本文關鍵詞：廣州、哈爾濱氣象及空氣污染因素與腦卒中入院人數(shù)關系的研究　出處：《南方醫(yī)科大學》2017年博士論文　論文類型：學位論文

  更多相關文章： 腦卒中 空氣污染 氣象 入院風險

【摘要】：研究背景腦卒中是一種病死率、致殘率較高的疾病,氣象、空氣污染是腦卒中的危險因素之一。通過本研究,分析廣州、哈爾濱氣象、空氣污染因素變化與人群出血性腦卒中入院風險(HSr)、缺血性腦卒中入院風險(ISr)的關系。方法收集從2009年1月1日至2014年12月31日,觀察醫(yī)院的腦卒中入院病例、氣象和大氣污染物資料。為了簡述,平均氣溫簡稱氣溫,相對濕度簡稱濕度,N02濃度簡稱NO2,SO2濃度簡稱SO2,PM10濃度簡稱PM10。采用描述性統(tǒng)計分析數(shù)據的分布,用廣義相加、分布滯后非線性模型展開研究。統(tǒng)計分析用R軟件完成。結果共收集到病例108991例,其中廣州67640例、哈爾濱41351例,缺血性腦卒中83060例、出血性腦卒中25931例。1.氣象因素與腦卒中的關系(1)氣溫的影響。分別以廣州23℃(50th)時及哈爾濱7(50th)時的腦卒中入院人數(shù)為參考值,發(fā)現(xiàn):在廣州,當氣溫為7℃時(1th),HSr上升,RR:1.251(95%CI:1.109-1.412);在哈爾濱,當氣溫為 27℃時(75th),HSr 下降,RR:0.54(95%CI:0.448-0.650)。在廣州,當氣溫為 31℃時(99th),ISr 上升,RR:1.089(95%CI:1.022-1.162)。(2)相對濕度的影響。分別以廣州濕度79%(50th)時及哈爾濱濕度68%(50th)時的腦卒中入院人數(shù)為參考值,發(fā)現(xiàn):相對濕度與兩地的出血性腦卒中入院風險無顯著相關性。在廣州,當濕度97%(99th)時,ISr下降,RR:0.913(95%CI:0.866-0.963);在哈爾濱,當濕度 29%(1th)時,ISr 下降,RR:0.851(95%CI:0.779-0.929)。(3)氣溫差的影響。分別以廣州氣溫差8℃(50th)時及哈爾濱氣溫差12℃(50th)時的腦卒中入院人數(shù)為參考值,發(fā)現(xiàn):在廣州,當氣溫差5℃(25th)時,HSr 上升,RR:1.058(95%CI:1.006-1.114);氣溫差 10℃(75th)時,HSr 下降,RR:0.934(95%CI:0.896-0.975)。在哈爾濱,當氣溫差 22℃(99th)時,HSr 下降,RR:0.805(95%CI:0.670-0.966)。在廣州,當氣溫差 16℃(99th)時,ISr 下降,RR:0.912(95%CI:0.855-0.972);在哈爾濱,當氣溫差 3℃(1th)時,ISr下降,RR:0.898(95%CI:0.816-0.989)。2.空氣污染與腦卒中的關系(1)N02的影響。分別以兩地NO2濃度值(40μg/m3)時腦卒中入院人數(shù)為參考值,發(fā)現(xiàn):在廣州,當NO2為128μg/m3(99th)時,HSr上升,RR:1.282(95%CI:1.140-1.441)。在廣州,當 NO2 為 128μg/m3(99th)時,ISr 上升,RR:1.124(95%CI:1.062,1.190);在哈爾濱,當 N02為137μg/m3(99th 時,ISr上升,RR:1.131(95%CI:1.045,1.223)。(2)S02的影響。分別以兩地S02濃度值(20μg/m3)時腦卒中入院人數(shù)為參考值,發(fā)現(xiàn):在廣州,當SO2為34μμg/m3(75th)時,HSr上升,RR:1.045(95%CI:1.004-1.088)。在廣州,當 SO2 為4μg/m3(1th)時,Isr 下降;RR:0.897(95%CI:0.865,0.942);當 SO2 為 85μg/m3(99th)時,ISr 上升,RR:1.062(95%CI:1.012,1.154)。在哈爾濱,當 S02為 203μg/m3(99th)時,ISr上升,RR:1.255(95%CI:1.114,1.413)。(3)PM10的影響。分別以兩地PM10濃度值(5μg/m3)時腦卒中入院人數(shù)為參考值,發(fā)現(xiàn):在廣州,當PM10為178μg/m3(99th)時:HSr上升,RR:1.128(95%CI:1.007-1.264);ISr上升,RR:1.107(95%CI:1.054-1.163)。在哈爾濱,119μg/m3(75th)時,ISr 下降,RR:0.961(95%CI:0.931-0.992)。3.氣溫與腦卒中的滯后關系(1)氣溫與HSr的關系。分別以廣州23℃(50th)時及哈爾濱7℃(50th)時的腦卒中入院人數(shù)為參考值,發(fā)現(xiàn):7℃(1th)時,廣州HSr滯后1天的風險最高,RR:1.106(95%CI:1.043,1.172);27℃(99th)時,哈爾濱HSr滯后 1天的風險最高,RR:0.838(95%CI:0.751,0.935)。(2)氣溫與ISr的關系。分別以廣州23℃(50th)時及哈爾濱7℃(50th)時的腦卒中入院人數(shù)為參考值,發(fā)現(xiàn):7℃(1th)時,廣州ISr滯后1天的風險最高,RR:0.951(95%CI:0.928,0.976)。-25℃(1th)時,哈爾濱 ISr 滯后 1天的風險最高,RR:1.086(95%CI:1.012,1.165)。27℃(99th)時,哈爾濱ISr滯后 1 天的風險最高,RR:0.926(95%CI:0.879,0.975)。4.空氣污染與廣州腦卒中的滯后關系(1)NO2的影響。HSr滯后1天的風險最高,RR:1.011(95%CI:1.006,1.016)。ISr滯后 1 天的風險最高,RR:1.002(95%CI:1.000,1.005)。(2)SO2的影響。HSr滯后1天的風險最高,RR:1.008(95%CI:1.001,1.014)。ISr 滯后 1 天的風險最高,RR:1.004(95%CI:1.001,1.006)。(3)PM10 的影響。HSr滯后 1 天的風險最高,RR:1.004(95%CI:1.001,1.007)。ISr 滯后 1 天的風險最高,RR:1.001(95%CI:1.000,1.002)。結論1、氣溫與出血性、缺血性腦卒中相關,存在暴露反應及滯后效應。2、相對濕度與缺血性腦卒中相關,廣州高相對濕度降低入院風險,哈爾濱低相對濕度降低入院風險。3、NO2、SO2、PM10與腦卒中入院風險相關,但對兩個地區(qū)不同卒中類型的效應不同,且滯后和累積滯后效應不同。
[Abstract]:Background stroke is a higher morbidity mortality rate, meteorological diseases, air pollution is one of the risk factors of stroke. Through this research, analysis of Guangzhou, Harbin meteorology, stroke admission hemorrhage risk factors of air pollution and population change (HSr), short hospital ischemic stroke risk (ISr).. methods from January 1, 2009 to December 31, 2014, the observation of hospital stroke hospitalized cases, meteorological and air pollution data. In order to the average temperature as temperature, relative humidity or humidity, the concentration of N02 or NO2, the concentration of SO2 referred to as SO2, the concentration of PM10 PM10. using the descriptive statistical analysis of the data distribution, a general additive, distributed lag the nonlinear model is studied. Statistical analysis was completed by R software. The results were collected in 108991 cases, including 67640 cases of Guangzhou, Harbin 41351 cases, 83060 cases were ischemic stroke, a The relationship between ischemic stroke and 25931 cases of.1. and meteorological factors of stroke (1). The influence of air temperature in Guangzhou were 23 C (50th) and Harbin 7 (50th) stroke admission number as the reference value, we found that in Guangzhou, when the temperature is 7 degrees centigrade (1th), HSr Rose RR:1.251 (95%CI:1.109-1.412); in Harbin, when the temperature is 27 degrees centigrade (75th), HSr decreased, RR:0.54 (95%CI:0.448-0.650). In Guangzhou, when the temperature is 31 degrees centigrade (99th), ISr increased, RR:1.089 (95%CI:1.022-1.162). (2) the effect of relative humidity. Humidity respectively in Guangzhou 79% (50th) and Harbin 68% humidity (50th) stroke admission number as the reference value, found that the relative humidity and the two hemorrhagic stroke risk was not significantly correlated. In Guangzhou, when the humidity is 97% (99th), ISr decreased, RR:0.913 (95%CI:0.866-0.963); in Harbin, when the humidity is 29% (1th), ISr decreased RR:0.851 (95%CI:0.779-0.929 ).(3)姘旀俯宸殑褰卞搷.鍒嗗埆浠ュ箍宸炴皵娓╁樊8鈩，

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