【摘要】：目的:1、了解2005-2014年合肥市精神分裂癥發(fā)作的分布特征;2、利用分布滯后非線性模型分析平均溫度與精神分裂癥發(fā)作的關(guān)系,并明確脆弱人群;3、探討溫度變異(晝夜溫差和相鄰兩日溫差)對(duì)精神分裂癥發(fā)作的影響。方法:收集合肥市2005年1月1日至2014年12月31日每日氣象數(shù)據(jù)資料,包括最高溫度,平均溫度,最低溫度,相對(duì)濕度和降雨量等。同期,收集合肥市精神衛(wèi)生中心每日入院的精神分裂癥發(fā)作資料,包括患者的發(fā)病時(shí)間,年齡,性別,現(xiàn)居地址,婚姻狀況和出生季節(jié)。采用泊松廣義線性回歸模型結(jié)合分布滯后非線性模型分析溫度變化(包括平均溫度,晝夜溫差和相鄰兩日溫差)與精神分裂癥發(fā)作的關(guān)系,調(diào)整季節(jié)性和長(zhǎng)期趨勢(shì)和星期幾效應(yīng)等混雜因素的影響。結(jié)果:(1)在2005-2014年研究期間內(nèi),合肥地區(qū)總共有36607人次因精神分裂癥發(fā)作入院,21-40歲就診人次顯著多于其余年齡組就診人次;已婚患者就診人次多于未婚患者,比例為2.7:1(26249:9809);冬季出生的患者就診人次多于其它季節(jié)出生的患者就診人次。(2)當(dāng)日均氣溫較高時(shí)(第75百分位數(shù):24.9°C),溫度對(duì)精神分裂癥發(fā)作有影響,并存在一定的滯后效應(yīng),其中滯后0-7天的累積效應(yīng)達(dá)到1.27%(95%CI:1.14-1.42)。在不同性別,年齡組,婚姻狀況和出生季節(jié)間,發(fā)現(xiàn)男性患者,21-60歲患者,已婚患者和春冬兩季出生的患者更易受到溫度升高的影響。(3)極端晝夜溫差改變(第95百分位數(shù):14.6°C)與精神分裂癥發(fā)作存在統(tǒng)計(jì)學(xué)關(guān)聯(lián),呈現(xiàn)急性效應(yīng)(RR=1.027,95%CI:1.007-1.047),且其危害效應(yīng)一直持續(xù)至滯后第六天。通過(guò)對(duì)個(gè)體特征進(jìn)行分層分析,分別發(fā)現(xiàn)男性,"g21歲,春秋兩季出生以及已婚精神分裂癥患者較其他患者更易受到極端晝夜溫差變化的影響。同時(shí),第二個(gè)5年(2010-2014)相比第一個(gè)5年(2005-2009),精神分裂癥患者受到極端晝夜溫差的危害效應(yīng)呈上升趨勢(shì)。然而,尚未發(fā)現(xiàn)中等程度的晝夜溫差變化(第75百分位數(shù):11°C)對(duì)精神分裂癥發(fā)作有影響。(4)較大的相鄰兩日溫差改變(第75百分位數(shù):1.4°C)可能會(huì)增加精神分裂癥發(fā)作的風(fēng)險(xiǎn),尤其在滯后當(dāng)天,危害效應(yīng)的增加達(dá)到1.9%(95%CI:0.4%-3.4%)。并且,找出脆弱人群的特征為21-40歲,已婚和春秋兩季出生的患者。結(jié)論:溫度上升和短時(shí)間內(nèi)溫度的快速變化能夠顯著地增加精神分裂癥發(fā)作的風(fēng)險(xiǎn),且溫度變化的危害效應(yīng)受到患者個(gè)體特征的修飾。整體而言,男性,21-40歲,已婚和春季出生的患者更易受到溫度變化對(duì)精神分裂癥發(fā)作的影響。
[Abstract]:Objective: To study the distribution of the onset of schizophrenia in Hefei from 2005 to 2014, and to analyze the relationship between the average temperature and the onset of schizophrenia by using the distributed lag non-linear model, and to identify the vulnerable groups. The effects of temperature variation (temperature difference between day and night and the temperature difference between two adjacent days) on the onset of schizophrenia were discussed. Method: Collect the daily meteorological data from January 1,2005 to December 31,2014, including the highest temperature, average temperature, minimum temperature, relative humidity and rainfall. In the same period, the information on the onset of schizophrenia, including the time, age, sex, living address, marital status and birth season, was collected on a daily basis in the mental health center of Hefei. The effect of temperature variation (including average temperature, day-and-night temperature difference and the adjacent two-day temperature difference) and the onset of schizophrenia was analyzed by a Poisson generalized linear regression model in combination with the distribution-lag nonlinear model, and the effects of seasonal and long-term and day-of-week effects were adjusted. Results: (1) During the study period from 2005 to 2014, a total of 36607 patients in Hefei were admitted to the hospital due to the onset of schizophrenia, and the number of visits to the 21-40 year-old patients was significantly higher than that of the other age groups; the number of visits to the married patients was 2.7:1 (26249:9809); The number of patients born in winter is more than that of the patients born in other seasons. (2) At the same day, the temperature was higher (the 75th percentile: 24.9 擄 C), and the temperature had an effect on the onset of the schizophrenia, and there was a certain lag effect, in which the cumulative effect of the delay of 0-7 days reached 1.27% (95% CI: 1.14-1.42). In the different sex, age group, marital status and the birth season, male patients,21-60 years of age, married patients and patients born in the spring of the winter are more likely to be affected by elevated temperature. (3) The extreme diurnal temperature difference (95th percentile: 14.6 擄 C) was statistically associated with the onset of schizophrenia, presenting an acute effect (RR = 1.027,95% CI: 1.007-1.047), and its hazard effect continued until the sixth day of the lag. By stratified analysis of individual characteristics, it was found that male, "g21", "Spring and Autumn" and married schizophrenia patients were more likely to be affected by extreme day and night temperature differences compared with other patients, while the second 5 years (2010-2014) were the first five years (2005-2009). The effect of extreme day and night temperature difference on the patients with schizophrenia is on the rise. However, A moderate degree of diurnal temperature change (75th percentile:11 擄 C) has not been found to have an effect on the onset of schizophrenia. (4) The larger adjacent two-day temperature difference (75th percentile: 1.4 擄 C) may increase the risk of the onset of schizophrenia, especially on the day of the lag, The increase in the hazard effect reached 1.9% (95% CI: 0.4%-3.4%) and found that the vulnerable population was characterized by 21-40 years of age, married and spring-and-autumn-born patients. Conclusion: The rapid change in temperature and the temperature in a short period of time can significantly increase the risk of the onset of schizophrenia. In general, men,21-40 years of age, married and spring-born patients are more susceptible to temperature changes on the onset of schizophrenia.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R749.3
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本文編號(hào)：2506129