相邻日间温度变化对缺血性脑卒中的影响

王影; 胡皖琴; 孙浩翔; 杨吉丹; 康芮含; 胡华青

doi:10.16462/j.cnki.zhjbkz.2024.06.010

相邻日间温度变化对缺血性脑卒中的影响

doi: 10.16462/j.cnki.zhjbkz.2024.06.010

1.
安徽医科大学第一附属医院全科医学科，合肥 230022
2.
安徽医科大学公共卫生学院，合肥 230022
3.
深圳市宝安区人民医院全科医学科，深圳 518101
4.
安徽医科大学第一附属医院物资设备处，合肥 230022

基金项目:

国家重点研发计划 2020YFC2006506

详细信息

通讯作者:
胡华青, E-mail: huhuaqing_ayfy@163.com

中图分类号: R122
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出版历程
- 收稿日期: 2023-11-15
- 修回日期: 2024-03-18
- 网络出版日期: 2024-07-13
- 刊出日期: 2024-06-10

Impact of temperature changes between neighboring days on ischemic stroke

1.
Department of General Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
2.
School of Public Health, Anhui Medical University, Hefei 230022, China
3.
Department of General Medicine, Bao′an People′s Hospital, Shenzhen 518101, China
4.
Materials and Equipment Department, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

Funds:

National Key Research and Development Program of China 2020YFC2006506

More Information

Corresponding author: HU Huaqing, E-mail: huhuaqing_ayfy@163.com

摘要

摘要: 目的评估相邻日间温度变化(temperature changes between neighboring days, TCN)对缺血性脑卒中门诊就诊风险的影响。方法利用合肥市一所大型三甲医院缺血性脑卒中门诊就诊数据进行分析，采用分布滞后非线性模型结合泊松广义线性回归模型分析TCN与缺血性脑卒中门诊就诊人次之间的关系，对相关环境因素进行校正，并对不同性别和年龄的人群进行了分层分析。结果合肥市2014—2018年共有32 560例缺血性脑卒中患者，其中男性占57.2%，≥65岁的人群占49.7%，平均每日就诊人数为17.8人次。暴露-反应关系曲线显示TCN与缺血性脑卒中门诊就诊量相关。以TCN无变化(0)为参考，极端负TCN(P₅，-3.9 ℃)的相对风险在累计滞后7 d达到最大(RR=1.796, 95% CI：1.150~2.805)，而极端正TCN(P₉₅，3.0 ℃)的相对风险在累计滞后6 d达到最大(RR=0.686, 95% CI：0.499~0.945)。亚组分析显示，男性和≥65岁缺血性脑卒中患者更易受负TCN的影响。结论合肥市TCN与缺血性脑卒中呈非线性关系; 负TCN增加缺血性脑卒中患者的门诊就诊风险，当气温骤降时注意缺血性脑卒中的发生; 正TCN降低缺血性脑卒中患者的门诊就诊风险，当气温升高时需要注意防暑降温，避免高温引起的其他健康问题。
- 缺血性脑卒中 /
- 相邻日间温度变化 /
- 分布滞后非线性模型 /
- 时间序列研究
Abstract: Objective To assess the effect of temperature changes between neighboring days on the risk of ischemic stroke outpatient visits. Methods A distributional lag nonlinear model combined with a Poisson generalised linear regression model was used to analyse the relationship between temperature changes between neighboring days and ischemic stroke outpatient visits at a large tertiary hospital in Hefei city, with corrections for relevant environmental factors and stratified by different gender and age groups. Results In this study, there were 32 560 ischemic stroke patients, with an average of 17.8 ischemic stroke visits per day. Exposure relationship curves show significant association between TCN and ischemic stroke outpatient visits. The relative risk over 0-7days Reached 1.796(95% CI: 1.150-2.805) for extreme negative temperature changes between neighboring days (5th percentile), whereas the relative risk of extreme positive temperature changes between neighboring days (95th percentile) was 0.686(95% CI: 0.499-0.945) and maximized at a cumulative lag of 6 days. Subgroup studies revealed that men and ischemic stroke patients over the age of 65 were more vulnerable to negative temperature changes between neighboring days. Conclusions Temperature changes between neighboring days and ischemic stroke are nonlinearly related in Hefei; with negative temperature changes between neighboring days increases the likelihood for ischemic stroke patients, watch for ischemic stroke when temperature drops suddenly; and positive temperature changes between neighboring days decreases the risk of ischemic stroke patients, who require protection from heat and other health concerns induced by rising temperature.
- Ischemic stroke /
- Temperature changes between neighboring days /
- Distributed lag nonlinear model /
- Time-series study

HTML全文

图 1 合肥市TCN与缺血性脑卒中就诊的暴露-反应关系

TCN: 相邻日间温度变化；图A: TCN与缺血性脑卒中总体暴露-反应3D图；图B: TCN与缺血性脑卒中总体暴露-反应曲线图。

Figure 1. Exposure-response relationships between TCN and visits with ischemic stroke in Hefei City

TCN: temperature changes between neighboring days; Figure A: the 3D graph of the overall exposure response between TCN and ischemic stroke; Figure B: the overall exposure response curve of TCN and ischemic stroke.

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图 2 合肥市各亚组缺血性脑卒中就诊者与TCN暴露-反应关系

TCN：相邻日间温度变化；A表示男性；B表示女性；C表示＜65岁；D表示≥65岁。

Figure 2. Exposure-response relationships between ischemic stroke visits and TCN in a subgroup of patients, in Hefei City

TCN: temperature changes between neighboring days; A represents male; B represents female; C represents < 65 years old; D represents ≥ 65 years old.

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表 1 合肥市缺血性脑卒中就诊人次、气象数据的统计资料

Table 1. Statistics on outpatient ischemic stroke visits, climate data in Hefei City

变量 Variable	总计 Total	x±s	P₁	P₅	P₂₅	P₅₀	P₇₅	P₉₅	P₉₉
总就诊人次 Total population	32 560	17.80±11.10	0	2.0	8.0	17.0	26.0	38.0	45.0
男性 Male	18 645	10.20±6.80	0	1.0	4.0	10.0	15.0	22.0	28.0
女性 Female	13 915	7.60±5.20	0	0	3.0	7.0	11.0	17.0	22.0
年龄组/岁 Age group/years
＜65	16 377	9.00±6.00	0	1.0	4.0	8.0	13.0	19.0	25.0
≥65	16 183	8.90±6.10	0	0	4.0	8.0	13.0	20.0	25.0
TCN/℃		0.00±2.30	-6.4	-3.9	-1.1	0.2	1.4	3.0	4.2
平均温度/℃ Mean temperature/℃		16.90±9.20	-1.1	2.0	8.9	17.9	24.6	30.5	33.0
最高温度/℃ Maxmum temperature/℃		21.60±9.60	1.0	5.7	13.9	22.9	29.4	35.3	37.7
最低温度/℃ Minimum temperature/℃		13.10±0.30	-5.2	-2.2	5.1	13.9	21.2	26.8	28.5
风速/(m·s^-1) Wind speed/(m·s^-1)		1.90±0.80	0.7	0.9	1.4	1.8	2.3	3.3	4.1
相对湿度/% Relative humidity/%		75.50±18.40	42.0	53.0	68.0	76.0	85.0	95.0	98.0
日照时数/h Sunlight hours/h		4.09±4.07	0	0	0	4.3	8.3	11.0	11.9
降雨量/mm Rainfall/mm		3.50±10.60	0	0	0	0	1.0	20.1	48.8
注：TCN, 相邻日间温度变化；P₁，第1百分位数；P₅，第5百分位数；P₂₅，第25百分位数；P₅₀，第50百分位数；P₇₅，第75百分位数；P₉₅，第95百分位数；P₉₉，第99百分位数。 Note：TCN, temperature changes between neighboring days；P₁, 1th percentile; P₅, 5th percentile; P₂₅, 25th percentile; P₅₀, 50th percentile; P₇₅, 75th percentile; P₉₅, 95th percentile; P₉₉, 99th percentile.

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表 2 合肥市气象因素间的Spearman相关系数

Table 2. Coefficients of spearman correlation between meteorological factors in Hefei City

变量 Variable	平均温度/℃ Mean temperature/℃	TCN/℃	相对湿度/% Relative humidity/%	日照时数/h Sunlight hours/h	风速/(m·s^-1) Wind speed/(m·s^-1)	降雨量/mm Rainfall/mm
平均温度/℃ Mean temperature/℃	1.00
TCN/℃	0.09 ^①	1.00
相对湿度/% Relative humidity/%	0.01	-0.22 ^①	1.00
日照时数/h Sunlight hours/h	0.30 ^①	0.38 ^①	-0.63 ^①	1.00
风速/(m·s^-1) Wind speed/(m·s^-1)	0.03	-0.21 ^①	-0.02	-0.23	1.00
降雨量/mm Rainfall/mm	-0.03	-0.39 ^①	0.65 ^①	-0.60 ^①	0.18 ^①	1.00
注：TCN, 相邻日间温度变化。 ① P＜0.01。 Note：TCN, temperature changes between neighboring days. ① P＜0.01.

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表 3 不同亚组中TCN对缺血性脑卒中就诊的单日滞后效应

Table 3. Single day lag effect of TCN on ischemic stroke visits in different subgroups

项目 Project	滞后天数 Lag days RR值 value(95% CI)
项目 Project	Lag0	Lag1	Lag2	Lag3
总就诊人次 Total population
P₅(-3.9 ℃)	1.049(0.975~1.129)	1.040(0.979~1.105)	1.039(0.973~1.109)	1.048(0.977~1.123)
P₉₅(3.0 ℃)	0.934(0.862~1.103)	0.958(0.904~1.015)	0.972(0.922~1.024)	0.971(0.920~1.024)
男性 Male
P₅(-3.9 ℃)	1.082(0.999~1.173)	1.063(0.995~1.136)	1.054(0.981~1.132)	1.063(0.982~1.145)
P₉₅(3.0 ℃)	0.889(0.814~0.972)	0.926(0.870~0.987)	0.951(0.898~1.009)	0.958(0.902~1.016)
女性 Female
P₅(-3.9 ℃)	1.007(0.927~1.094)	1.010(0.944~1.081)	1.017(0.946~1.095)	1.030(0.953~1.114)
P₉₅(3.0 ℃)	0.996(0.910~1.090)	1.001(0.939~1.067)	0.999(0.942~1.059)	0.988(0.930~1.049)
＜65岁 years
P₅(-3.9 ℃)	1.037(0.954~1.126)	1.026(0.959~1.098)	1.024(0.902~1.102)	1.103(0.957~1.119)
P₉₅(3.0 ℃)	0.904(0.825~0.990) ^①	0.946(0.887~1.009)	0.973(0.917~1.003)	0.978(0.921~1.039)
≥65岁 years
P₅(-3.9 ℃)	1.059(0.976~1.150)	1.053(0.984~1.127)	1.053(0.979~1.133)	1.061(0.981~1.148)
P₉₅(3.0 ℃)	0.963(0.880~1.053)	0.969(0.909~1.033)	0.970(0.915~1.030)	0.964(0.907~1.024)

项目 Project	滞后天数 Lag days RR值 value(95% CI)
项目 Project	Lag4	Lag5	Lag6	Lag7
总就诊人次 Total population
P₅(-3.9 ℃)	1.066(0.995~1.141)	1.091(1.023~1.164) ^①	1.122(1.052~1.197) ^①	1.156(1.074~1.244) ^①
P₉₅(3.0 ℃)	0.957(0.909~1.008)	0.935(0.890~0.980) ^①	0.907(0.862~0.953) ^①	0.877(0.825~0.932) ^①
男性 Male
P₅(-3.9 ℃)	1.079(1.001~1.163) ^①	1.107(1.032~1.188) ^①	1.143(1.065~1.226) ^①	1.183(1.092~1.283) ^①
P₉₅(3.0 ℃)	0.947(0.895~1.003)	0.926(0.878~0.976) ^①	0.897(0.848~0.948) ^①	0.865(0.808~0.926) ^①
女性 Female
P₅(-3.9 ℃)	1.048(0.971~1.132)	1.070(0.995~1.150)	1.095(1.018~1.177) ^①	1.122(1.032~1.219) ^①
P₉₅(3.0 ℃)	0.970(0.915~1.027)	0.946(0.896~0.999) ^①	0.920(0.870~0.973) ^①	0.893(0.834~0.955) ^①
＜65岁 years
P₅(-3.9 ℃)	1.056(0.978~1.139)	1.085(1.010~1.116) ^①	1.121(1.043~1.205) ^①	1.161(1.069~1.261) ^①
P₉₅(3.0 ℃)	0.963(0.909~1.021)	0.934(0.885~0.987) ^①	0.898(0.847~0.951) ^①	0.858(0.978~0.922) ^①
≥65岁 years
P₅(-3.9 ℃)	1.077(0.997~1.162)	1.097(1.021~1.180) ^①	1.122(1.004~1.207) ^①	1.150(1.058~1.249) ^①
P₉₅(3.0 ℃)	0.951(0.897~1.008)	0.934(0.885~0.986) ^①	0.914(0.865~0.965) ^①	0.893(0.836~0.953) ^①
注：TCN, 相邻日间温度变化; P₅，第5百分位数；P₉₅，第95百分位数。 ① P＜0.05。 Note：TCN, temperature changes between neighboring days; P₅, 5th percentile; P₉₅, 95th percentile. ① P＜0.05.

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表 4 不同亚组中TCN对缺血性脑卒中就诊的累积滞后效应

Table 4. Cumulative lag effect of TCN on ischemic stroke visits in different subgroups

项目 Project	滞后天数 Lag days RR值 value(95% CI)
项目 Project	Lag0	Lag0~1	Lag0~2	Lag0~3
总就诊人次 Total population
P₅(-3.9 ℃)	1.049(0.975~1.129)	1.091(0.960~1.241)	1.134(0.947~1.358)	1.189(0.938~1.506)
P₉₅(3.0 ℃)	0.934(0.862~1.103)	0.895(0.783~1.024)	0.870(0.731~1.037)	0.845(0.684~1.045)
男性 Male
P₅(-3.9 ℃)	1.082(0.999~1.173)	1.151(1.000~1.325)	1.214(0.996~1.479)	1.288(0.997~1.669)
P₉₅(3.0 ℃)	0.889(0.814~0.972) ^①	0.825(0.711~0.956) ^①	0.785(0.648~0.952) ^①	0.752(0.595~0.950) ^①
女性 Female
P₅(-3.9 ℃)	1.007(0.927~1.094)	1.018(0.881~1.176)	1.036(0.846~1.394)	1.068(0.818~1.394)
P₉₅(3.0 ℃)	0.996(0.910~1.090)	0.997(0.858~1.159)	0.996(0.820~1.211)	0.985(0.777~1.248)
＜65岁 years
P₅(-3.9 ℃)	1.037(0.954~1.126)	1.064(0.921~1.126)	1.090(0.891~1.335	1.129(0.866~1.471)
P₉₅(3.0 ℃)	0.904(0.825~0.990) ^①	0.856(0.973~0.995)	0.833(0.684~1.014)	0.815(0.642~1.035)
≥65岁years
P₅(-3.9 ℃)	1.059(0.976~1.150)	1.117(0.967~1.289)	1.177(0.961~1.440)	1.250(0.958~1.629)
P₉₅(3.0 ℃)	0.963(0.880~1.053)	0.933(0.803~1.084)	0.906(0.746~1.101)	0.874(0.689~1.108)

项目 Project	滞后天数 Lag days RR值 value(95% CI)
项目 Project	Lag0~4	Lag0~5	Lag0~6	Lag0~7
总就诊人次 Total population
P₅(-3.9 ℃)	1.268(0.944~1.701)	1.384(0.976~1.961)	1.553(1.043~2.313) ^①	1.796(1.150~2.805) ^①
P₉₅(3.0 ℃)	0.809(0.630~1.039)	0.757(0.569~1.007)	0.686(0.499~0.945) ^①	0.602(0.423~0.858) ^①
男性 Male
P₅(-3.9 ℃)	1.390(1.007~1.919) ^①	1.540(1.051~2.256) ^①	1.760(1.138~2.724) ^①	2.084(1.279~3.396) ^①
P₉₅(3.0 ℃)	0.713(0.541~0.939) ^①	0.660(0.482~0.905) ^①	0.592(0.417~0.842) ^①	0.513(0.347~0.757) ^①
女性 Female
P₅(-3.9 ℃)	1.120(0.805~1.559)	1.199(0.810~1.775)	1.314(0.840~2.056)	1.474(0.893~2.434)
P₉₅(3.0 ℃)	0.955(0.722~1.262)	0.904(0.657~1.244)	0.832(1.583~1.188)	0.743(0.501~1.103)
＜65岁 years
P₅(-3.9 ℃)	1.192(0.858~1.657)	1.294(0.876~1.912)	1.452(0.930~2.664)	1.686(1.024~2.776) ^①
P₉₅(3.0 ℃)	0.785(0.593~1.040)	0.734(0.532~1.012)	0.659(0.460~0.944) ^①	0.566(0.379~0.845) ^①
≥65岁 years
P₅(-3.9 ℃)	1.134(0.967~1.873)	1.478(0.999~2.816)	1.659(1.061~2.595) ^①	1.908(1.156~3.418) ^①
P₉₅(3.0 ℃)	0.832(0.629~1.099)	0.777(0.565~1.069)	0.711(0.498~1.014)	0.635(0.428~0.940) ^①
注：TCN, 相邻日间温度变化; P₅，第5百分位数；P₉₅，第95百分位数。 ① P＜0.05。 Note：TCN, temperature changes between neighboring days; P₅, 5th percentile; P₉₅, 95th percentile. ① P＜0.05.

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