田小雨, 石红霞, 李盛, 白彦君, 胡克勤, 严俊, 薛宝德, 李棪琳, 牛静萍, 罗斌. 甘肃农村地区居民肺通气功能的影响因素及其与室内空气污染的关联性研究[J]. 环境与职业医学, 2022, 39(5): 485-492, 498. DOI: 10.11836/JEOM21421
引用本文: 田小雨, 石红霞, 李盛, 白彦君, 胡克勤, 严俊, 薛宝德, 李棪琳, 牛静萍, 罗斌. 甘肃农村地区居民肺通气功能的影响因素及其与室内空气污染的关联性研究[J]. 环境与职业医学, 2022, 39(5): 485-492, 498. DOI: 10.11836/JEOM21421
TIAN Xiaoyu, SHI Hongxia, LI Sheng, BAI Yanjun, HU Keqin, YAN Jun, XUE Baode, LI Yanlin, NIU Jingping, LUO Bin. Influencing factors of pulmonary ventilation function and its relationship with indoor air pollution in rural areas of Gansu Province[J]. Journal of Environmental and Occupational Medicine, 2022, 39(5): 485-492, 498. DOI: 10.11836/JEOM21421
Citation: TIAN Xiaoyu, SHI Hongxia, LI Sheng, BAI Yanjun, HU Keqin, YAN Jun, XUE Baode, LI Yanlin, NIU Jingping, LUO Bin. Influencing factors of pulmonary ventilation function and its relationship with indoor air pollution in rural areas of Gansu Province[J]. Journal of Environmental and Occupational Medicine, 2022, 39(5): 485-492, 498. DOI: 10.11836/JEOM21421

甘肃农村地区居民肺通气功能的影响因素及其与室内空气污染的关联性研究

Influencing factors of pulmonary ventilation function and its relationship with indoor air pollution in rural areas of Gansu Province

  • 摘要: 背景 室内空气污染是影响呼吸系统健康的重要危险因素,我国就此方面的研究多局限于中东部,西北农村地区研究较少。

    目的 基于横断面调查研究探讨甘肃省农村地区居民肺通气功能障碍的影响因素及其与室内空气污染的关系。

    方法 研究选取甘肃省白银、榆中两地四个村399名研究对象。通过调查问卷收集人口社会学信息、生活习惯、疾病史、燃料使用等信息,同时进行身高、体重、肺功能等体格和功能检查,根据吸烟、燃料使用、每周通风情况等计算室内空气污染(IAP)暴露指数。IAP>5被认为存在较高水平的室内空气污染。肺功能指标包括用力肺活量(FVC)、第一秒用力呼气量(FEV1)、第一秒用力呼气量与用力肺活量的比值(FEV1/FVC)、用力肺活量占预测值的百分比(FVC%)、第一秒用力呼气量占预测值的百分比(FEV1%),根据肺功能指标判断研究对象是否发生肺通气功能障碍。采用logistic回归评价室内空气污染状况与居民肺通气功能障碍的关系,同时根据研究对象家庭住址、体重指数(BMI)进行亚组分析,以期发现发生肺通气功能障碍的高危人群。

    结果 研究对象平均年龄(56.75±7.31)岁;肺通气功能正常155人(38.85%),肺通气功能障碍244人(61.14%);89.97%的研究对象暴露于较高水平的室内空气污染(IAP>5)。logistic回归发现,控制年龄、BMI、居住地、性别、吸烟、饮酒、是否患心血管疾病后,IAP>5(OR=2.327,95%CI:1.089~4.974),冬季使用有烟煤作为主要取暖燃料(OR=3.467,95%CI:1.197~10.037)可能会增加肺通气功能障碍发生的风险。亚组分析发现,白银地区客厅/卧室不通风(OR=3.460,95%CI:1.116~10.268)会增加肺通气功能障碍发生的风险;在BMI≤24 kg·m−2的研究对象中,卧室取暖方式为煤炉和烧炕(OR=2.092,95%CI:1.030~4.247)、冬季在卧室烹饪(OR=2.954,95%CI:1.046~8.344)同样可能增加肺通气功能障碍发生的风险;在BMI>24 kg·m−2研究对象中,IAP>5(OR=3.739,95%CI:1.147~12.182)发生肺通气功能障碍的风险较高。

    结论 甘肃农村室内空气污染及当地居民肺通气功能状况均不乐观,且两者之间呈负相关。煤炭的使用、超重、在卧室烹饪及同时采用煤炉和烧炕取暖均可能导致肺通气功能障碍发生的风险增高,而通风有益于肺通气功能健康。

     

    Abstract: Background Indoor air pollution is an important risk factor affecting health of the respiratory system. Studies on indoor air pollution in China are mostly limited to the central and eastern regions, and there are few studies in the rural areas of northwest China.

    Objective To explore the influencing factors of lung ventilation function and its relationship with indoor air pollution in rural areas of Gansu Province based on a cross-sectional investigation.

    Methods A total of 399 subjects were selected from four villages in Baiyin and Yuzhong of Gansu Province. Questionnaires were used to collect demographic information, lifestyle, disease history, fuel use, and other information, and physical and functional tests were ordered such as height, weight, and lung function. The Indoor Air Pollution (IAP) exposure index was calculated based on smoking, fuel type, and weekly ventilation. IAP > 5 was defined as a high level of indoor air pollution. Lung function indexes included forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC, forced vital capacity as a percentage of predicted value (FVC%), and forced expiratory volume in the first second as a percentage of predicted value (FEV1%), which were used to determine pulmonary ventilation dysfunction. Logistic regression model was used to evaluate the relationship between indoor air pollution and pulmonary ventilation function, and subgroup analysis was further conducted according to home address and BMI , in order to identify the high-risk population of pulmonary ventilation dysfunction.

    Results The mean age of the subjects was (56.75±7.31) years old; 155 subjects (38.85%) had normal pulmonary ventilation function, and the other 244 subjects (61.14%) had impaired pulmonary ventilation function; about 89.97% of the subjects were exposed to high level of indoor air pollution (IAP > 5). We found that IAP > 5 ( OR=2.327, 95%CI: 1.089-4.974) and use of bituminous coal as the main heating fuel in winter (OR=3.467, 95%CI: 1.197-10.037) increased the risk of pulmonary ventilation dysfunction after adjusting for age, BMI, residence, gender, smoking, drinking, and cardiovascular disease. The subgroup analysis results showed that no ventilation in the living room/bedroom (OR=3.460, 95%CI: 1.116-10.268) increased the risk of pulmonary ventilation dysfunction in Baiyin. Heating with coal stoves and Chinese Kang in the bedroom (OR=2.092, 95%CI: 1.030-4.247) and cooking in the bedroom in winter ( OR =2.954, 95% CI : 1.046-8.344) also increased the risk of pulmonary ventilation dysfunction in the residents with BMI≤24 kg·m−2. IAP > 5 ( OR=3.739, 95%CI: 1.147-12.182) was associated with a significantly increased risk of pulmonary ventilation dysfunction in the BMI > 24 kg·m −2 subgroup.

    Conclusion The pulmonary ventilation function of rural residents in Gansu is poor, which is negatively correlated with indoor air pollution. Coal use, overweight, cooking in bedroom, and use of coal stoves and Chinese Kang for heating may increase the risk of pulmonary ventilation dysfunction, while room ventilation is a beneficial factor.

     

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