2019—2023年大气污染物对儿童哮喘的影响——基于南京市儿童医院哮喘门诊量的分析

韦丽; 龚兴; 熊丽林; 张艺; 孙凤霞; 潘伟; 许长娣

doi:10.11836/JEOM24364

2019—2023年大气污染物对儿童哮喘的影响——基于南京市儿童医院哮喘门诊量的分析

韦丽^1,,
龚兴¹,
熊丽林¹,
张艺¹,
孙凤霞¹,
潘伟^2a,
许长娣^2b, ,

1.
南京市疾病预防控制中心环境卫生科，江苏 210003
2a.
南京医科大学附属儿童医院检验科
2b.
南京医科大学附属儿童医院呼吸科，江苏 210008

基金项目:

南京市卫生科技发展项目（ZKX20046，YKK21177）

详细信息

作者简介:
韦丽（1988—），女，硕士，主管医师；E-mail：weilisunny@163.com

通讯作者:
许长娣，E-mail：xcd_118@163.com

中图分类号: R12
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出版历程
- 收稿日期: 2024-07-25
- 录用日期: 2025-02-16
- 刊出日期: 2025-04-24

Impacts of ambient air pollutants on childhood asthma from 2019 to 2023: An analysis based on asthma outpatient visits of Nanjing Children's Hospital

1.
Departmental of Environmental Health, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu 210003, China
2a.
Department of Clinical Laboratory
2b.
Respiratory Department, Children’s Hospital of Nanjing Medical University, Nanjing , Jiangsu 210008, China

Funds:

This study was funded.

More Information

Corresponding author:
XU Changdi, E-mail: xcd_118@163.com

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摘要

摘要:
背景
哮喘严重影响着儿童的生长发育和心理健康，对儿童哮喘水平的控制和风险因素的评估逐渐为人们所重视。越来越多的研究发现大气污染物暴露能够明显增加儿童哮喘的发病风险。
目的
了解南京市大气污染物浓度变化及南京市儿童医院哮喘门诊就诊情况，定量分析不同大气污染物暴露对儿童哮喘门诊就诊量的影响。
方法
收集南京市2019年1月1日—2023年12月31日的逐日细颗粒物（PM_2.5）、可吸入颗粒物（PM₁₀）、二氧化硫（SO₂）、二氧化氮（NO₂）、一氧化碳（CO）、臭氧（O₃）浓度数据，气象数据（气温、气压和相对湿度）以及哮喘儿童门诊就诊资料，采用基于类泊松分布的广义相加模型定量分析大气污染物短期暴露对儿童哮喘门诊就诊量的影响。
结果
2019—2023年南京市大气污染物PM_2.5、PM₁₀、SO₂、NO₂年平均浓度均未超过国家限值。单污染物模型分析显示PM_2.5、PM₁₀、NO₂、CO均对儿童哮喘就诊量的单日滞后效应均在污染当天时最大，污染物浓度每升高10个单位，超额风险（ER）值分别为1.39%（95%CI：0.65%~2.14%）、1.46%（95%CI：0.97%~1.95%）、5.46%（95%CI：4.36%~6.57%）、0.18%（95%CI：0.11%~0.26%），SO₂在lag1时达到最大效应，浓度每升高10个单位，ER值为23.15%（95%CI：13.57%~33.53%）。不同污染物最大累积滞后效应的时间不同，PM₁₀、PM_2.5、SO₂、NO₂、CO分别在lag01、lag01、lag02、lag02和lag03时的累积滞后效应最大，ER值分别为1.35%（95%CI：0.77%~1.92%）、0.96%（95%CI：0.10%~1.83%）、28.50%（95%CI：15.49%~42.98%）、6.92%（95%CI：5.53%~8.33%）和0.31%（95%CI：0.20%~0.42%）。PM_2.5、PM₁₀对儿童哮喘门诊量的影响随年龄的增大而增加，NO₂、SO₂和CO则呈现随年龄的增大而减小的现象。
结论
大气污染物（PM_2.5、PM₁₀、SO₂、NO₂、CO）会增加儿童哮喘就诊量，且不同污染物对不同年龄段儿童哮喘就诊量的影响不同。
- 大气污染物 /
- 儿童 /
- 哮喘 /
- 门诊就诊量 /
- 滞后效应
Abstract:
Background
Asthma poses a serious threat to children's growth, development, and mental health, thus there has been an increasing focus on the control of asthma morbidity in children and the assessment of its risk factors. A growing body of research has found that exposure to ambient air pollutants an significatly increase the risk of childhood asthma.
Objective
To understand the changes of ambient air pollutant concentrations in Nanjing and asthma outpatient visits to Nanjing Children's Hospital, and to quantitatively analyze the effects of exposure to different ambient air pollutants on children's asthma outpatient visits.
Methods
Daily data of ambient air pollutants fine particulate matter (PM_2.5), inhalable particle (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), ozone (O₃), meteorological factors (air temperature & relative humidity), and outpatient visits due to asthma in the hospital from January 1, 2019 to December 31, 2023 were collected, and a generalized additive model based on quasi poisson distributions was used to quantitatively analyze the short-term effects of ambient air pollutant exposure on outpatient visits due to asthma in the hospital.
Results
The annual average concentrations of PM_2.5, PM₁₀, SO₂, and NO₂ in Nanjing from 2019 to 2023 did not exceed the national limits. For single-day lagged effects, the single-pollutant model showed that the effects of PM_2.5, PM₁₀, NO₂, and CO on children's asthma outpatient visits were greatest for every 10 units increase at lag0, with excess risk (ER) of 1.39% (95%CI: 0.65%, 2.14%), 1.46% (95%CI: 0.97%, 1.95%), 5.46% (95%CI: 4.36%, 6.57%), and 0.18% (95%CI: 0.11%, 0.26%), respectively, and SO₂ reached the maximum effect at lag1, with an ER of 23.15% (95%CI: 13.57%, 33.53%) for each 10 units increase in concentration. Different pollutants reached their maximum cumulative lag effects at different time. The PM₁₀, PM_2.5, SO₂, NO₂, and CO showed the largest cumulative lag effects at lag01, lag01, lag02, lag02, and lag03, respectively, with ERs of 1.35% (95%CI: 0.77%, 1.92%), 0.96% (95%CI: 0.10%, 1.83%), 28.50% (95%CI: 15.49%, 42.98%), 6.92% (95%CI: 5.53%, 8.33%), and 0.31% (95%CI: 0.20%, 0.42%), respectively. The influences of PM_2.5 and PM₁₀ on outpatient visits due to asthma in the hospital became more pronounced with advancing age, while the associations with NO₂, SO₂, and CO were weakened as children grew older.
Conclusion
Ambient air pollutants (PM_2.5, PM₁₀, SO₂, NO₂, CO) can increase childhood asthma visits, and different pollutants have varied effects on the number of asthmatic children's visits at different ages.
- ambient air pollutant /
- child /
- asthma /
- outpatient visit /
- lag effect

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图 1 2019—2023年南京市大气污染物浓度每升高10 个单位时儿童哮喘的超额就诊风险[ER(95%CI)，%]

Figure 1. The excess risk of per 10 units increase in ambient air pollutants on outpatient visits of children with asthma in Nanjing from 2019 to 2023[ER (95%CI),%]

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图 2 2019—2023年南京市大气污染物浓度每升高10个单位时各年龄段儿童哮喘的超额就诊风险[ER(95%CI)，%]

A：PM_2.5（μg·m⁻³），B：PM₁₀（μg·m⁻³），C：NO₂（μg·m⁻³），D：O₃（μg·m⁻³），E：CO（mg·m⁻³），F：SO₂（μg·m⁻³）。

Figure 2. The excess risk of per 10 units increase in ambient air pollutants on outpatient visits for children with asthma by age group in Nanjing from 2019 to 2023[ER (95%CI), %]

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表 1 2019—2023年南京市大气污染物浓度、气象条件及儿童哮喘门诊量情况

Table 1 Ambient air pollutant concentrations, meteorological variables, and outpatient visits of children with asthma in Nanjing from 2019 to 2023

指标	Min	P₂₅	P₅₀	P₇₅	Max	超标天数/d
大气污染物
NO₂/(μg·m⁻³)	5.64	19.89	27.91	39.89	109.00	0
SO₂/(μg·m⁻³)	3.00	5.00	6.14	8.00	19.86	0
CO/(mg·m⁻³)	0.30	0.58	0.70	0.84	1.64	0
O₃/(μg·m⁻³)	9.36	70.00	100.56	136.84	241.07	252
PM_2.5/(μg·m⁻³)	4.00	18.14	27.00	39.57	140.79	0
PM₁₀/(μg·m⁻³)	6.36	36.00	51.67	74.63	304.07	0
气象条件
气温/℃	−4.80	9.40	17.90	25.30	35.40	—
相对湿度/%	31.00	61.00	72.00	84.00	100.00	—
日均门诊量/人次	0	14.00	23.00	32.00	85.00	—
[注] 根据GB 3095—2012《环境空气质量标准》中二级浓度限值要求，PM_2.5、PM₁₀、SO₂和NO₂年平均质量浓度（后简称为浓度）限值分别为35、70、60和40 μg·m⁻³，CO的24 h平均浓度限值为4 mg·m⁻³，O₃的日最大8 h平均浓度限值为160 μg·m⁻³。

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表 2 2019—2023年南京市大气污染物和气象因素相互之间的相关性（r）

Table 2 Correlations between ambient air pollutants and meteorological factors in Nanjing from 2019 to 2023 (r)

分类	PM₁₀	PM_2.5	NO₂	O₃	CO	SO₂	气温	相对湿度
PM₁₀	1
PM_2.5	0.900^*	1
NO₂	0.766^*	0.716^*	1
O₃	0.001^*	−0.103^*	−0.187^*	1
CO	0.544	0.623^*	0.581^*	−0.016	1
SO₂	0.549^*	0.446^*	0.551^*	0.190^*	0.580^*	1
气温	−0.433^*	−0.492^*	−0.471^*	0.649^*	−0.095^*	−0.083^*	1
相对湿度	−0.420^*	−0.172^*	−0.259^*	−0.335^*	0.098^*	−0.403^*	0.139*	1
[注]*：P<0.05。

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表 3 大气污染物对儿童哮喘门诊就诊量影响的双污染物及多污染物模型分析

Table 3 Dual- and multi-pollutant models of the impact of ambient air pollutants on outpatient visits of children with asthma

大气污染物	最佳滞后	双污染物模型						多污染物模型
大气污染物	最佳滞后	+PM₁₀	+PM_2.5	+NO₂	+O₃	+CO	+SO₂	多污染物模型
PM₁₀	lag0	—	2.68 (1.71~3.66)^*	0.06 (−0.53~0.69)	1.68 (1.17~2.19)^*	1.12 (0.50~1.75)^*	1.38 (0.85~1.92)^*	2.49 (1.48~3.51)^*
	lag01	—	1.23 (0.38~2.09)^*	−0.05 (−0.70~0.60)	1.45 (0.87~2.04)^*	0.78 (0.12~1.47)^*	1.18 (0.58~1.79)^*	1.05 (0.19~1.91)^*
PM_2.5	lag0	−2.10 (−3.51~−0.66)^*	—	−1.35 (−2.26~−0.42)^*	1.61 (0.83~2.39)^*	−0.003 (−1.08~1.08)	1.11 (0.31~1.92)^*	−4.30 (−5.93~−2.63)^*
	lag01	−2.45 (−3.74~−1.14)^*	—	−1.48 (−2.44~−0.50)^*	1.10 (0.22~1.99)^*	−0.64 (−1.72~0.45)	0.64 (−0.26~1.54)	−3.24 (−4.53~−1.93)^*
NO₂	lag0	5.38 (4.03~6.74)^*	6.67 (5.29~8.09)^*	—	5.57 (4.47~6.69)^*	6.58 (5.09~8.10)^*	6.54 (5.21~7.88)^*	7.11 (5.45~8.79)^*
	lag02	6.67 (5.02~8.34)^*	8.21 (6.50~9.96)^*	—	6.98 (5.59~8.38)^*	7.08 (5.44~8.75)^*	7.10 (5.61~8.61)^*	7.47 (5.68~9.29)^*
CO	lag0	0.08 (−0.01~0.17)	0.19 (0.08~0.29)^*	−0.11 (−0.21~−0.01)	0.20 (0.13~0.28)^*	—	0.17 (0.09~0.26)^*	0.04 (−0.08~0.17)
	lag03	0.19 (0.07~0.32)^*	0.28 (0.15~0.40)^*	0.10 (−0.02~0.22)	0.32 (0.21~0.43)^*	—	0.28 (0.17~0.40)^*	0.17 (0.04~0.30)^*
SO₂	lag1	17.51 (8.13~27.71)^*	19.84 (10.19~30.33)^*	11.01 (2.02~20.80)^*	23.16 (13.59~33.54)^*	17.78 (8.27~28.14)^*	—	13.15 (3.87~23.27)^*
	lag02	18.37 (5.81~32.43)^*	23.11 (9.97~37.82)	3.20 (−8.26~16.09)	28.89 (15.83~43.43)	18.23 (5.20~32.88)	—	5.00 (−6.88~18.39)
[注]*：P<0.05。

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