摘要
【目的】探讨大气细颗粒物(PM_(2.5))和臭氧(O_(3))短期暴露与肺炎患者炎症指标的关联,以识别易感人群和易感因素。【方法】收集2018年9月—2020年4月在山西省太原市某三甲医院因肺炎就诊入院的患者1 480人,运用广义相加模型(GAMs)分别探讨PM_(2.5)、O_(3)与肺炎患者炎性指标的关联,并通过分层分析探讨PM_(2.5)和O_(3)暴露的易感因素和易感人群。【结果】大气PM_(2.5)短期暴露与肺炎患者的外周血C-反应蛋白(CRP)、红细胞沉降率(ESR)、嗜酸性粒细胞(EOS)计数、中性粒细胞(NEU)计数、中性粒细胞与淋巴细胞比值(NLR)的变化存在关联,并且存在不同程度的滞后效应,分别在滞后3 d(lag03)、lag03、滞后0 d(lag0)、lag03、lag03达到最大,即PM_(2.5)每升高10μg·m^(-3),分别升高4.13%(95%CI:0.43%~7.84%)、3.10%(95%CI:0.24%~5.97%)、5.27%(95%CI:3.12%~7.42%)、1.85%(95%CI:0.36%~3.34%)、2.53%(95%CI:0.53%~4.74%)。O_(3)浓度变化与肺炎患者的外周血降钙素原(PCT)、ESR的升高存在关联,其效应值均在lag01达到最大,即O_(3)每升高1μg·m^(-3)分别升高0.38%(95%CI:0.04%~0.73%)、0.47%(95%CI:0.19%~0.76%)。分层分析显示,PM_(2.5)与肺炎患者外周血中的CRP、ESR、NEU、NLR的关联均在男性、老年人群中以及冷季发病的人群中更为显著。O_(3)与肺炎患者PCT、ESR的关联均在老年人群及暖季发病人群中更显著,女性肺炎患者外周血CRP、PCT对O_(3)的变化更为易感。【结论】大气短期PM_(2.5)及O_(3)短期暴露与肺炎患者的炎症指标的变化呈正相关,且PM_(2.5)对肺炎患者的影响比O_(3)更广泛,短期滞后效应延长。老年肺炎患者对大气污染更敏感,男性肺炎患者对PM_(2.5)更敏感,女性肺炎患者对O_(3)更敏感,冷、暖季可分别加重PM_(2.5)、O_(3)对肺炎患者炎症指标的影响,必须做好防护。
[Objective]To explore the association between short-term exposure to atmospheric fine particulate matter(PM_(2.5))and ozone(O_(3))and systemic inflammatory indicators in patients with pneumonia,and to identify the susceptible populations.[Methods]From September 2018 to April 2020,data of 1480 patients admitted for pneumonia was collected from a tertiary hospital in Taiyuan City.Generalized additive models(GAMs)were used to explore the associations between PM_(2.5) and O_(3) exposure and inflammatory indicators of patients with pneumonia;and to explore the susceptibility factors and susceptible populations to PM_(2.5) and O_(3) exposures through stratified analyses.[Results]The short-term exposure to PM_(2.5) was associated with changes in peripheral blood C-reation protein(CRP),erythrocyte sedimentation(ESR),easinophil(EOS),neutrophil(NEU)and neutrophil-lymphocyte ratio(NLR)in patients with pneumonia,and there were different degrees of hysteresis effects,with the effect values reaching a maximum at lag03,lag03,lag0,lag03,lag03,respectively,which were 4.13%(95%CI:0.43%‒7.84%),3.10%(95%CI:0.24%‒5.97%),5.27%(95%CI:3.12%‒7.42%),1.85%(95%CI:0.36%‒3.34%),and 2.53%(95%CI:0.53%‒4.74%)for every 10µg·m^(-3) of PM_(2.5).The changes in O_(3)concentration were associated with the elevation of peripheral blood PCT and ESR in patients with pneumonia,and their effect values all reached the maximum at lag01 d,every 1µg·m^(-3) of O_(3) elevation increased by 0.38%(95%CI:0.04%‒0.73%)and 0.47%(95%CI:0.19%‒0.76%),respectively.Stratified analyses showed that the associations of PM_(2.5) with peripheral blood CRP,ESR,NEU,and NLR in pneumonia patients were more significant in males,the elderly,and those with onset in the cold season;the associations of O_(3) with peripheral blood PCT and ESR in pneumonia patients were more significant in the elderly and those with onset in the warm season,and the peripheral blood CRP and PCT in female patients with pneumonia were more susceptible to the changes of O_(3).[Conclusion]Sho
作者
宋露露
于琦
刘楠楠
高宇卉
牛泽宇
张妍
郑会秋
田家瑜
刘军霞
赵利芳
张志红
SONG Luu;YU Qi;LIU Nannan;GAO Yuhui;NIU Zeyu;ZHANG Yan;ZHENG Huiqiu;TIAN Jiayu;LIU Junxia;ZHAO Lifang;ZHANG Zhihong(School of Public Health,Shanxi Medical University,Taiyuan,Shanxi 030001,China;School of Management,Shanxi Medical University,Taiyuan,Shanxi 030001,China;Medical Duyun Big Data Research Institute of Shanxi Medical University,Taiyuan,Shanxi 030001,China;Center for Ecological Public Health Security of Yellow River Basin,Shanxi Medical University,Taiyuan,Shanxi 030001,China;Key Laboratory of Coal Environmental Pathogenicity and Prevention(Shanxi Medical University),Ministry of Education,Taiyuan,Shanxi China)
出处
《上海预防医学》
CAS
2024年第6期551-558,共8页
Shanghai Journal of Preventive Medicine
基金
国家自然科学基金项目(82273595)
山西省社会经济统计科研课题(KY〔2021〕165)。
关键词
细颗粒物
臭氧
肺炎
血常规
炎症
fine particulate matter
ozone
pneumonia
blood routine test
inflammation
