upper respiratory tract infections(URI),bronchitis,and pneumonia were265(interquartile range,282),143(interquartile range,178)and 128(interquartile range,120)person-times,respectively.The daily mean concentrations of atmospheric NO_(X)and NO_(2)were 67.8(interquartile range,50.7)and 49.3(interquartile range,30.7)μg/m^(3),respectively.Conditional logistic regression analysis showed the largest lagged effect of NO_(X)and NO_(2)on pediatric respiratory diseases at cumulative lags of 0 to 7 days.An increase in NO_(X)concentrations by an interquartile range resulted in the excess risks of URI,bronchitis and pneumonia by 6.87%(95%CI:6.37%-7.38%),7.25%(95%CI:6.51%-7.99%),and 5.51%(95%CI:4.69%-6.33%),and an increase in NO_(2)concentrations by an interquartile range resulted in excess risks of URI,bronchitis and pneumonia by 5.71%(95%CI:5.12%-6.31%),5.32%(95%CI:4.51%-6.14%),and 4.83%(95%CI:3.91%-5.75%),respectively.NO_(X)and NO_(2)presented a more remarkable effect on outpatient visits of pediatric respiratory diseases among children at ages of over 5 years.Conclusion NOxand NO_(2)acute exposure may increase the outpatient visits of pediatric respiratory diseases.