本文選題：NO_2 + PM_(10)��； 參考：《華中科技大學(xué)》2013年博士論文

【摘要】：目的：分析海南地區(qū)出生缺陷的基本情況、影響因素及變化趨勢，研究孕期空氣污染物暴露與出生缺陷、早產(chǎn)以及低出生體重等妊娠不良結(jié)局的關(guān)系，探討降低出生缺陷、早產(chǎn)和低出生體重等妊娠不良結(jié)局的預(yù)防策略，為公共衛(wèi)生決策提供科學(xué)依據(jù)。 方法：1.利用海南省2000～2010年以醫(yī)院為基礎(chǔ)的出生缺陷監(jiān)測資料，對(duì)海南地區(qū)出生缺陷總發(fā)生率、發(fā)生順位、城鄉(xiāng)的發(fā)生率、圍產(chǎn)兒性別的發(fā)生率等特征進(jìn)行描述；采用Poisson回歸法對(duì)出生缺陷發(fā)生率的城鄉(xiāng)差異、性別差異和在孕母年齡上的差異進(jìn)行分析，了解海南地區(qū)出生缺陷的一般影響因素；利用海口、三亞兩市2009～2011年的空氣污染資料和出生登記資料，采用成組設(shè)計(jì)的病例-對(duì)照研究法，采用t檢驗(yàn)和logistic回歸法，分析孕期不同階段空氣污染物暴露與出生缺陷的關(guān)系； 2.利用�？谑�2009～2011年的空氣污染資料、氣象資料及出生登記系統(tǒng)的活產(chǎn)兒早產(chǎn)、低出生體重等出生情況資料，采用Poisson廣義相加模型進(jìn)行時(shí)間序列分析，研究空氣污染物暴露與早產(chǎn)和低出生體重的關(guān)系。 結(jié)果：1.2001～2010年海南省出生缺陷總發(fā)生率99.13/萬，低于全國平均水平；出生缺陷發(fā)生率城市低于農(nóng)村(IRR=0.765，95%CI：0.715-0.819，P0.001)；男性圍產(chǎn)兒高于女性圍產(chǎn)兒(IRR=1.092，95%CI：1.021-1.169，P=0.010)；出生缺陷發(fā)生率與孕母年齡相關(guān)，20歲年齡組和≥35歲年齡組發(fā)病率較高，且組間沒有差異(P0.05)，其次為20～25歲年齡組(IRR=0.816，95%CI：0.701-0.949，P=0.008)、25～30歲(IRR=0.761，95%CI：0.655-0.883，P0.001)及30～35歲年齡組(IRR=0.731，95%CI：0.623-0.858，P0.001)。 2.孕早期空氣污染物PM_(10)的暴露對(duì)出生缺陷有不良影響。�？谑卸辔廴疚飈ogistic回歸調(diào)整模型結(jié)果顯示，在控制了一般因素和另外兩種污染物的影響后，妊娠第2月(OR=1.039，95%CI：1.016-1.063，P=0.001)與第3月(OR=1.066，95%CI：1.043-1.090，P0.001)空氣中PM_(10)的暴露對(duì)出生缺陷的總發(fā)生率有不良影響。三亞市多污染物logistic回歸調(diào)整模型結(jié)果顯示，妊娠第3月(OR=1.025，95%CI：1.006-1.044，P=0.009)空氣中PM_(10)的暴露對(duì)出生缺陷總發(fā)生率有不良影響。�？谑锌諝馕廴疚锉┞杜c先天性心臟病和唇腭裂的關(guān)系研究顯示，�？谑性性缙诳諝庵蠵M_(10)的暴露為先天性心臟病的影響因素(OR=1.103，95%CI：1.023-1.190，P=0.011)。而所研究的三種污染物孕早期對(duì)嬰兒唇腭裂發(fā)生的影響無統(tǒng)計(jì)學(xué)意義。 3.�？谑写髿庵饕廴疚颬M_(10)和SO_2濃度水平對(duì)早產(chǎn)發(fā)生率有不利影響，全污染物模型擬合分析結(jié)果顯示，PM_(10)污染物滯后當(dāng)天對(duì)新生兒日早產(chǎn)數(shù)影響的相對(duì)危險(xiǎn)度為1.016(95%CI：1.003-1.030，P0.05)；SO_2污染物累積6天對(duì)新生兒日早產(chǎn)數(shù)影響的相對(duì)危險(xiǎn)度為1.141(95%CI：1.039-1.242，P0.05)；大氣主要污染物PM_(10)對(duì)低出生體重發(fā)生率有不利影響，PM_(10)污染物滯后1天對(duì)新生兒日低出生體重?cái)?shù)影響的相對(duì)危險(xiǎn)度為1.024(95%CI：1.011-1.038，P0.05)；累積6天對(duì)新生兒日低出生體重?cái)?shù)影響的相對(duì)危險(xiǎn)度為1.064(95%CI：1.042-1.087，P0.05)。 結(jié)論：孕早期空氣污染物PM_(10)的暴露是出生缺陷和先天性心臟病的危險(xiǎn)因素；大氣主要污染物SO_2和PM_(10)的濃度水平與早產(chǎn)率發(fā)生有關(guān)，，PM_(10)濃度水平與新生兒低出生體重率發(fā)生有關(guān)；一級(jí)預(yù)防是控制和減少妊娠不良結(jié)局最具成本效益的預(yù)防措施，要考慮探討醫(yī)療保健部門與環(huán)境監(jiān)控與保護(hù)部門聯(lián)動(dòng)的預(yù)防機(jī)制，努力發(fā)揮一級(jí)預(yù)防的效力。
[Abstract]:Objective: to analyze the basic conditions, influencing factors and trends of birth defects in Hainan, to study the relationship between the exposure of air pollutants and birth defects, preterm birth and low birth weight, and to explore the prevention strategies for reducing the adverse outcomes of pregnancy, such as birth defects, preterm birth and low birth weight, and to make public health decisions. Provide a scientific basis.
Methods: 1. the birth defect monitoring data based on the hospital in Hainan province for 2000~2010 years was used to describe the total incidence of birth defects in Hainan, the occurrence of birth defects, the incidence of urban and rural areas and the incidence of perinatal sex, and the difference in the incidence of birth defects, gender differences and the year of pregnant mother by the Poisson regression method. The difference in age was analyzed in order to understand the general factors of birth defects in Hainan area. Using the data of air pollution and birth registration in two cities of Haikou, Sanya, and 2009~2011 years, a group designed case control study was used, and t test and logistic regression were used to analyze the exposure of air pollutants and birth defects at different stages of pregnancy. The relationship of depression;
2. the relationship between air pollution exposure and premature birth and low birth weight was studied by using the data of air pollution in Haikou for 2009~2011 years, the data of birth registration system and birth registration system, such as premature birth, low birth weight, and other birth data. The Poisson generalized additive model was used to analyze the time series.
Results: the total incidence of birth defects in Hainan province from 1.2001 to 2010 was 99.13/ million, which was lower than the national average; the incidence of birth defects in cities was lower than that in rural areas (IRR=0.765,95%CI:0.715-0.819, P0.001); male perinatal infants were higher than female perinatal infants (IRR=1.092,95%CI:1.021-1.169, P= 0.010), and the incidence of birth defects was related to the age of pregnant women, 20 The incidence of the age group and the age group over 35 years was higher, and there was no difference between the groups (P0.05), followed by 20~25 year old age group (IRR=0.816,95%CI:0.701-0.949, P=0.008), 25~30 years (IRR=0.761,95%CI:0.655-0.883, P0.001) and 30~35 year old age group (IRR=0.731,95%CI: 0.623-0.858, P0.001).
The exposure to air pollutants PM_ (10) in the early 2. pregnancies had adverse effects on birth defects. The Haikou multi pollutant logistic regression model showed that after the control of the general factors and the effects of the other two pollutants, second months of pregnancy (OR=1.039,95%CI:1.016-1.063, P=0.001) and third months (OR=1.066,95%CI:1.043-1.090, P0.001) air The exposure of PM_ (10) had adverse effects on the total incidence of birth defects. The Sanya multi pollutant logistic regression model showed that the exposure to PM_ (10) in the air of third months of pregnancy (OR=1.025,95%CI:1.006-1.044, P=0.009) had adverse effects on the total incidence of birth defects. Air pollutants were exposed to congenital heart disease and congenital heart disease in Haikou. The study of the relationship between cleft lip and palate shows that the exposure of PM_ (10) in the early stage of pregnancy in Haikou is an influential factor of congenital heart disease (OR=1.103,95%CI:1.023-1.190, P=0.011). The effect of the early pregnancy of the three kinds of pollutants on cleft lip and palate in infants is not statistically significant.
3. the level of PM_ (10) and SO_2 concentration of main pollutants in Haikou had adverse effects on the incidence of premature birth. The result of the model fitting analysis showed that the relative risk was 1.016 (95%CI:1.003-1.030, P0.05) for the daily premature birth of newborns with PM_ (10), and SO_2 pollutants accumulated for 6 days of neonatal daily preterm birth. The relative risk was 1.141 (95%CI:1.039-1.242, P0.05), and the main pollutant PM_ (10) had an adverse effect on the incidence of low birth weight. The relative risk of the PM_ (10) pollutant lag 1 days to the neonatal daily low birth weight was 1.024 (95%CI:1.011-1.038, P0.05), and the cumulative 6 days for the neonatal daily low birth weight. The relative risk of noise was 1.064 (95%CI:1.042-1.087, P0.05).
Conclusion: exposure to air pollutants PM_ (10) in the early pregnancy is a risk factor for birth defects and congenital heart disease. The concentration level of SO_2 and PM_ (10) of major air pollutants is related to the incidence of premature birth. The concentration level of PM_ (10) is related to the incidence of low birth weight of the newborn; primary prevention is the most effective control and reduction of bad pregnancy outcome. The preventive measures for this benefit should consider the preventive mechanism of linkage between the medical care department and the environmental monitoring and protection department, so as to exert the effectiveness of primary prevention.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R114

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