嘉峪关市肺结核病与气象相关影响因素研究

目的研究气象因素与肺结核病发病的关联性。方法根据2008—2016年甘肃省嘉峪关市肺结核病发病人数,结合同期气象资料,用广义相加模型结合分布滞后非线性模型,分析不同气象因素对肺结核病发病的影响。结果2008—2016年嘉峪关市共报告肺结核病2 029例,男性发病数(1 146例)多于女性(883例),性别比为1.30∶1;36～64岁最多、占54.16%;肺结核病发病时间分布呈"两峰两谷"型规律变化,4—6月、7—11月肺结核病病例数明显下降,2—3月、12月—次年1月明显增多;气象因素在不同滞后日与肺结核病的关联呈非线性,日平均气温对肺结核病发病效应曲线呈现波动变化趋势,日平均气温在-16.4～-13℃和-3～8℃时,发病风险随着气温的升高而逐渐下降,且滞后14 d的RR值均有统计学意义(t=4.567,P<0.05);肺结核病发病风险随着日平均相对湿度的升高在一定湿度范围内有危害效应,日平均相对湿度在69%～81%时,滞后14 d时RR值的95%CI下限均大于1,RR值有统计学意义(t=5.623,P<0.05);其余湿度范围RR值的95%CI下限均小于1,RR值无统计学意义(t=3.120,P>0.05);日平均风速在0～6 m/s范围内,发病风险随着风速的增加而逐渐增加,但滞后14 d时RR值的95%CI下限均小于1,差异无统计学意义(t=2.358,P>0.05)。结论嘉峪关市的气温、相对湿度和风速等气象因素可能是肺结核病暴发的重要原因之一,气象因素对肺结核病在人群中的发生和流行发挥了重要作用。

Study on influential factors of meteorology correlated to tuberculosis in Jiayuguan city

Objective To investigate the correlation between meteorological factors and onset of pulmonary tuberculosis.Methods Based on the number of patients of pulmonary tuberculosis and the meteorological data in Jiayuguan from 2008 to2016, the influence of different meteorological factors on the onset of pulmonary tuberculosis were analyzed with the generalized additive model combined with a distributed lag nonlinear mode. Results There were 2 029 patients of pulmonary tuberculosis reported in Jiayuguan during 2008 to 2016. Male patients(1 146 cases) were more than the female(883 cases), with the ratio of the male to female of 1.30∶1. Patients were mainly in age group of 36-64 years and accounted for 54.16%. The time of onset showed regular distribution with two peaks and two valleys, and the case numbers decreased significantly from April to June and July to November, increased clearly from February to March and December to the January of the next year. The correlation between meteorological factors and pulmonary tuberculosis on different lagged days was nonlinear. The effect curve of average temperature corresponding with the onset of pulmonary tuberculosis showed fluctuating trend. The onset risk gradually decreased along with the temperature increasing within the range of daily average temperature from-16.4℃ to-13℃ and-3℃ to 8℃, and there were statistically differences(t=4.567, P<0.05) in RR values on the lagged 14 d. The onset risk increased with the growth of daily average relative humidity and there was hazard effect in a certain humidity range. When the average daily relative humidity was from 69% to 81%, the lower limit value of 95%CI of RR on the lagged 14 d was bigger than 1, and the RR value was statistically significant(t=5.623, P<0.05), and the RR value wasn’t statistically significant(t=3.120, P>0.05) in the other humidity range. In the range of daily average wind speed of 0-6 m/s, the onset risks gradually increased with the wind speed. The lower limit value of 95%CI of RR on the lagged 14 d was smaller than 1, without statistical difference(t=2.358, P>0.05). Conclusions The meteorological factors of temperature,relative humidity and wind speed, etc. could be the one important reason for outbreak of pulmonary tuberculosis in Jiayuguan, and play important role in the occurrence and prevalence of pulmonary tuberculosis in the population.