發(fā)布時(shí)間：2018-05-29 17:06

  本文選題：大氣污染 + 缺血性心臟病��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1.了解太原市缺血性心臟病住院患者的基本情況。2.了解太原市大氣污染的基本情況。3.建立太原市大氣污染與缺血性心臟病日住院人數(shù)的關(guān)系模型,定量分析太原市大氣污染對缺血性心臟病日住院人數(shù)的影響。方法:采用生態(tài)學(xué)研究方法,收集2013年9月-2015年8月太原市5所省級三級甲等綜合性醫(yī)院的缺血性心臟病住院患者的電子病歷首頁資料,同時(shí)分別收集同期太原市每日大氣污染物的濃度資料與氣象資料。描述研究期間太原市大氣污染物、氣象因素、缺血性心臟病日住院人數(shù)的分布情況,采用時(shí)間序列研究的廣義相加模型建立太原市大氣污染對缺血性心臟病日住院人數(shù)的影響模型。結(jié)果:1.2013年9月-2015年8月共收集太原市缺血性心臟病住院人數(shù)14538例,其中男性住院人數(shù)多于女性,"g65歲住院人數(shù)多于65歲,春冬季住院人數(shù)多于夏秋季。2.2013年9月-2015年8月太原市主要大氣污染物為SO_2、PM_(10)、O_3、PM_(2.5)。四季主要污染物分布不同:春季主要污染物為PM_(10)與PM_(2.5),夏季主要污染物為O_3與PM_(2.5),秋、冬季主要污染物均為SO_2、PM_(10)與PM_(2.5),但冬季污染較秋季嚴(yán)重。3.按性別分析:單污染模型中,SO_2、PM_(10)、CO、O_3、PM_(2.5)對女性缺血性心臟病日住院人數(shù)影響的最強(qiáng)效應(yīng)滯后期分別為滯后1、4、1、0、4天,污染物濃度每增加一個(gè)四分位數(shù)間距缺血性心臟病日住院人數(shù)增加的RR值分別為1.02(95%CI:1.01-1.05)、1.10(95%CI:1.02-1.18)、1.03(95%CI:1.01-1.08)、1.13(95%CI:1.03-1.23)、1.08(95%CI:1.01-1.16),其暴露-反應(yīng)系數(shù)為污染物濃度每增加10μg/m~3,女性缺血性心臟病日住院人數(shù)增加的百分比分別為0.28%、1.22%、0.03%、1.87%、1.55%。雙污染模型中,分別調(diào)整NO_2、PM_(10)、CO、O_3、PM_(2.5)進(jìn)入SO_2模型,SO_2、NO_2、CO、O_3進(jìn)入PM_(10)模型,NO_2進(jìn)入CO模型,SO_2、NO_2、CO進(jìn)入O_3模型,SO_2、CO、O_3進(jìn)入PM_(2.5)模型后調(diào)整模型有統(tǒng)計(jì)學(xué)意義。單污染模型中,SO_2、PM_(10)、CO、O_3對男性缺血性心臟病日住院人數(shù)影響最強(qiáng)效應(yīng)滯后期分別為滯后3、0、2、0天,污染物濃度每增加一個(gè)四分位數(shù)間距男性缺血性心臟病日住院人數(shù)增加的RR值分別為1.02(95%CI:1.00-1.09)、1.13(95%CI:1.02-1.25)、1.04(95%CI:1.01-1.09)、1.11(95%CI:1.04-1.19),其暴露-反應(yīng)系數(shù)為污染物濃度每增加10μg/m~3,男性缺血性心臟病日住院人數(shù)增加的百分比分別為0.28%、1.62%、0.04%、1.73%。雙污染模型中,分別調(diào)整PM_(10)、CO、PM_(2.5)進(jìn)入SO_2模型,SO_2、NO_2、CO、O_3進(jìn)入PM_(10)模型,NO_2、PM_(10)、PM_(2.5)進(jìn)入CO模型,SO_2、NO_2、PM_(10)、CO、PM_(2.5)進(jìn)入O_3模型后調(diào)整模型有統(tǒng)計(jì)學(xué)意義。4.按年齡分析:單污染模型中,SO_2、PM_(10)、O_3對65歲缺血性心臟病日住院人數(shù)影響的最強(qiáng)效應(yīng)滯后期分別為滯后3、5、3天,污染物濃度每增加一個(gè)四分位數(shù)間距缺血性心臟病日住院人數(shù)增加的RR值分別為1.04(95%CI:1.01-1.09)、1.13(95%CI:1.03-1.25)、1.12(95%CI:1.05-1.20),其暴露-反應(yīng)系數(shù)為污染物濃度每增加10μg/m~3,65歲缺血性心臟病日住院人數(shù)增加的百分比分別為0.55%、1.57%、1.73%。雙污染模型中,分別調(diào)整NO_2、PM_(10)、CO、PM_(2.5)進(jìn)入SO_2模型,SO_2、NO_2、CO、O_3進(jìn)入PM_(10)模型,SO_2、NO_2進(jìn)入O_3模型后的調(diào)整模型有統(tǒng)計(jì)學(xué)意義。單污染模型中,SO_2、CO、PM_(2.5)對≥65歲缺血性心臟病日住院人數(shù)影響的最強(qiáng)效應(yīng)滯后期分別為滯后3、3、0天,污染物濃度每增加一個(gè)四分位數(shù)間距缺血性心臟病日住院人數(shù)增加的RR值分別為1.04(95%CI:1.01-1.07)、1.03(95%CI:1.02-1.09)、1.14(95%CI:1.06-1.22),其暴露-反應(yīng)系數(shù)為污染物濃度每增加10μg/m~3,≥65歲缺血性心臟病日住院人數(shù)增加的百分比分別為0.55%、0.03%、2.71%。雙污染模型中,分別調(diào)整NO_2、PM_(10)、PM_(2.5)進(jìn)入SO_2模型,SO_2、NO_2、PM_(2.5)進(jìn)入CO模型,SO_2、NO_2、CO、O_3進(jìn)入PM_(2.5)模型后的調(diào)整模型具有統(tǒng)計(jì)學(xué)意義。5.按季節(jié)分析:單污染模型中,PM_(10)和PM_(2.5)在春季對缺血性心臟病日住院人數(shù)影響的最強(qiáng)效應(yīng)滯后期分別為滯后0、5天,污染物濃度每增加一個(gè)四分位數(shù)間距缺血性心臟病日住院人數(shù)增加的RR值分別為1.02(95%CI:1.01-1.07)、1.07(95%CI:1.01-1.13),其暴露-反應(yīng)系數(shù)為污染物濃度每增加10μg/m~3,春季缺血性心臟病日住院人數(shù)增加的百分比分別為0.24%、1.35%。雙污染模型中,分別調(diào)整SO_2、NO_2、CO、O_3進(jìn)入PM_(10)模型,SO_2、NO_2、CO、O_3進(jìn)入PM_(2.5)模型后的調(diào)整模型具體統(tǒng)計(jì)學(xué)意義。單污染模型中,SO_2、O_3、PM_(2.5)在夏季對缺血性心臟病日住院人數(shù)影響的最強(qiáng)效應(yīng)滯后期分別為滯后4、0、2天,污染物濃度每升高一個(gè)四分位數(shù)間距缺血性心臟病日住院人數(shù)增加的RR值分別為1.04(95%CI:1.01-1.16)、1.07(95%CI:1.01-1.11)、1.12(95%CI:1.00-1.28),其暴露-反應(yīng)系數(shù)為污染物濃度每增加10μg/m~3,夏季缺血性心臟病日住院人數(shù)增加的百分比分別為0.55%、1.01%、2.32%。雙污染模型中,分別調(diào)整NO_2、PM_(10)、CO、O_3、PM_(2.5)進(jìn)入SO_2模型,SO_2、NO_2、CO、O_3進(jìn)入PM_(2.5)模型,SO_2、NO_2、PM_(10)、CO、PM_(2.5)進(jìn)入O_3模型后的調(diào)整模型具有統(tǒng)計(jì)學(xué)意義。單污染模型中,PM_(10)、O_3、PM_(2.5)在秋季對缺血性心臟病日住院人數(shù)影響的最強(qiáng)效應(yīng)滯后期分別為滯后0、4、0天,污染物濃度每升高一個(gè)四分位數(shù)間距缺血性心臟病日住院人數(shù)增加的RR值分別為1.21(95%CI:1.03-1.42)、1.16(95%CI:1.04-1.30)、1.17(95%CI:1.01-1.36),其暴露-反應(yīng)系數(shù)為污染物濃度每增加10μg/m~3,秋季缺血性心臟病日住院人數(shù)增加的百分比分別為2.53%、2.31%、3.29%。雙污染模型中,分別調(diào)整SO_2、NO_2、CO、O_3進(jìn)入PM_(10)模型,SO_2、NO_2、PM_(10)、CO進(jìn)入O_3模型,NO_2、CO、O_3進(jìn)入PM_(2.5)模型。單污染模型中,SO_2、PM_(10)、PM_(2.5)在冬季對缺血性心臟病日住院人數(shù)影響的最強(qiáng)效應(yīng)滯后期分別為滯后4、4、4天,污染物濃度每升高一個(gè)四分位數(shù)間距缺血性心臟病日住院人數(shù)增加的RR值分別為1.52(95%CI:1.00-2.18)、1.17(95%CI:1.01-1.36)、1.20(95%CI:1.03-1.39),其暴露-反應(yīng)系數(shù)為污染物濃度每增加10μg/m~3,冬季缺血性心臟病日住院人數(shù)增加的百分比分別為7.15%、2.05%、3.87%。雙污染模型中,分別調(diào)整NO_2、PM_(10)、CO、O_3、PM_(2.5)引入SO_2模型,O_3進(jìn)入PM_(10)模型,SO_2、NO_2、O_3進(jìn)入PM_(2.5)模型后的調(diào)整模型具有統(tǒng)計(jì)學(xué)意義。結(jié)論:大氣污染物SO_2、PM_(10)、CO、O_3、PM_(2.5)均可增加缺血性心臟病日住院人數(shù),具有一定的滯后效應(yīng)與暴露-反應(yīng)關(guān)系,并且隨不同性別、年齡、季節(jié)而不同。
[Abstract]:Objective: 1. understand the basic situation of ischemic heart disease in Taiyuan,.2. understand the basic situation of air pollution in Taiyuan city.3. establish the relationship model of air pollution and ischemic heart disease in Taiyuan, quantitative analysis of the influence of air pollution on the number of ischemic heart disease in Taiyuan. Study methods, collected data of the first page of the electronic medical records of inpatients of ischemic heart disease in 5 provincial level three grade first class hospitals in Taiyuan in September 2013 and August, and collect the daily atmospheric pollutant concentration and meteorological data in the same period of Taiyuan, and describe the atmospheric pollutants, meteorological factors and ischemic factors in the period of the study of Taiyuan. The distribution of the number of hospitalized heart disease days, using the generalized additive model of time series study to establish the influence model of air pollution in Taiyuan on the number of ischemic heart disease in Taiyuan. Results: in August -2015 September, 14538 cases of ischemic heart disease in Taiyuan were collected, and the number of hospitalized men was more than that of women, "G65 years old." The number of hospitalized people is more than 65 years old. The number of inpatients in spring and winter is more than that in summer and autumn.2.2013 years and September -2015 years in August. The main air pollutants in Taiyuan city are SO_2, PM_ (10), O_3, PM_ (2.5). The main pollutants in the four seasons are different: the main pollutants in the spring are PM_ (10) and PM_ (2.5), the main pollutants in the summer season are O_3 and PM_ (2.5), and the main pollutants in autumn and winter are SO_2, PM. (10) and PM_ (2.5), but the winter pollution is more severe than the autumn.3. by sex analysis: in the single pollution model, SO_2, PM_ (10), CO, O_3, PM_ (2.5) have the strongest lag behind the lag 1,4,1,0,4 days for the number of patients with ischemic heart disease, and the increase of the concentration of the pollutants is increased by a four quantile interval, and the number of hospitalized days of ischemic heart disease increases. The added RR values were 1.02 (95%CI:1.01-1.05), 1.10 (95%CI:1.02-1.18), 1.03 (95%CI:1.01-1.08), 1.13 (95%CI:1.03-1.23), and 1.08 (95%CI:1.01-1.16). The exposure reaction coefficient was 10 mu per increase of the concentration of pollutants, and the increase in the number of inpatients in the days of ischemic heart disease was 0.28%, 1.22%, 0.03%, 1.87%, and 1.55%. double pollution models, respectively. NO_2, PM_ (10), CO, O_3, PM_ (2.5) entered SO_2 model respectively, SO_2, NO_2, CO, O_3 entered PM_ (10) model. The latter was delayed 3,0,2,0 days respectively. The increased RR value of the number of male ischemic heart disease days with each increase of four quantile spacing was 1.02 (95%CI:1.00-1.09), 1.13 (95%CI:1.02-1.25), 1.04 (95%CI:1.01-1.09), 1.11 (95%CI:1.04-1.19), and the exposure reaction coefficient was 10 mu per increase of the concentration of pollutants. /m~3, the percentage of male ischemic heart disease days increased in 0.28%, 1.62%, 0.04%, and 1.73%. double pollution model, adjusting PM_ (10), CO, PM_ (2.5) into SO_2 model, SO_2, NO_2, CO, O_3 into PM_ (10) model, NO_2, 10, 2.5, 2.5 Study significance.4. according to age analysis: in single pollution model, SO_2, PM_ (10), the strongest effects of O_3 on 65 year old ischemic heart disease days were lagging behind 3,5,3 days respectively. The RR value of the number of inpatients increased by each four quantile interval of four quantile interval was 1.04 (95%CI:1.01-1.09) and 1.13 (95%CI:1). .03-1.25), 1.12 (95%CI:1.05-1.20), the percentage of the exposure response coefficient was 0.55%, 1.57%, and 1.73%. in the 0.55%, 1.57%, and 1.73%. double pollution model, respectively, to adjust NO_2, PM_ (10), CO, PM_ (2.5) into the SO_2 model, SO_2, NO_2, CO, and entered the 10 model. The adjustment model after 3 model was statistically significant. In the single pollution model, SO_2, CO, and PM_ (2.5) were respectively lagging behind 3,3,0 days for the strongest effect in the hospitalization of ischemic heart disease more than 65 years old, and the RR value of the increase of the number of inpatients with each increase of the concentration of four quantiles of the pollutant concentration was 1.04 (95%CI:1.01-1. 07), 1.03 (95%CI:1.02-1.09), 1.14 (95%CI:1.06-1.22), the exposure response coefficient was 10 mu g/m~3 per increase, and the percentage of the number of ischemic heart disease days increased in 0.55%, 0.03%, and 2.71%. were respectively adjusted to NO_2, PM_ (10) and PM_ (2.5) into SO_2 model, SO_2, NO_2, PM_ (2.5) entered the CO model. The adjustment model of NO_2, CO, O_3 after entering PM_ (2.5) model has statistical significance in seasonal analysis: in the single pollution model, the strongest effect lag behind PM_ (10) and PM_ (2.5) in the spring for ischemic heart disease days is lagged 0,5 days respectively, and the concentration of pollutants is increased by an four quantile interval of ischemic heart day. The increased RR values were 1.02 (95%CI:1.01-1.07), 1.07 (95%CI:1.01-1.13), the exposure reaction coefficient was 10 g/m~3 per increase of the concentration of pollutants, the percentage of the increase in the number of inpatients in the day of ischemic heart disease was 0.24% respectively. In the 1.35%. double pollution model, SO_2, NO_2, CO, and O_3 entered the PM_ (10) model respectively. The adjustment model after the PM_ (2.5) model was statistically significant. In the single pollution model, the strongest effect lag behind the SO_2, O_3, and PM_ (2.5) in the summer was 4,0,2 days respectively, and the RR value of the increase of the number of ischemic heart disease days with each increase of four quantile spacing was 1.04 (9). 5%CI:1.01-1.16), 1.07 (95%CI:1.01-1.11), 1.12 (95%CI:1.00-1.28), its exposure response coefficient is 10 mu per increase of the concentration of pollutants, the percentage of the increase in the number of inpatients in the summer of ischemic heart disease is 0.55%, 1.01%, and 2.32%. double pollution model, NO_2, PM_ (10), CO, O_3, PM_ (2.5) into the SO_2 model. SO_2, SO_2, PM_ (2.5) are entered. The PM_ (2.5) model, SO_2, NO_2, PM_ (10), CO, PM_ (2.5) entered the O_3 model with statistical significance. In the single pollution model, the strongest effect lag time of PM_ (10), O_3, PM_ (2.5) on the number of ischemic heart disease days in autumn is divided into lagging 0,4,0 days, and the concentration of pollutants is increased by a four quantile interval. The increase in the number of hospitalized heart disease days was 1.21 (95%CI:1.03-1.42), 1.16 (95%CI:1.04-1.30) and 1.17 (95%CI:1.01-1.36). The exposure response coefficient was 10 mu per increase of the concentration of pollutants, and the percentage of the increase in the number of inpatients in the autumn ischemic heart disease was 2.53%, 2.31%, and 3.29%. double pollution models, respectively, to adjust SO_2, NO_2, CO respectively. O_3 entered the PM_ (10) model, SO_2, NO_2, PM_ (10), and CO entered the O_3 model, NO_2, CO, O_3 entered the PM_ (2.5) model. In the single pollution model, SO_2, 10, and 2.5 were lagging behind the strongest effects in the winter hospitalization for ischemic heart disease, and the concentration of pollutants increased by a four quantile interval of ischemic heart disease. The increased RR values of daily inpatients were 1.52 (95%CI:1.00-2.18), 1.17 (95%CI:1.01-1.36) and 1.20 (95%CI:1.03-1.39). The exposure response coefficient was 10 mu per increase of the concentration of pollutants, and the percentage of the increase in the number of inpatients in winter ischemic heart disease was 7.15%, 2.05%, and 3.87%. double pollution models, respectively, NO_2, PM_ (10), CO, O_3, P. M_ (2.5) introduced the SO_2 model, O_3 entered the PM_ (10) model, SO_2, NO_2, and O_3 entered PM_ (2.5) model with statistical significance. Conclusion: air pollutants SO_2, PM_ (10), CO, O_3, 2.5) can increase the number of ischemic heart disease days, with a certain lag effect and exposure response relationship, and with different sex, age, season. The festival is different.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R122;R541.9

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