【摘要】：研究目的流行病學(xué)相關(guān)研究提示,兒童呼吸系統(tǒng)疾病患病率、癥狀發(fā)生率以及肺功能降低均與大氣污染物存在一定的相關(guān)性。本研究選擇在濟(jì)南市空氣污染較重的區(qū)域(歷城區(qū))背景下,開(kāi)展空氣污染物與小學(xué)生健康狀況的連續(xù)性監(jiān)測(cè),評(píng)估高濃度空氣污染情況下的小學(xué)生病癥率以及肺功能的健康效應(yīng),旨在初步探索嚴(yán)重空氣污染情況下小學(xué)生健康影響的變化趨勢(shì)與顯著特征,為今后的相關(guān)研究奠定基礎(chǔ),同時(shí)依據(jù)研究結(jié)果,提出針對(duì)性的措施與建議,為本地空氣污染影響下的低年齡段人群(兒童)的健康干預(yù)、健康管理提供基礎(chǔ)依據(jù),指導(dǎo)學(xué)生和家長(zhǎng)做好個(gè)人的防護(hù)與保護(hù),減少健康損失。研究方法選取濟(jì)南市空氣污染相對(duì)較重的歷城區(qū)(重工業(yè)、化工企業(yè)區(qū)較多)作為本項(xiàng)研究的實(shí)施區(qū)域,選擇歷城區(qū)內(nèi)空氣質(zhì)量環(huán)保監(jiān)測(cè)站點(diǎn)——寶勝電纜監(jiān)測(cè)點(diǎn)2公里范圍內(nèi)的一所小學(xué)學(xué)校作為研究現(xiàn)場(chǎng),對(duì)該校三至五年級(jí)的所有在校學(xué)生開(kāi)展連續(xù)性監(jiān)測(cè)。本次調(diào)查為自愿性參加,調(diào)查對(duì)象簽署知情同意書(shū),最終納入研究者共計(jì)614人。本項(xiàng)研究采用重復(fù)性測(cè)量設(shè)計(jì)調(diào)查小學(xué)生每周疾病、癥狀出現(xiàn)情況與空氣污染的相關(guān)性,采用現(xiàn)況研究設(shè)計(jì)評(píng)估小學(xué)生肺功能與空氣污染的相關(guān)性。小學(xué)生每周疾病和癥狀出現(xiàn)情況采用自行設(shè)計(jì)的調(diào)查問(wèn)卷于每周五下午由班級(jí)輔導(dǎo)員集中收集本班級(jí)內(nèi)學(xué)生從本周六開(kāi)始至周五期間的健康狀況,調(diào)查問(wèn)卷由學(xué)生家長(zhǎng)和學(xué)生本人共同完成填寫(xiě)。問(wèn)卷調(diào)查時(shí)間范圍為2014年11月15日~12月26日,共計(jì)6周。在問(wèn)卷調(diào)查開(kāi)始前和結(jié)束時(shí),分別開(kāi)展一次小學(xué)生肺功能檢測(cè),檢測(cè)對(duì)象均為意愿參與問(wèn)卷調(diào)查者,采用分層整群隨機(jī)抽樣方法,分別從三年級(jí)、四年級(jí)、五年級(jí)各抽取一個(gè)班級(jí)開(kāi)展肺功能檢測(cè),累計(jì)檢測(cè)小學(xué)生149人。肺功能檢測(cè)指標(biāo)包括用力肺活量(FVC)、1秒用力呼氣量(FEV1)、呼氣流速峰值(PEF)、25%FVC時(shí)的用力呼氣流量(V25/PEF75)、75%FVC時(shí)的用力呼氣流量(V75/PEF25)。同時(shí)收集空氣質(zhì)量環(huán)保監(jiān)測(cè)站點(diǎn)寶勝電纜監(jiān)測(cè)點(diǎn)2014年11月1日~12月31日期間的細(xì)顆粒物(PM_2.5)、可吸入顆粒物(PM_10)、一氧化碳(CO)、二氧化氮(NO_2)、二氧化硫(SO_2)以及臭氧(O_3)六種污染物日均濃度數(shù)據(jù)以及同期濟(jì)南市日均溫度和相對(duì)濕度數(shù)據(jù)。描述性分析研究對(duì)象的基本特征和研究期間的空氣污染物時(shí)間分布特征,計(jì)算小學(xué)生連續(xù)性測(cè)量期間每周的疾病患病率、癥狀出現(xiàn)率,比較各周疾病患病率和癥狀出現(xiàn)率的差異,分析每周疾病患病率和癥狀出現(xiàn)率與每周六種空氣污染物濃度的相關(guān)性,評(píng)估空氣污染物濃度升高時(shí)的疾病與癥狀發(fā)生風(fēng)險(xiǎn);比較小學(xué)生兩次短時(shí)間內(nèi)不同空氣污染暴露濃度下的肺功能各項(xiàng)指標(biāo)差異,同時(shí)按照性別、年齡分層,進(jìn)一步分析不同空氣污染暴露情況下的短期肺功能變化效應(yīng)。結(jié)果連續(xù)監(jiān)測(cè)結(jié)果分析顯示,呼吸系統(tǒng)疾病中以急性鼻咽炎(普通感冒)、氣管炎/扁桃體炎的患病率最高,監(jiān)測(cè)的癥狀中,咽喉和鼻腔部位的癥狀發(fā)生率最高,其中咳嗽和流鼻涕是主要癥狀。SO_2濃度的升高,會(huì)引起總疾病、呼吸系統(tǒng)疾病以及普通感冒患病風(fēng)險(xiǎn)的增高,此外,PM_10、SO_2以及NO_2還會(huì)加劇過(guò)敏性鼻炎的患病風(fēng)險(xiǎn);PM_10、SO_2以及NO_2濃度的升高會(huì)引起總癥狀、咽喉部位(咳嗽、咳痰)以及鼻腔部位(流鼻涕、鼻塞、打噴嚏)等癥狀發(fā)生率的增高,此外,SO_2濃度的升高,還會(huì)引起眼睛部位(眼睛疼、紅、癢)癥狀發(fā)生率的增高;CO和03濃度的變化對(duì)小學(xué)生疾病患病率和癥狀發(fā)生率的影響均無(wú)統(tǒng)計(jì)學(xué)意義。肺功能檢測(cè)結(jié)果顯示,PM_2.5和NO_2濃度的降低會(huì)引起小學(xué)生FVC和FEV1肺功能指標(biāo)的顯著升高,然而并未發(fā)現(xiàn)各項(xiàng)肺功能指標(biāo)與其他污染物濃度的變化存在顯著相關(guān)性。結(jié)論P(yáng)M_10、SO_2以及NO_2濃度的升高會(huì)導(dǎo)致濟(jì)南市歷城區(qū)小學(xué)生呼吸系統(tǒng)疾病患病率和癥狀發(fā)生率的顯著增多,其中SO_2對(duì)疾病患病率和癥狀發(fā)生率的影響最為強(qiáng)烈。推斷歷城區(qū)小學(xué)生可能對(duì)周?chē)諝庵械腜M_2.5、NO_2尤其是SO_2更敏感,受到的不利影響也更嚴(yán)重。此外,空氣污染物濃度的升高還會(huì)導(dǎo)致濟(jì)南市歷城區(qū)小學(xué)生肺功能相關(guān)指標(biāo)的顯著降低,按性別分層后,發(fā)現(xiàn)PM_2.5和NO_2濃度的降低會(huì)引起小學(xué)生FVC和FEV1肺功能指標(biāo)的顯著升高;按年級(jí)分層后,發(fā)現(xiàn)PM2.5和NO2濃度的降低會(huì)引起三年級(jí)學(xué)生FVC、FEV1和V75肺功能指標(biāo)的顯著升高,而對(duì)于四、五年級(jí)的學(xué)生來(lái)說(shuō),僅發(fā)現(xiàn)FVC和V25兩項(xiàng)肺功能指標(biāo)顯著升高。推斷空氣污染物對(duì)低年齡段的健康影響更為明顯。
[Abstract]:The epidemiological study of the aim of the study indicated that the prevalence of respiratory diseases, the incidence of symptoms and the decrease of the function of the lung were related to the atmospheric pollutants. In this study, under the background of the heavy air pollution in Jinan (Licheng District), the continuous monitoring of the air pollutants and the health status of the primary school students is carried out, and the disease rate of the primary school students and the health effects of the lung function under the condition of high concentration of air pollution are evaluated. The aim of this paper is to explore the changing trend and characteristics of the health impact of primary school students in the condition of severe air pollution, to lay the foundation for the future research, and to put forward some measures and suggestions based on the results of the research. To provide the basic basis for the health intervention and health management of the low-age group (children) under the influence of local air pollution, to guide the students and the parents to protect and protect the individual, and to reduce the health loss. According to the research method, the relatively heavy urban area of Jinan (heavy industry and chemical enterprise area) is selected as the implementation area of this study, and a primary school in the range of 2 km of the air quality environmental protection monitoring station point _ Baosheng cable monitoring point in the Licheng District is selected as the study site. Continuity monitoring of all school students in the three to fifth grades of the school. The survey was voluntary, and the investigation object signed the informed consent form, which was finally included in the total of 614 investigators. In this study, the correlation between the weekly disease, the occurrence of symptoms and air pollution was investigated by using the repetitive measurement and design, and the correlation between the pulmonary function and the air pollution of the primary school students was assessed by the current research and design. A self-designed questionnaire was used to collect the health status of the students in the class from the beginning of Saturday to Friday in the afternoon of each Friday afternoon, and the questionnaire was completed by the student parents and the students themselves. The time of the survey was from November 15 to December 26,2014 for a total of 6 weeks. At the beginning and end of the questionnaire, a primary school student's lung function test was carried out. The test subjects were willing to participate in the questionnaire. The stratified cluster random sampling method was adopted to carry out the lung function test from the third grade, the fourth grade and the fifth grade respectively. A total of 149 primary school pupils were detected. The lung function test indicators included forced vital capacity (FVC),1 second forced expiratory volume (FEV1), peak expiratory flow rate (PEF), forced expiratory flow at 25% FVC (V25/ PEF75), and forced expiratory flow at 75% FVC (V75/ PEF25). At the same time, collect fine particulate matter (PM _ 2.5), fine particulate matter (PM _ 10), carbon monoxide (CO), nitrogen dioxide (NO _ 2), The daily daily concentration data of sulfur dioxide (SO _ 2) and ozone (O _ 3) and the daily average daily temperature and relative humidity data of Jinan city. The basic characteristics of the study object and the characteristics of the time distribution of air pollutants during the study were analyzed in a descriptive way. The prevalence of the disease and the rate of occurrence of the symptoms were calculated during the continuous measurement of the primary school pupils, and the prevalence of the disease and the rate of the occurrence of the symptoms were compared. analyzing the correlation between the occurrence rate of the weekly disease and the occurrence rate of the symptom and the concentration of the air pollutants on each Saturday, and evaluating the risk of the disease and the symptom when the concentration of the air pollutants is increased; and comparing the difference of the indexes of the lung function under the different air pollution exposure concentration in the primary school for two times, At the same time, the effects of short-term lung function changes in different air pollution exposures were further analyzed by gender and age stratification. Results The results of continuous monitoring show that the prevalence of acute nasopharyngitis (common cold), trachitis/ tonsillitis is the highest in the respiratory system, and the symptoms of the throat and the nasal cavity are the highest in the monitoring symptoms, and the cough and the runny nose are the main symptoms. The increase of the concentration of SO _ 2 can raise the risk of general diseases, respiratory diseases and common cold. In addition, PM _ 10, SO _ 2 and NO _ 2 can increase the risk of allergic rhinitis. The increase of PM _ 10, SO _ 2 and NO _ 2 can cause total symptoms and throat part (cough, The incidence of the symptoms such as cough and phlegm and the nasal part (nose, nose, sneezing) increased, and the increase of the concentration of SO _ 2 can also cause the incidence of the symptoms of the eyes (the eyes, the red and the itchy) to increase. The changes of CO and 03 concentration had no significant effect on the prevalence of disease and the incidence of symptoms in primary school students. The results of lung function test showed that the decrease of the concentration of PM _ 2.5 and NO _ 2 could cause a significant increase in the function of FVC and FEV1 in primary school students. Conclusion The increase of the concentration of PM _ 10, SO _ 2 and NO _ 2 can lead to a significant increase in the incidence of respiratory diseases and symptoms of primary school students in Licheng District of Jinan, and the effect of SO _ 2 on the prevalence of disease and the incidence of symptoms is the most intense. It is concluded that primary school students in Licheng District may be more sensitive to PM _ 2.5, NO _ 2, especially SO _ 2, in the surrounding air. In addition, the increase of the air pollutant concentration can also lead to a significant decrease of the pulmonary function related index of primary school students in Licheng District of Jinan. After the sex stratification, the decrease of the concentration of PM _ 2.5 and NO _ 2 will cause a significant increase in the function index of FVC and FEV1 of primary school students; after the grade is layered, A decrease in the concentration of PM2.5 and NO2 was found to cause a significant increase in FVC, FEV1, and V75 lung function in the third grade, whereas for students in the fourth and fifth grades, only two pulmonary function indicators of FVC and V25 were found to be significantly elevated. It is concluded that the effect of air pollutant on the health of low age group is more obvious.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R179

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