大气污染对变应性疾病及花粉症就诊人次的影响

目的 研究大气污染物浓度对医院变应性疾病和花粉症日就诊人次的影响.方法 收集2004年4-9月北京市8个国家监测点大气污染物SO2、NO2、可吸入颗粒物(PM10)]浓度、4个观测点花粉日监测数据、气象资料及北京世纪坛医院变态反应科同时段变应性疾病和花粉症日就诊人次资料,应用时间序列分析的广义相加泊松回归模型进行定量分析,并考虑滞后效应和多种空气污染物的影响.结果 研究期间大气SO2、NO2、PM10日均浓度分别为(20.9±12.9)、(58.6±13.6)、(126.8 ±64.1)μg/m3,花粉日均浓度为(163.8±209.0)粒/1000 mm2,变应性疾病日就诊(16.3±5.3)人次,花粉症日就诊(3.5±5.0)人次.时间序列分析显示,花粉浓度每升高100粒/1000 mm2,第2天的变应性疾病日就诊人次增加2.44%(95%CI:0.75%～4.13%),当天的花粉症日就诊人次增加6.58%(95%CI:3.82%～9.34%).而大气污染物(NO2、SO2和PM10)对变应性疾病和花粉症日就诊人次的影响呈现明显的滞后效应:NO2每升高10 μg/m3,滞后6 d的变应性疾病日就诊人次增加3.14%(95%CI:0.42%～5.85%);S02滞后1 d、NO2滞后6 d、PM10滞后3 d对花粉症日就诊人次影响较大,但差异均无统计学意义RR值(95%CI值)分别为1.0460(0.9640～1.1280)、1.0325(0.9633～1.1017)、1.0079(0.9942～1.0217)].将4种大气污染物同时引入模型分析时,其效应稍微增强:花粉浓度每升高100粒/1000 mm2,变应性疾病日就诊人次增加2.56%(95%CI:0.80%～4.31%),花粉症日就诊人次增加6.81%(95%CI:3.91%～9.71%).结论 影响变应性疾病和花粉症日就诊人次的环境因素主要为空气花粉浓度,大气污染物的作用不大.

The influence of ambient air pollutants on outpatient visits for allergic disease and pollinosis

Objective To assess the effects of ambient air pollutants on hospital outpatient visits for allergic disease and pollinosis. Methods The monitoring data of daily air pollution (SO2, NO2 and PM10) in 8 national monitoring and controlling sites of Beijing air quality,airborne pollen in 4 monitoring sites of Beijing,and daily meteorological data, along with the daily numbers of outpatients visits for allergic disease and pollinosis at the Allergy Department of Beijing Shijitan Hospital from April to September in 2004 were collected. Associations between the levels of air pollutants and outpatient visits for allergic disease and pollinosis were estimated by time serial analysis using a generalized addictive model (GAM), considering lag effect and the influence of multipollutants. Results During the study period, the average daily ambient concentrations of SO2, NO2 and PM10 were (20. 9 ± 12. 9), (58.6 ± 13.6) and (126. 8 ± 64.1) μg/m3,respectively. The mean daily pollen count was (163.8 ± 209.0)grains/1000 mm2,while the average daily numbers of doctor visits for allergic disease and pollinosis were (16. 3 ± 5.3) and (3.5 ± 5.0),respectively. Time serial analysis showed that significant positive associations were found between levels of airborne pollen and doctor visits,with an excess risk(ER)of 2. 44% (95% CI:0. 75% -4.13%)for allergic disease and 6. 58% (95% CI:3. 82% -9. 34%)for pollinosis per 100 grains/1000 mm2 increase in pollen,in single-pollutant models. There were associations between ambient air pollutants (SO2, NO2, PM10) and doctor visits with lag effects. A 10 μg/m3 increase in NO2 was associated with a 3. 14% (95% CI:0. 42% -5. 85%) increase in doctor visits for allergic disease at lag 6 d. For pollinosis,the highest ER was observed for 10 μg/m3 increases in SO2 at lag 1 d,NO2 at lag 6 d,PM10 at lag 3 d. However,this association was not statistically significant(RR(95 % CI) were 1. 0460 (0. 9640 - 1.1280), 1.0325 (0. 9633 - 1. 1017), 1. 0079 (0. 9942 - 1. 0217) ,respectively). The associations enhanced slightly in multi-pollutant models with an ER of 2. 56% (95% CI: 0. 80% - 4. 31%) for allergic disease and 6. 81% (95% CI: 3.91% - 9.71%) for pollinosis per 100 grains/1000 mm2 of pollen. Conclusions Our results suggest that level of airborne pollen may have a stronger effect than ambient air pollutants on allergic disease and pollinosis.