室外气态污染物暴露对肺结核风险的影响

徐冬梅; 陆峰; 王文梅

doi:10.16462/j.cnki.zhjbkz.2022.05.011

室外气态污染物暴露对肺结核风险的影响

doi: 10.16462/j.cnki.zhjbkz.2022.05.011

徐冬梅^{1, 2},
陆峰³,
王文梅^1, ,

1.
210008 南京，南京大学医学院附属口腔医院口腔黏膜病科
2.
226001 南通，南通市新城桥街道社区卫生服务中心口腔科
3.
226007 南通，南通市疾病预防控制中心结核科

基金项目:

江苏省科技计划临床专项 BL2014018

详细信息

通讯作者:
王文梅，E-mail: wangwenmei0102@163.com

中图分类号: R122
计量
- 文章访问数: 479
- HTML全文浏览量: 211
- PDF下载量: 63
- 被引次数: 0
出版历程
- 收稿日期: 2021-12-20
- 修回日期: 2022-03-17
- 网络出版日期: 2022-05-11
- 刊出日期: 2022-05-10

Effects of outdoor gaseous pollutant exposure on the risk of pulmonary tuberculosis

XU Dong-mei^{1, 2},
LU Feng³,
WANG Wen-mei^{1
, ,}

1.
Department of Oral Mucosal Diseases, Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
2.
Departmental of Oral, Xinchengqiao Street Community Health Service Center of Nantong City, Nantong 226001, China
3.
Departmental of Tuberculosis, Center for Disease Control and Prevention of Nantong City, Nantong 226007, China

Funds:

Jiangsu Provincial Science and Technology Program Clinical Project BL2014018

More Information

Corresponding author: WANG Wen-mei, E-mail: wangwenmei0102@163.com

摘要

摘要: 目的探索室外气态污染物二氧化硫(sulfur dioxide, SO₂)和二氧化氮(nitrogen dioxide, NO₂)暴露与肺结核风险之间的关联。方法收集南通市2014-2018年肺结核的逐日报告病例数，以及同期的空气污染物浓度、气象因素和社会经济指标数据，通过构建分布滞后非线性模型(distributed lag nonlinear model, DLNM)来探索气态污染物SO₂和NO₂暴露对肺结核风险的影响。结果 2014-2018年南通市共报告肺结核15 799例。在此期间，南通市SO₂和NO₂周平均浓度分别为21.14(16.43, 28.35) μg/m³和35.57(25.07, 46.29) μg/m³。在单污染物模型和双污染物模型中，NO₂浓度每增加10 μg/m³，肺结核在滞后24周的累积RR分别为1.41(95% CI: 1.02~1.96, P=0.040)和1.56(95% CI: 1.02~2.39, P=0.042)。结论室外NO₂暴露会增加肺结核的风险，降低室外NO₂的浓度将有利于控制肺结核的流行。
- 空气污染 /
- 肺结核 /
- 分布滞后非线性模型 /
- 时间序列分析
Abstract: Objective To explore the relationship between outdoor exposure to gaseous pollutants sulfur dioxide (SO₂) and nitrogen dioxide (NO₂) and the risk of pulmonary tuberculosis. Methods We collected the daily number of pulmonary tuberculosis cases reported in Nantong from 2014 to 2018, and the data of air pollutant concentration, meteorological factors and socio-economic indicators during the same period. We constructed the distributed lag nonlinear model (DLNM) to estimate the effects of SO₂ and NO₂ exposure on the risk of pulmonary tuberculosis. Results Between 2014 and 2018, a total of 15 799 pulmonary tuberculosis cases was reported in Nantong. During this period, the weekly average concentration of SO₂ and NO₂ in Nantong was 21.14 (16.43, 28.35) μg/m³ and 35.57 (25.07, 46.29) μg/m³, respectively. In the single-and double-pollutant model, for each 10 μg/m³ increase in NO₂, the cumulative RR of pulmonary tuberculosis was 1.41 (95% CI: 1.02-1.96, P=0.040) and 1.56 (95% CI: 1.02-2.39, P=0.042), respectively, at lag 24 weeks. Conclusions Outdoor NO₂ exposure increased the risk of pulmonary tuberculosis. Reducing the concentration of outdoor NO₂ will help control the epidemic of pulmonary tuberculosis.
- Air pollution /
- Pulmonary tuberculosis /
- Distributed lag nonlinear model /
- Time series analysis

HTML全文

图 1 SO₂和NO₂每升高10 μg/m³时肺结核RR的变化

注：A表示SO₂的单污染物模型；B表示SO₂的双污染物模型；C表示NO₂的单污染物模型；D表示NO₂的双污染物模型；1表示RR；2表示累积RR。

Figure 1. Changes in the RR of pulmonary tuberculosis for every 10 μg/m³ increase in SO₂ and NO₂

下载: 全尺寸图片幻灯片

表 1 2014-2018年南通市肺结核报告病例的基本特征[n(%)]

Table 1. Basic characteristics of reported pulmonary tuberculosis cases in Nantong from 2014 to 2018 [n(%)]

特征	人数
性别
男	11 169(70.69)
女	4 630(29.31)
年龄(岁)
< 60	8 718(55.18)
≥60	7 081(44.82)
职业
农、林、牧、渔业或者为工人	13 402(84.83)
离退休人员	816(5.16)
学生	553(3.50)
其他	1 028(6.51)
病原学检查结果
病原学阳性	4 425(28.01)
病原学阴性	10 355(65.54)
结核性胸膜炎	657(4.16)
未痰检	362(2.29)

下载: 导出CSV

表 2 2014-2018年南通市空气污染物浓度和气象因素周平均值的基本特征

Table 2. Basic characteristics of the weekly averages of air pollutant concentrations and meteorological factors in Nantong from 2014 to 2018

变量	Min	P₂₅	中位数	x值	P₇₅	Max
空气污染物
SO₂(μg/m³)	6.46	16.43	21.14	23.75	28.35	63.06
NO₂(μg/m³)	9.87	25.07	35.57	36.43	46.29	75.57
气象因素
气温(℃)	-1.26	8.51	17.41	16.47	23.79	33.93
相对湿度(%)	54.14	72.86	80.86	79.33	86.36	95.86

下载: 导出CSV

表 3 2014-2018年南通市NO₂浓度每增加10 μg/m³时肺结核在滞后24周的累积RR及其95%CI值

Table 3. Cumulative RR of pulmonary tuberculosis at a lag of 24 weeks and its 95% CI for each 10 μg/m³ increase in NO₂ in Nantong from 2014 to 2018

变量	单污染物模型^a	P值	双污染物模型^b	P值
全人群	1.41(1.02~1.96)	0.040	1.56(1.02~2.39)	0.042
性别
男	1.69(1.18~2.41)	0.004	1.65(1.05~2.60)	0.032
女	0.96(0.59~1.55) ^c	0.855	1.35(0.72~2.56) ^c	0.352
年龄(岁)
< 60	1.34(0.91~1.97)	0.143	1.71(1.03~2.84)	0.040
≥60	1.46(0.96~2.21) ^c	0.080	1.32(0.77~2.27) ^c	0.307
注：^a表示调整长期趋势和周期波动、前一周病例数、气温、相对湿度和PGDP；^b表示在单污染物模型的基础上额外调整了SO₂；^c表示两组之间的效应差异无统计学意义(P>0.05)。

下载: 导出CSV

参考文献(23)

[1]	WHO. Global tuberculosis report 2021[EB/OL]. (2021-11-20) [2021-11-02]. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2021.
[2]	Ferrara G, Murray M, Winthrop K, et al. Risk factors associated with pulmonary tuberculosis: smoking, diabetes and anti-TNFα drugs [J]. Curr Opin Pulm Med, 2012, 18(3): 233-240. DOI: 10.1097/MCP.0b013e328351f9d6.
[3]	石婉荧, 陈晨, 曹亚强, 等. 大气PM_2.5持续高暴露对中老年人群心血管代谢风险的影响[J]. 中华疾病控制杂志, 2021, 25(10): 1120-1125, 1168. DOI: 10.16462/j.cnki.zhjbkz.2021.10.002. Shi WY, Chen C, Cao YQ, et al. Impact of persistent high ambient fine particulate matters exposure on cardiometabolic risk factors among middle-aged and elderly people [J]. Chin J Dis Control Prev, 2021, 25(10): 1120-1125, 1168. DOI: 10.16462/j.cnki.zhjbkz.2021.10.002.
[4]	杜鹏, 张文静, 张翼, 等. 大气臭氧长期暴露与中老年人群抑郁的关联[J]. 中华疾病控制杂志, 2021, 25(10): 1126-1132, 1138. DOI: 10.16462/j.cnki.zhjbkz.2021.10.003. Du P, Zhang WJ, Zhang Y, et al. Chronic ozone exposure and depression among middle-aged and elderly people in China [J]. Chin J Dis Control Prev, 2021, 25(10): 1126-1132, 1138. DOI: 10.16462/j.cnki.zhjbkz.2021.10.003.
[5]	Smith GS, Van Den Eeden SK, Garcia C, et al. Air pollution and pulmonary tuberculosis: a nested case-control study among members of a Northern California health plan [J]. Environ Health Perspect, 2016, 124(6): 761-768. DOI: 10.1289/ehp.1408166.
[6]	You S, Tong YW, Neoh KG, et al. On the association between outdoor PM(2.5) concentration and the seasonality of tuberculosis for Beijing and Hong Kong [J]. Environ Pollut, 2016, 218: 1170-1179. DOI: 10.1016/j.envpol.2016.08.071.
[7]	Zhu S, Xia L, Wu J, et al. Ambient air pollutants are associated with newly diagnosed tuberculosis: a time-series study in Chengdu, China [J]. Sci Total Environ, 2018, 631-632: 47-55. DOI: 10.1016/j.scitotenv.2018.03.017.
[8]	Hwang SS, Kang S, Lee JY, et al. Impact of outdoor air pollution on the incidence of tuberculosis in the Seoul Metropolitan Area, South Korea [J]. Korean J Intern Med, 2014, 29(2): 183-190. DOI: 10.3904/kjim.2014.29.2.183.
[9]	Wang Q, Guo L, Wang J, et al. Spatial distribution of tuberculosis and its socioeconomic influencing factors in mainland China 2013-2016[J]. Trop Med Int Health, 2019, 24(9): 1104-1113. DOI: 10.1111/tmi.13289.
[10]	Li Z, Liu Q, Zhan M, et al. Meteorological factors contribute to the risk of pulmonary tuberculosis: A multicenter study in eastern China [J]. Sci Total Environ, 2021, 793: 148621. DOI: 10.1016/j.scitotenv.2021.148621.
[11]	Li Z, Mao X, Liu Q, et al. Long-term effect of exposure to ambient air pollution on the risk of active tuberculosis [J]. Int J Infect Dis, 2019, 87: 177-184. DOI: 10.1016/j.ijid.2019.07.027.
[12]	Yin P, Chen R, Wang L, et al. Ambient ozone pollution and daily mortality: a nationwide study in 272 Chinese Cities [J]. Environ Health Perspect, 2017, 125(11): 117006. DOI: 10.1289/ehp1849.
[13]	Chen R, Yin P, Wang L, et al. Association between ambient temperature and mortality risk and burden: time series study in 272 main Chinese Cities [J]. BMJ, 2018, 363: k4306. DOI: 10.1136/bmj.k4306.
[14]	Liu C, Chen R, Sera F, et al. Ambient particulate air pollution and daily mortality in 652 Cities [J]. N Engl J Med, 2019, 381(8): 705-715. DOI: 10.1056/NEJMoa1817364.
[15]	Zhan M, Li Z, Li X, et al. Effect of short-term ambient PM(2.5) exposure on fasting blood glucose levels: A longitudinal study among 47, 471 people in eastern China [J]. Environ Pollut, 2021, 290: 117983. DOI: 10.1016/j.envpol.2021.117983.
[16]	Huang K, Ding K, Yang XJ, et al. Association between short-term exposure to ambient air pollutants and the risk of tuberculosis outpatient visits: a time-series study in Hefei, China [J]. Environ Res, 2020, 184: 109343. DOI: 10.1016/j.envres.2020.109343.
[17]	Naranbat N, Nymadawa P, Schopfer K, et al. Seasonality of tuberculosis in an Eastern-Asian country with an extreme continental climate [J]. Eur Respir J, 2009, 34(4): 921-925. DOI: 10.1183/09031936.00035309.
[18]	Leung CC, Yew WW, Chan TY, et al. Seasonal pattern of tuberculosis in Hong Kong [J]. Int J Epidemiol, 2005, 34(4): 924-930. DOI: 10.1093/ije/dyi080.
[19]	Zhang QY, Yang DM, Cao LQ, et al. Association between economic development level and tuberculosis registered incidence in Shandong, China [J]. BMC Public Health, 2020, 20(1): 1557. DOI: 10.1186/s12889-020-09627-z.
[20]	Harling G, Castro MC. A spatial analysis of social and economic determinants of tuberculosis in Brazil [J]. Health Place, 2014, 25: 56-67. DOI: 10.1016/j.healthplace.2013.10.008.
[21]	Houtmeyers E, Gosselink R, Gayan-Ramirez G, et al. Regulation of mucociliary clearance in health and disease [J]. Eur Respir J, 1999, 13(5): 1177-1188. DOI: 10.1034/j.1399-3003.1999.13e39.x.
[22]	Saito Y, Azuma A, Kudo S, et al. Effects of diesel exhaust on murine alveolar macrophages and a macrophage cell line [J]. Exp Lung Res, 2002, 28(3): 201-217. DOI: 10.1080/019021402753570509.
[23]	Saito Y, Azuma A, Kudo S, et al. Long-term inhalation of diesel exhaust affects cytokine expression in murine lung tissues: comparison between low- and high-dose diesel exhaust exposure [J]. Exp Lung Res, 2002, 28(6): 493-506. DOI: 10.1080/01902140290096764.