我国大气PM <sub>2.5</sub>与呼吸系统疾病门诊量关系的meta分析

doi:10.3969/j.issn.1006-5253.2022.06.013

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (5093 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的系统评价我国大气PM _2.5与呼吸系统疾病门诊量的短期暴露效应相关性。方法计算机检索CNKI、WanFang Data、VIP、PubMed、EMbase、The Cochrane Library和Web of science数据库，搜集我国大气PM _2.5与呼吸系统疾病门诊量的相关研究，检索时限为2000年1月至2022年8月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险，采用Stata 14.0软件进行meta分析。结果共纳入48篇文献。采用随机效应模型进行meta分析，结果显示大气PM _2.5 质量浓度每增加10 μg·m^-3，呼吸系统疾病门诊量增加0.66%(95%CI:0.56%～0.76%)。将纳入研究对象按人群（年龄、性别）、季节、研究地区、城市经济水平、PM _2.5浓度和效应类型进行亚组分析，结果显示大气PM _2.5质量浓度每增加10 μg·m^-3，0～14岁组呼吸系统疾病门诊增量最高0.61%(95%CI:0.50%～0.73%)，其次为≥65岁组0.50%(95%CI:0.35%～0.66%)和15～64岁组0.44%(95%CI:0.32%～0.56%)；春季呼吸系统疾病门诊增量最高0.61%(95%CI:0.12%～1.11%)；相比于二三线城市而言，一线城市呼吸系统疾病门诊增量最高0.63%(95%CI:0.50%～0.75%);南方地区呼吸系统疾病门诊增量0.75%(95%CI:0.63%～0.88%)高于北方地区0.37%(95%CI:0.28%～0.47%)；PM _2.5<75 μg·m^-3组呼吸系统疾病门诊增量0.78%(95%CI:0.63%～0.88%)高于PM _2.5≥75 μg·m^-3组0.26%(95%CI:0.17%～0.36%)；不同性别和效应类型的呼吸系统疾病门诊量增加相差不大。敏感性分析显示本次研究结果相对稳健可靠。经漏斗图和Egger′s检验，存在一定的发表偏倚。结论我国大气PM _2.5与呼吸系统疾病门诊量之间呈正相关，随着大气中PM _2.5浓度升高，可增加呼吸系统疾病的发病风险，尤其是儿童、老年人、春季、一线城市和南方地区，呼吸系统疾病门诊量均有所增加。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ： PM_2.5, 呼吸系统疾病, 门诊量, 时间序列分析, meta分析

Abstract：

Objective systematically review the short-term exposure effects of atmospheric PM_2.5 and respiratory disease outpatient visits in China.Methods Databases including CNKI, WanFang Data, VIP, PubMed, EMbase, The Cochrane Library and Web of science databases were electronically searched to collect studies on the association between atmospheric PM_2.5and outpatient visits of respiratory diseases from January 2000 to August 2022 in China. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Metaanalysis was performed by using Stata 14.0 software.Results Forty-eight articles were included. The random effect model was used for meta-analysis. The results showed that the increase of PM_2.5 concentration by 10 μg·m^-3was associated with an increase of 0.66%(95%CI: 0.56%-0.76%) in the number of respiratory disease outpatient visits. Subgroup analysis was conducted according to population (age, gender), season, study area, urban economic level, PM_2.5concentration and effect type. The results showed that for every 10 μg·m^-3 increase in atmospheric PM_2.5concentration, the increase of outpatient visits for respiratory diseases was the highest in the 0-14 years group 0.61%(95%CI: 0.50%-0.73%), followed by ≥65 years old group 0.50% (95%CI:0.35%-0.66%) and 15-64 years old group 0.44%(95%CI: 0.32%-0.56%). In spring, the highest increase was 0.61% (95%CI: 0.12%-1.11%). Compared with the second and third-tier cities, the increase of outpatient clinics for respiratory diseases in firsttier cities was the highest by 0.63% (95%CI: 0.50%-0.75%). The increase of outpatient clinics for respiratory diseases in southern China was 0.75%(95%CI: 0.63%-0.88%), higher than that in northern China 0.37%(95%CI: 0.28%-0.47%). PM_2.5<75 μg·m^-3 groups of respiratory disease outpatient increment of 0.78% (95%CI: 0.63%-0.88%) was higher than PM_2.5≥75 μg·m^-3 group-0.26% (95%CI: 0.17%-0.36%). There was no significant difference in the increase of outpatient visits for respiratory diseases by gender and effect type. Sensitivity analysis showed that the results of this study were relatively robust and reliable. The funnel plot and Egger′s test showed that there was a certain publication bias.Conclusion There is a positive correlation between PM_2.5and the number of respiratory diseases in China. With the increase ofPM_2.5concentration in the atmosphere, the risk of respiratory diseases will increase, especially in children, the elderly, in spring, first-tier cities and the southern region, and the number of respiratory diseases outpatients increases.

Key words： PM_2.5 respiratory disease number of outpatient visits time series analysis meta analysis

收稿日期: 2022-07-24

基金资助:嘉兴市科技计划项目(2020AD30123)

通讯作者: 洪伟伟，Email:hongweiwei1992@163.com

引用本文:

王熙蓓，周哲华，吴益康，胡赞，朱泽，孟盼，吴大明，洪伟伟. 我国大气PM _2.5与呼吸系统疾病门诊量关系的meta分析[J]. 中国医院统计, 2022, 29(6): 472-480.
Wang Xibei， Zhou Zhehua，Wu Yikang，Hu Zan， Zhu Ze，Meng Pan,，Wu Daming， Hong Weiwei. Relationship between atmosphericPM _2.5and outpatient visits of respiratory diseases in China:a meta-analysis. journal1, 2022, 29(6): 472-480.

链接本文:

http://manu58.magtech.com.cn/Jwk_zgyytj/CN/10.3969/j.issn.1006-5253.2022.06.013 或 http://manu58.magtech.com.cn/Jwk_zgyytj/CN/Y2022/V29/I6/472

［1］XING Y F, XU Y H, SHI M H, et al. The impact of PM_2.5on the human respiratory system［J］. J Thorac Dis, 2016, 8(1):E69-E74. DOI:10.3978/j.issn.2072-1439.2016.01.19.
［2］LIU Q, XU C, JI G, et al. Effect of exposure to ambient PM_2.5 pollution on the risk of respiratory tract diseases: A meta-analysis of cohort studies［J］. J Biomed Res, 2017, 31(2):130-142. DOI:10.7555/jbr.31.20160071.
［3］顾雯雯，杨洛贤，程庆林．大气PM_2.5 对呼吸系统疾病死亡率影响的Meta分析［J］．预防医学，2018，30(11)：1100-1105． DOI:10.19485/j.cnki.issn2096-5087.2018.11.006.
［4］张良，冯伟，陆蓓蓓，等．宁波市大气PM_2.5 污染对城区居民慢性阻塞性肺疾病门诊量影响研究［J］．中华流行病学杂志，2019，40(6)：686-691．DOI:10.3760/cma.j.issn.0254-6450.2019.06.016.
［5］ZHENG X Y, DING H, JIANG L N, et al. Association between air pollutants and asthma emergency room visits and hospital admissions in time series studies: A systematic review and meta-analysis［J］. PLoS One, 2015, 10(9):e0138146. DOI:10.1371/journal.pone.0138146.
［6］ATKINSON R W, KANG S, ANDERSON H R, et al. Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis［J］. Thorax. 2014, 69(7):660-665. DOI: 10.1136/thoraxjnl-2013-204492.
［7］ZHANG F, LIU X, ZHOU L, et al. Spatiotemporal patterns of particulate matter (PM) and associations between PM and mortality in Shenzhen, China［J］. BMC Public Health, 2016, 16:215. DOI:10.1186/s12889-016-2725-6.
［8］STANG A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses［J］. Eur J Epidemiol, 2010, 25(9):603-605. DOI:10.1007/s10654-010-9491-z.
［9］刘芳盈，刘晓利，李平，等．淄博市主城区大气PM_2.5 与呼吸系统疾病门诊人次的相关性研究［J］．环境与健康杂志，2019，36(3)：223-226．DOI:10.16241/j.cnki.1001-5914.2019.03.009.
［10］周君，姚向辉，董宏爽，等．唐山市空气污染物对某医院呼吸系统疾病门诊量的影响［J］．环境卫生学杂志，2019，9(2)：162-166．DOI:10.13421/j.cnki.hjwsxzz.2019.02.014.

［11］冯建纯，张聪瑶，张珣，等．石家庄市空气污染对呼吸系统疾病门诊量的急性影响［J］．医学动物防制，2020，36(8)：719-723．
［12］王荀，廖玉学，刘丽红，等．深圳市龙岗区大气污染物与医院呼吸系统疾病门诊量的广义相加模型分析［J］．实用预防医学，2019，26(1)：59-62．
［13］张慧东，周连，陈晓东．淮安市空气PM_2.5 污染对呼吸系统疾病门诊量影响［J］．江苏预防医学，2015，26(6)：41-43．DOI:10.13668/j.issn.1006-9070.2015.06.014.
［14］骆善彩，杨娟，徐志勇，等．淮安市城区大气污染与呼吸系统疾病门诊量的时间序列分析［J］．现代预防医学，2016，43(23)：4225-4228.
［15］段振华，高绪芳，杜慧兰，等．成都市空气PM_2.5 浓度与呼吸系统疾病门诊人次的时间序列研究［J］．现代预防医学，2015，42(4)：611-614.
［16］韩璐瑶，吴克坚，高永恒，等．不同大气污染物对呼吸系统疾病门诊量的影响［J］．中华肺部疾病杂志(电子版)，2020，13(2)：229-235．
［17］朱小红，刘强，周晓龙，等．2017—2019年苏州市空气主要污染物浓度对医院门诊数影响的时间序列分析［J］．职业与健康，2021，37(9)：1241-1246．DOI:10.13329/j.cnki.zyyjk.2021.0313.
［18］游颖琦，朱晶颖，张旭辉，等．无锡市大气污染对成人内科门诊量影响的时间序列研究［J］．山东大学学报(医学版)，2018，56(11)：53-60．
［19］马关培，邹宝兰，许振成，等．广州市某区医院呼吸系统疾病门诊人数与大气污染关系的时间序列研究［J］．环境与健康杂志，2012，29(6)：526-528．DOI:10.16241/j.cnki.1001-5914.2012.06.014.
［20］朱昱，肖长春，马子建．合肥市大气颗粒物污染对成人内科门诊量影响的时间序列分析［J］．环境卫生学杂志，2021，11(4)：348-354．DOI:10.13421/j.cnki.hjwsxzz.2021.04.008.
［21］陈帅，周海泓，于蕾，等．空气污染物对呼吸系统疾病门诊量影响的时间序列分析［J］．江苏预防医学，2022，33(1)：8-11．DOI:10.13668/j.issn.1006-9070.2022.01.003.
［22］洪也，张莹，马雁军，等．沈阳大气污染物与气象因素对呼吸疾病门诊数的影响［J］．中国环境科学，2020，40(9)：4077-4090．DOI:10.19674/j.cnki.issn1000-6923.2020.0454.
［23］滕婉莹，杨浩峰，马龙．乌鲁木齐市大气PM_2.5 和PM₁₀与居民呼吸系统疾病急救人次的关系［J］．环境与职业医学，2020，37(6)：594-598．DOI:10.13213/j.cnki.jeom.2020.19753.
［24］刘睿聪，蒋先雁，曾婕，等．成都市细颗粒物对医院门诊就诊量的影响研究［J］．预防医学情报杂志，2018，34(3)：264-269．
［25］张金艳，田霖，李书明，等．北京市朝阳区大气PM_2.5 暴露与医院呼吸系统疾病门诊量关系的时间序列分析［J］．环境卫生学杂志，2020，10(4)：367-371．DOI:10.13421/j.cnki.hjwsxzz.2020.04.007.
［26］张文增，甄国新，陈东妮，等．北京市顺义区大气污染物对呼吸系统疾病门诊量的影响［J］．中国卫生统计，2017，34(2)：275-279．
［27］吴和岩，谭爱军，黄利群，等．珠海市大气PM_2.5 与儿科呼吸系统疾病门诊日就诊人次的关系研究［J］．环境与健康杂志，2018，35(11)：973-976．DOI:10.16241/j.cnki.1001-5914.2018.11.009.
［28］金武，张开月，姚庆兵，等．扬州市大气污染对儿童门诊量的影响［J］．环境与健康杂志，2020，37(1)：47-51．DOI:10.16241/j.cnki.1001-5914.2020.01.011. 
［29］王大虎，石同幸，吕嘉韵，等．2013—2015年广州市大气PM_2.5 浓度对儿童呼吸系统门诊量影响分析［J］．医学动物防制，2017，33(12)：1230-1234．
［30］王晓捷，彭燕云，邓伟均，等．2015—2017年广州市番禺区大气PM_2.5 污染对某医院儿童呼吸系统疾病门诊量的影响［J］．华南预防医学，2019，45(2)：124-127．DOI:10.13217/j.scjpm.2019.0124.
［31］严亚琼，赵原原，杨念念，等．武汉市大气污染对儿童呼吸系统门诊量影响的时间序列分析［J］．中国预防医学杂志，2020，21(9)：969-973．DOI:10.16506/j.1009-6639.2020.09.003.
［32］史亚妮，董继元，刘玉荣．兰州市空气污染对儿童呼吸疾病的影响［J］．中国环境科学，2020，40(4)：1792-1799．DOI:10.19674/j.cnki.issn1000-6923.2020.0201.
［33］张开月，李小琴，姚庆兵，等．2017—2019年扬州市大气污染物与儿童呼吸系统门诊量的时间序列分析［J］．环境监控与预警，2021，13(5)：67-70，123．
［34］刘鹏达，石同幸，冯文如，等．广州市某区大气PM_2.5 浓度与儿童呼吸门诊量相关性［J］．中国热带医学，2018，18(1)：48-51．DOI:10.13604/j.cnki.46-1064/r.2018.01.11.
［35］贾云飞，韦丽，唐彦钊，等．2015—2017年南京市大气污染物对儿童内科门诊量影响的时间序列分析［J］．职业与健康，2020，36(5)：666-669．DOI:10.13329/j.cnki.zyyjk.2020.0174.
［36］陈宇，蒋兆峰，姜方平．2016—2019年镇江市大气颗粒物与儿科呼吸系统门诊人次的关系研究［J］．职业与健康，2021，37(20)：2814-2818．DOI:10.13329/j.cnki.zyyjk.2021.0685.
［37］徐兴兴，高红梅，赵锦江．上海市青浦区大气污染物与某医院儿童呼吸系统疾病日就诊量的时间序列研究［J］．职业与健康，2021，37(12)：1670-1674．DOI:10.13329/j.cnki.zyyjk.2021.0417.
［38］陈浪，赵川，陈凤格，等．石家庄市大气颗粒污染物浓度对儿童呼吸系统疾病门诊量的影响［J］．山东大学学报(医学版)，2018，56(11)：68-75．
［39］黄琳璐，刘长云，王艳，等．潍坊市区大气污染物与儿科呼吸系统疾病日门诊量的相关性研究［J］．智慧健康，2020，6(4)：32-34．DOI:10.19335/j.cnki.2096-1219.2020.04.014.
［40］丁亚萍，虞明星，郝海燕，等．石家庄市空气PM_2.5 浓度与儿童呼吸系统疾病门诊量的关系［J］．中华疾病控制杂志，2018，22(7)：672-676．DOI:10.16462/j.cnki.zhjbkz.2018.07.005.
［41］LI Y W, LI C C, LIU J Y, et al. An association between PM2.5 and pediatric respiratory outpatient visits in four Chinese cities［J］. Chemosphere, 2021, 280:130843. DOI:10.1016/j.chemosphere.2021.130843.
［42］MA Y L, YUE L, LIU J T et al. Association of air pollution with outpatient visits for respiratory diseases of children in an ex-heavily polluted Northwestern City, China［J］. BMC Public Health, 2020, 20(1):816. DOI:10.1186/s12889-020-08933-w.
［43］LI Y R, XIAO C C, LI J, et al. Association between air pollution and upper respiratory tract infection in hospital outpatients aged 0-14 years in Hefei, China: A time series study［J］. Public Health, 2018, 156:92-100. DOI:10.1016/j.puhe.2017.12.006.
［44］MO Z, FU Q, ZHANG L, et al. Acute effects of air pollution on respiratory disease mortalities and outpatients in Southeastern China［J］. Sci Rep, 2018, 8(1):3461. DOI:10.1038/s41598-018-19939-1.
［45］XU Q, LI X, WANG S, et al. Fine particulate air pollution and hospital emergency room visits for respiratory disease in urban areas in Beijing, China, in 2013［J］. PLoS One, 2016, 11(4):e0153099. DOI:10.1371/journal.pone.0153099.
［46］WANG S S, LI Y F, NIU A M, et al. The impact of outdoor air pollutants on outpatient visits for respiratory diseases during 2012-2016 in Jinan, China［J］. Respir Res, 2018, 19(1):246. DOI:10.1186/s12931-018-0958-x.
［47］LIU P, WANG X, FAN J, et al. Effects of air pollution on hospital emergency room visits for respiratory diseases: Urban-suburban differences in Eastern China［J］. Int J Environ Res Public Health, 2016, 13(3):E341. DOI:10.3390/ijerph13030341.
［48］PENG C Q, CAI J F, YU S Y, et al. Impact of PM_2.5 on daily outpatient numbers for respiratory diseases in Shenzhen, China［J］. Zhonghua Yu Fang Yi Xue Za Zhi. 2016, 50(10):874-879. DOI: 10.3760/cma.j.issn.0253-9624.2016.10.008.
［49］ZHAI G Y, ZHANG K, CHAI G R. Lag effects of size-fractionated particulate matter pollution on outpatient visits for respiratory diseases in Lanzhou, China［J］. Ann Agric Environ Med, 2021, 28(1):131-141. DOI:10.26444/aaem/132179.
［50］CHANG J H, HSU S C, BAI K J, et al. Association of time-serial changes in ambient particulate matters (PMs) with respiratory emergency cases in Taipei′s Wenshan District［J］. PLoS One, 2017, 12(7):e0181106. DOI:10.1371/journal.pone.0181106.
［51］DONG J Y, YANG R Q, ZHAI G Y, et al. Risks of hospital outpatient visits for overall and cause-specific respiratory disease associated with particulate matter pollution in Lanzhou, China［J］. Air Qual Atmos Heal, 2021, 14(9):1405-1415. DOI:10.1007/s11869-021-01030-w.
［52］DONG J Y, WANG Y R, WANG J C, et al. Association between atmosphericPM_2.5 and daily outpatient visits for children′s respiratory diseases in Lanzhou［J］. Int J Biometeorol, 2021, 65(7):989-999. DOI:10.1007/s00484-021-02080-6.
［53］SONG J, LU M, ZHENG L, et al. Acute effects of ambient air pollution on outpatient children with respiratory diseases in Shijiazhuang, China［J］. BMC Pulm Med, 2018, 18(1):150. DOI:10.1186/s12890-018-0716-3.
［54］ZHANG F X, ZHANG H, WU X C, et al. Acute effects of ambient air pollution on clinic visits of college students for upper respiratory tract infection in Wuhan, China［J］. Environ Sci Pollut Res Int, 2021, 28(23):29820-29830. DOI:10.1007/s11356-021-12828-7.
［55］YANG H H, YAN C X, LI M, et al. Short term effects of air pollutants on hospital admissions for respiratory diseases among children: A multi-city time-series study in China［J］. Int J Hyg Environ Health, 2021, 231:113638. DOI:10.1016/j.ijheh.2020.113638.
［56］ZHENG P W, WANG J B, ZHANG Z Y, et al. Air pollution and hospital visits for acute upper and lower respiratory infections among children in Ningbo, China: A time-series analysis［J］. Environ Sci Pollut Res Int, 2017, 24(23):18860-18869. DOI:10.1007/s11356-017-9279-8.
［57］周慧霞，谢俊卿，刘晓君，等．北京市丰台区大气PM₁₀与呼吸系统疾病门诊量关系的研究［J］．环境卫生学杂志，2013，3(6)：490-493．
［58］KIM S Y, PEEL J L, HANNIGAN M P, et al. The temporal lag structure of short-term associations of fine particulate matter chemical constituents and cardiovascular and respiratory hospitalizations［J］. Environ Health Perspect, 2012, 120(8):1094-1099. DOI:10.1289/ehp.1104721.
［59］梁肖，闫英洁，张迪，等．PM_2.5污染与呼吸系统疾病门诊量关系的Meta分析［J］．环境与职业医学，2016，33(9)：874-879．DOI:10.13213/j.cnki.jeom.2016.16205.
［60］谢鹏，刘晓云，刘兆荣，等．我国人群大气颗粒物污染暴露-反应关系的研究［J］．中国环境科学，2009，29(10)：1034-1040．
［61］刘佳莉，芦静，胡宝翠，等．我国PM2.5 污染与儿童呼吸系统疾病门诊量关系的Meta分析［J］．现代预防医学，2021，48(12)：2170-2174．
［62］洪也，张莹，马雁军，等．沈阳市PM2.5 离子成分对呼吸疾病门诊数影响研究［J］．中国环境科学，2018，38(12)：4697-4705．DOI:10.19674/j.cnki.issn1000-6923.2018.0530.