室外SO_(2)和NO_(2)暴露与中学生结核潜伏感染风险的关联研究

Association between outdoor SO_(2) and NO_(2) exposure and latent tuberculosis infection risk among middle school students

目的探索室外空气污染物二氧化硫(sulfur dioxide,SO_(2))和二氧化氮(nitrogen dioxide,NO_(2))暴露与中学生结核潜伏感染风险之间的关联。方法收集2018—2021年中国东部6个地级市68所中学接受新生入学体检的学生的基本信息和结核潜伏感染检测的结果,其中,结核潜伏感染采用结核菌素纯化蛋白衍生物的方法进行检测。此外,还收集了2015—2021年这6个城市室外空气污染物浓度和气象因素的数据。采用广义相加模型来评估SO_(2)和NO_(2)暴露对中学生结核潜伏感染风险的影响,并进行了敏感性分析和亚组分析。结果共有198275名学生纳入了最终的分析,其中11721名学生被诊断为结核潜伏感染。与非结核潜伏感染组相比,结核潜伏感染组男性和汉族的占比更高,并且具有较大的年龄和更高的体质量指数(P均<0.001)。SO_(2)浓度每增加10个单位,结核潜伏感染风险在滞后1年、2年和3年的时间下分别增加12.22%(95%CI:4.47~20.54)、23.25%(95%CI:16.13~30.81)和22.77%(95%CI:16.78~29.07);而NO_(2)浓度每增加10个单位,结核潜伏感染风险分别对应地增加22.20%(95%CI:17.23~27.38)、27.22%(95%CI:21.41~33.31)和32.05%(95%CI:25.76~38.65)。此外,SO_(2)和NO_(2)浓度与结核潜伏感染风险之间的正向关联在敏感性分析中是稳健的,并且在男性学生和女性学生中依然显著。结论室外空气污染物SO_(2)和NO_(2)暴露与中学生结核潜伏感染风险呈正相关。考虑到很多发展中国家正面临着高结核潜伏感染率和严重室外空气污染的双重挑战,降低室外空气污染物浓度将有助于降低这些国家的结核病负担。

Objective To explore the association between outdoor air pollutants sulfur dioxide(SO_(2))and nitrogen dioxide(NO_(2))exposure and latent tuberculosis infection(LTBI)risk among middle school students.Methods Basic information and LTBI screening results were collected from students undergoing entrance physical examinations in 68 middle schools across six prefecture-level cities in eastern China from 2018 to 2021.The LTBI test was conducted using the purified protein derivative method.Additionally,data on outdoor air pollutant concentrations and meteorological factors in these six cities from 2015 to 2021 were extracted.A generalized additive model was employed to assess the impact of SO_(2) and NO_(2) exposure on the risk of LTBI among middle school students,and sensitivity and subgroup analyses were further performed.Results A total of 198275 students were included in the final analysis,of which 11721 students were diagnosed with LTBI.Compared with the non-LTBI group,the LTBI group had a higher proportion of males and Han ethnicity,as well as older age and higher body mass index(all P<0.001).With every 10 units increase in SO_(2) concentration,LTBI risk increased by 12.22%(95%CI:4.47-20.54),23.25%(95%CI:16.13-30.81),and 22.77%(95%CI:16.78-29.07)at lag times of one year,two years,and three years,respectively.Similarly,for every 10 units increase in NO_(2) concentration,LTBI risk increased by 22.20%(95%CI:17.23-27.38),27.22%(95%CI:21.41-33.31),and 32.05%(95%CI:25.76-38.65),respectively,at the corresponding lag times.Furthermore,the positive association between SO_(2) and NO_(2) concentrations and the risk of LTBI was robust in the sensitivity analyses and remained significant in both male and female students.Conclusions Outdoor air pollutants SO_(2) and NO_(2) exposure are positively associated with the risk of LTBI among middle school students.Since many developing countries face the dual challenges of high LTBI rates and severe outdoor air pollution,reducing outdoor air pollutant concentrations may help mitigate the tuberculosis burden in these countries.