Article(id=1322590020200940020, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202406291, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1718640000000, receivedDateStr=2024-06-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793259633349, onlineDateStr=2026-10-29, pubDate=1736438400000, pubDateStr=2025-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793259633349, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793259633349, creator=13701087609, updateTime=1793259633349, updator=13701087609, issue=Issue{id=1322589954702688372, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='1736438400000', pubDateStr='2025-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793259617734, creator='13701087609', updateTime=1793260023378, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322591656147276425, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322591656147276426, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=58, endPage=62, ext={EN=ArticleExt(id=1322590021928993269, articleId=1322590020200940020, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Case-crossover study on the relationship between gaseous pollutants and outpatient visits for neurological disorders in children in Shijiazhuang, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the impact of changes in the concentrations of major gaseous pollutants in the air of Shijiazhuang on the outpatient visits for neurological disorders in children.

Methods

Data on air pollutants, meteorological conditions, and outpatient visits for pediatric neurological disorders from 2013 to 2021 in Shijiazhuang were collected. A case-crossover study based on conditional logistic regression models was employed to assess the effects of changes in NO2 and SO2 concentrations on the outpatient visits for neurological disorders in children.

Results

During the study period, for every increase of 10 μg/m3 in NO2 concentration, the risk of outpatient visits for neurological disorders in children increased by 1.445% (95%CI: 0.980%-1.911%); for every increase of 10 μg/m3 in SO2 concentration, the risk increased by 0.408% (95%CI: 0.161%-0.655%). Stratified analysis revealed that girls and children aged 7 to 14 years were sensitive populations to SO2 exposure, and the harmful effects of gaseous pollutants on the neurological system of children were stronger in winter.

Conclusion

Exposure to gaseous pollutants in Shijiazhuang is associated with an increase in outpatient visits for neurological disorders in children, with variations in effects observed based on gender, age, and season.

, authors=Zi-yue LIANG1, 2, Xu GAO3, Feng-ge CHEN1, 2, Hui KANG1, 2, Hong ZHANG1, Ying ZHANG1, 2, authorsList=Zi-yue LIANG, Xu GAO, Feng-ge CHEN, Hui KANG, Hong ZHANG, Ying ZHANG, authorCompany=null, correspAuthors=Ying ZHANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322590023522828794, articleId=1322590020200940020, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=石家庄市气态污染物与儿童神经疾病门诊量关系的病例交叉研究, columnId=1228016571273113811, journalTitle=现代预防医学, columnName=环境与职业卫生, runingTitle=null, highlight=null, articleAbstract=
目的

探究石家庄市空气中主要的气态污染物浓度变化对儿童神经系统疾病门诊量的影响。

方法

收集2013—2021年石家庄市空气污染物数据、气象数据以及儿童神经系统疾病门诊数据,采用基于条件logistic回归模型的病例交叉研究,评估空气中NO2和SO2浓度变化对儿童神经疾病门诊量的影响。

结果

研究期间空气中NO2浓度每升高10 μg/m3,儿童神经疾病就诊风险增加1.445%(95%CI: 0.980%~1.911%);空气中SO2浓度每升高10 μg/m3,儿童神经系统疾病就诊风险增加0.408%(95%CI: 0.161%~0.655%)。分层分析结果显示,女童以及7~14岁儿童是SO2暴露的敏感人群,冬季气态污染物暴露对儿童神经系统的危害效应更强。

结论

石家庄市气态污染物暴露可增加儿童神经系统疾病门诊量,不同性别、年龄和季节之间的效应具有差异性。

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梁子越(1997—),女,硕士在读,研究方向:环境与人群健康

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张莹,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=E9xDH85WfHz4XcJNYQxh6g==, magXml=UkN/vdk7cr6H5FWyP3OEYQ==, pdfUrl=null, pdf=V7a+f/FBCYXAweFxyD+Lhw==, pdfFileSize=543855, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=fzE085oR6DX5DyKW0tNZ5Q==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=e9RJCcoQafcfvqarTgplmQ==, mapNumber=null, fund=null)}, authors=[Author(id=1322590026479813124, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1322590026630808071, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, authorId=1322590026479813124, language=EN, stringName=Zi-yue LIANG, firstName=Zi-yue, middleName=null, lastName=LIANG, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, 2, address=Shijiazhuang Center for Disease Control and Prevention, Key Laboratory of Difficult Pathogens in Hebei Province, Shijiazhuang, Hebei 050011, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322590026735665672, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, authorId=1322590026479813124, language=CN, stringName=梁子越, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, 2, address=1.石家庄市疾病预防控制中心,河北省疑难病原重点实验室,河北 石家庄 050011
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Impact of short-term exposure to ambient Nitrogen dioxide on daily outpatient visits in 3 cities of China[J]. Shanghai Journal of Preventive Medicine, 2020, 32(4): 270-275.(In Chinese), articleTitle=Impact of short-term exposure to ambient Nitrogen dioxide on daily outpatient visits in 3 cities of China, refAbstract=null), Reference(id=1322590036147683926, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, doi=null, pmid=null, pmcid=null, year=2020, volume=716, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[24], rfOrder=27, authorNames=Bergmann S, Li BX, Pilot E, journalName=Science of the Total Environment, refType=null, unstructuredReference=Bergmann S, Li BX, Pilot E, et al. Effect modification of the short-term effects of air pollution on morbidity by season: A systematic review and meta-analysis[J]. Science of the Total Environment, 2020, 716: 136985., articleTitle=Effect modification of the short-term effects of air pollution on morbidity by season: A systematic review and meta-analysis, refAbstract=null), Reference(id=1322590036206404183, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, doi=null, pmid=null, pmcid=null, year=2022, volume=21, issue=1, pageStart=2, pageEnd=null, url=null, language=null, rfNumber=[25], rfOrder=28, authorNames=Halldorsdottir S, Finnbjornsdottir RG, Elvarsson BT, journalName=Environmental Health: a Global Access Science Source, refType=null, unstructuredReference=Halldorsdottir S, Finnbjornsdottir RG, Elvarsson BT, et al. Ambient Nitrogen dioxide is associated with emergency hospital visits for atrial fibrillation: a population-based case-crossover study in Reykjavik, Iceland[J]. Environmental Health: a Global Access Science Source, 2022, 21(1): 2., articleTitle=Ambient Nitrogen dioxide is associated with emergency hospital visits for atrial fibrillation: a population-based case-crossover study in Reykjavik, Iceland, refAbstract=null), Reference(id=1322590036277707352, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, doi=null, pmid=null, pmcid=null, year=2022, volume=23, issue=1, pageStart=71, pageEnd=null, url=null, language=null, rfNumber=[26], rfOrder=29, authorNames=Lu WF, Tian Q, Xu RJ, journalName=Respiratory Research, refType=null, unstructuredReference=Lu WF, Tian Q, Xu RJ, et al. Short-term exposure to ambient air pollution and pneumonia hospital admission among patients with COPD: a time-stratified case-crossover study[J]. Respiratory Research, 2022, 23(1): 71., articleTitle=Short-term exposure to ambient air pollution and pneumonia hospital admission among patients with COPD: a time-stratified case-crossover study, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322590024336523772, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, xref=1., ext=[AuthorCompanyExt(id=1322590024344912381, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, companyId=1322590024336523772, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Shijiazhuang Center for Disease Control and Prevention, Key Laboratory of Difficult Pathogens in Hebei Province, Shijiazhuang, Hebei 050011, China), AuthorCompanyExt(id=1322590024353300990, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, companyId=1322590024336523772, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.石家庄市疾病预防控制中心,河北省疑难病原重点实验室,河北 石家庄 050011)]), AuthorCompany(id=1322590024676262399, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, xref=2., ext=[AuthorCompanyExt(id=1322590024684651008, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, companyId=1322590024676262399, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.中国疾病预防控制中心环境与健康研究基地(石家庄),河北 石家庄 050011)]), AuthorCompany(id=1322590026341401089, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, xref=3., ext=[AuthorCompanyExt(id=1322590026353984002, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, companyId=1322590026341401089, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.河北医科大学公共卫生学院)])], figs=[ArticleFig(id=1322590031148073519, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, language=EN, label=Figure 1, caption=Effect of increasing NO2 and SO2 concentrations by 10 μg/m3 on outpatient visits for neurological diseases in children, figureFileSmall=HxwvJZV9kpl6CJB6wUJamA==, figureFileBig=fzE085oR6DX5DyKW0tNZ5Q==, tableContent=null), ArticleFig(id=1322590031240348208, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, language=CN, label=图1, caption=NO2和SO2浓度每增加10 μg/m3对儿童神经疾病门诊量的影响, figureFileSmall=HxwvJZV9kpl6CJB6wUJamA==, figureFileBig=fzE085oR6DX5DyKW0tNZ5Q==, tableContent=null), ArticleFig(id=1322590031454257713, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, language=EN, label=Table 1, caption=

Population characteristics and distribution of outpatient visits of children with neurological diseases in Shijiazhuang from 2013 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
指标门诊人次构成比(%)
总门诊量154 353100.00
性别
男91 56259.32
女62 79140.68
年龄(岁)
0~6110 16871.37
7~1444 18528.63
季节
冷季67 66343.84
暖季86 69056.16
), ArticleFig(id=1322590031567503922, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, language=CN, label=表1, caption=

2013—2021年石家庄市儿童神经疾病门诊量人群特征分布

, figureFileSmall=null, figureFileBig=null, tableContent=
指标门诊人次构成比(%)
总门诊量154 353100.00
性别
男91 56259.32
女62 79140.68
年龄(岁)
0~6110 16871.37
7~1444 18528.63
季节
冷季67 66343.84
暖季86 69056.16
), ArticleFig(id=1322590031655584307, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, language=EN, label=Table 2, caption=

Distribution of pollutants and meteorological factors in Shijiazhuang from 2013 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
指标平均值标准差MinP25P50P75Max
污染物
NO2(μg/m3)49.325.87.430.744.762.3188.0
SO2(μg/m3)38.546.72.01120.743.7319.4
气象因素
平均温度(℃)14.810.7-10.25.015.924.534.7
相对湿度(%)56.120.34.940.057.072.3100.0
), ArticleFig(id=1322590031747858996, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, language=CN, label=表2, caption=

2013—2021年石家庄市污染物与气象因素分布情况

, figureFileSmall=null, figureFileBig=null, tableContent=
指标平均值标准差MinP25P50P75Max
污染物
NO2(μg/m3)49.325.87.430.744.762.3188.0
SO2(μg/m3)38.546.72.01120.743.7319.4
气象因素
平均温度(℃)14.810.7-10.25.015.924.534.7
相对湿度(%)56.120.34.940.057.072.3100.0
), ArticleFig(id=1322590031848522293, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, language=EN, label=Table 3, caption=

Correlation analysis of pollutants and meteorological factors in Shijiazhuang from 2013 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
指标PM2.5PM10NO2SO2COO3平均温度相对湿度
PM2.51
PM100.920**1
NO20.660**0.701**1
SO20.635**0.715**0.697**1
CO0.800**0.729**0.734**0.630**1
O3-0.348**-0.292**-0.445**-0.286**-0.410**1
平均温度-0.382**-0.325**-0.447**-0.359**-0.470**0.801**1
相对湿度0.225**0.016-0.087**-0.288**0.123**-0.059**0.137**1
), ArticleFig(id=1322590031944991286, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, language=CN, label=表3, caption=

2013—2021年石家庄市污染物与气象因素的相关性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
指标PM2.5PM10NO2SO2COO3平均温度相对湿度
PM2.51
PM100.920**1
NO20.660**0.701**1
SO20.635**0.715**0.697**1
CO0.800**0.729**0.734**0.630**1
O3-0.348**-0.292**-0.445**-0.286**-0.410**1
平均温度-0.382**-0.325**-0.447**-0.359**-0.470**0.801**1
相对湿度0.225**0.016-0.087**-0.288**0.123**-0.059**0.137**1
), ArticleFig(id=1322590032041460279, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, language=EN, label=Table 4, caption=

Effects of NO2 and SO2 concentration increased by 10 μg/m3 on outpatient visits of neurological diseases in children with different sex, age and season

, figureFileSmall=null, figureFileBig=null, tableContent=
项目NO2(lag05)
ER (95%CI)
SO2(lag0)
ER (95%CI)
性别
男1.588 (0.982~2.197)0.203 (-0.115~0.522)
女1.244 (0.521~1.972)0.714 (0.324~1.105)
年龄(岁)
0~61.209 (0.668~1.753)0.264 (-0.014~0.543)
7~142.091 (1.186~3.004)0.921 (0.393~1.452)
季节
冷季2.464 (1.912~3.018)0.604 (0.335~0.875)
暖季-0.702 (-1.598~0.193)-0.455 (-1.071~0.164)
), ArticleFig(id=1322590032116957752, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, language=CN, label=表4, caption=

NO2、SO2浓度每升高10μg/m3对不同性别、年龄及季节儿童神经系统疾病门诊量的影响

, figureFileSmall=null, figureFileBig=null, tableContent=
项目NO2(lag05)
ER (95%CI)
SO2(lag0)
ER (95%CI)
性别
男1.588 (0.982~2.197)0.203 (-0.115~0.522)
女1.244 (0.521~1.972)0.714 (0.324~1.105)
年龄(岁)
0~61.209 (0.668~1.753)0.264 (-0.014~0.543)
7~142.091 (1.186~3.004)0.921 (0.393~1.452)
季节
冷季2.464 (1.912~3.018)0.604 (0.335~0.875)
暖季-0.702 (-1.598~0.193)-0.455 (-1.071~0.164)
), ArticleFig(id=1322590032188260921, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, language=EN, label=Table 5, caption=

Effects of NO2 and SO2 concentrations increased by 10 μg/m3 in dual pollutant model on outpatient visits of children with neurological diseases

, figureFileSmall=null, figureFileBig=null, tableContent=
污染物ER (95%CI)
NO2
+PM2.51.343 (0.836~1.851)
+SO21.323 (0.84~1.809)
+O31.445 (0.980~1.912)
SO2
+PM2.50.285 (-0.012~0.583)
+NO2-0.635 (-0.983~-0.286)
+CO0.302 (-0.021~0.625)
+O30.407 (0.161~0.654)
), ArticleFig(id=1322590032267952698, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322590020200940020, language=CN, label=表5, caption=

双污染物模型NO2、SO2浓度每升高10μg/m3对儿童神经疾病门诊量的影响

, figureFileSmall=null, figureFileBig=null, tableContent=
污染物ER (95%CI)
NO2
+PM2.51.343 (0.836~1.851)
+SO21.323 (0.84~1.809)
+O31.445 (0.980~1.912)
SO2
+PM2.50.285 (-0.012~0.583)
+NO2-0.635 (-0.983~-0.286)
+CO0.302 (-0.021~0.625)
+O30.407 (0.161~0.654)
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石家庄市气态污染物与儿童神经疾病门诊量关系的病例交叉研究
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梁子越 1, 2 , 高旭 3 , 陈凤格 1, 2 , 康慧 1, 2 , 张弘 1 , 张莹 1, 2
现代预防医学 | 环境与职业卫生 2025,52(1): 58-62
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现代预防医学 |环境与职业卫生 2025 , 52 (1) : 58 -62
石家庄市气态污染物与儿童神经疾病门诊量关系的病例交叉研究
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梁子越1, 2, 高旭3, 陈凤格1, 2, 康慧1, 2, 张弘1, 张莹1, 2
作者信息
  • 1.石家庄市疾病预防控制中心,河北省疑难病原重点实验室,河北 石家庄 050011
  • 2.中国疾病预防控制中心环境与健康研究基地(石家庄),河北 石家庄 050011
  • 3.河北医科大学公共卫生学院
通讯作者:
张莹,E-mail:
作者简介:

梁子越(1997—),女,硕士在读,研究方向:环境与人群健康

Case-crossover study on the relationship between gaseous pollutants and outpatient visits for neurological disorders in children in Shijiazhuang
Zi-yue LIANG1, 2, Xu GAO3, Feng-ge CHEN1, 2, Hui KANG1, 2, Hong ZHANG1, Ying ZHANG1, 2
Affiliations
  • Shijiazhuang Center for Disease Control and Prevention, Key Laboratory of Difficult Pathogens in Hebei Province, Shijiazhuang, Hebei 050011, China
出版时间: 2025-01-10 doi: 10.20043/j.cnki.MPM.202406291
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目的

探究石家庄市空气中主要的气态污染物浓度变化对儿童神经系统疾病门诊量的影响。

方法

收集2013—2021年石家庄市空气污染物数据、气象数据以及儿童神经系统疾病门诊数据,采用基于条件logistic回归模型的病例交叉研究,评估空气中NO2和SO2浓度变化对儿童神经疾病门诊量的影响。

结果

研究期间空气中NO2浓度每升高10 μg/m3,儿童神经疾病就诊风险增加1.445%(95%CI: 0.980%~1.911%);空气中SO2浓度每升高10 μg/m3,儿童神经系统疾病就诊风险增加0.408%(95%CI: 0.161%~0.655%)。分层分析结果显示,女童以及7~14岁儿童是SO2暴露的敏感人群,冬季气态污染物暴露对儿童神经系统的危害效应更强。

结论

石家庄市气态污染物暴露可增加儿童神经系统疾病门诊量,不同性别、年龄和季节之间的效应具有差异性。

病例交叉研究  /  气态污染物  /  门诊量  /  神经系统疾病  /  儿童
Objective

To investigate the impact of changes in the concentrations of major gaseous pollutants in the air of Shijiazhuang on the outpatient visits for neurological disorders in children.

Methods

Data on air pollutants, meteorological conditions, and outpatient visits for pediatric neurological disorders from 2013 to 2021 in Shijiazhuang were collected. A case-crossover study based on conditional logistic regression models was employed to assess the effects of changes in NO2 and SO2 concentrations on the outpatient visits for neurological disorders in children.

Results

During the study period, for every increase of 10 μg/m3 in NO2 concentration, the risk of outpatient visits for neurological disorders in children increased by 1.445% (95%CI: 0.980%-1.911%); for every increase of 10 μg/m3 in SO2 concentration, the risk increased by 0.408% (95%CI: 0.161%-0.655%). Stratified analysis revealed that girls and children aged 7 to 14 years were sensitive populations to SO2 exposure, and the harmful effects of gaseous pollutants on the neurological system of children were stronger in winter.

Conclusion

Exposure to gaseous pollutants in Shijiazhuang is associated with an increase in outpatient visits for neurological disorders in children, with variations in effects observed based on gender, age, and season.

Case-crossover study  /  Gaseous pollutants  /  Outpatient visits  /  Neurological disorders  /  Children
梁子越, 高旭, 陈凤格, 康慧, 张弘, 张莹. 石家庄市气态污染物与儿童神经疾病门诊量关系的病例交叉研究. 现代预防医学, 2025 , 52 (1) : 58 -62 . DOI: 10.20043/j.cnki.MPM.202406291
Zi-yue LIANG, Xu GAO, Feng-ge CHEN, Hui KANG, Hong ZHANG, Ying ZHANG. Case-crossover study on the relationship between gaseous pollutants and outpatient visits for neurological disorders in children in Shijiazhuang[J]. Modern Preventive Medicine, 2025 , 52 (1) : 58 -62 . DOI: 10.20043/j.cnki.MPM.202406291
随着工业进步以及经济发展迅速,空气污染问题日益严重,一项世界卫生组织(World Health Organization, WHO)的研究显示,空气污染已经成为人类健康的最大威胁之一[1]。有充分的证据表明[2-4],空气污染会导致暴露人群增加呼吸系统、心血管系统以及神经系统疾病等不良健康结局风险。儿童处在人类生长发育的时期,机体各器官系统尚未处在成熟阶段,自身免疫力较弱,因此更容易受到空气污染物的影响[5-8]。虽然关于空气污染物对神经系统产生影响的研究较多,但是以儿童为研究对象,探究不同空气污染物对儿童神经系统疾病影响的理论依据不够完善。同时,由于学者们多集中在颗粒物对神经系统影响的研究上,而针对气态污染物对神经疾病的发生发展影响的相关研究还不够全面。因此本研究收集了2013—2021年石家庄市某儿童医院的神经系统疾病日门诊量数据以及同期的环保和气象数据,采用病例交叉研究探究石家庄市主要气态污染物(NO2和SO2)与儿童神经系统疾病门诊量之间的关联性,为相关部门制定空气污染改善治理的策略措施提供理论依据,对保护儿童健康具有重要意义。
收集石家庄市某儿童医院2013—2021年门诊数据,剔除年龄大于14岁的患者数据,通过《国际疾病分类标准第十版(ICD-10)》,筛选出诊断为神经系统疾病(G00~G99)的门诊数据。环保数据(NO2和SO2日均浓度)及气象数据(平均温度、相对湿度)来源于石家庄市环境监测中心和石家庄市气象局。缺失数据采用相邻数据平均值法进行补全。
本研究采用双向病例交叉研究分析空气中气态污染物浓度变化对儿童神经系统疾病的影响,将患者就诊当天作为病例组,将患者就诊前以及就诊后7和14 d作为对照以控制“星期几效应”。如果事件的结果不会对后续暴露产生影响,那么与单项病例对照研究相比,双向病例交叉研究能够降低因暴露时间趋势导致的对照样本的信息偏倚[9]。采用条件logistic回归分析气态污染物暴露水平对儿童神经系统疾病发生的影响。由于空气污染物在不同的滞后天数对人群健康结局的影响可能不同,因此在控制患者就诊当日的平均气温、相对湿度等因素后,观察暴露当天(lag0)、滞后1~7 d(lag1~lag7)以及累积滞后1~7 d(lag01~lag07)的空气污染物浓度对儿童神经系统疾病门诊量的影响。空气污染物对神经系统疾病门诊量影响的效应用超额风险值(excess risk, ER)和95%置信区间(95% confidence interval, 95%CI)表示。其中ER表示NO2和SO2浓度每升高10 μg/m3,引起儿童神经系统疾病门诊就诊的额外风险,通常以百分比表示。
为探究针对不同年龄段、性别的儿童以及冷暖季节对空气污染物健康效应影响的差异性,本研究将研究人群分别按照年龄、性别以及冷暖季进行分组并进行了分层分析。其中年龄分组分为0~6岁以及7~14岁;冷季定义为每年的11月—次年4月,暖季定义为每年的5—10月。选取效应最强的滞后期,比较气态污染物对不同人群以及季节神经系统门诊量影响的差异性。并通过公式(1)检验组间效应:
其中,β1和β2分别代表两不同分组的回归系数,SE1和SE2则分别代表它们对应分组的标准误。
考虑到各空气污染物之间可能存在的相互影响会导致健康效应的改变,因此本研究进一步将单污染物模型中ER值最大的滞后天数作为最佳效应期后再进行双污染物分析,即将Spearman相关系数绝对值小于0.7的两个污染物同时纳入模型[10],检验其他污染物对NO2和SO2效应值的影响。
本研究使用SPSS 25.0软件对数据进行描述性以及相关性的分析,利用R 4.2.0中的“survival”包进行病例交叉分析。统计结果取双侧检验,检验水准为α=0.05。
如表1所示,2013—2021年石家庄市儿童神经系统疾病门诊总量为154 345人次,其中男童就诊人次多于女童;0~6岁年龄段门诊量多于7~14岁;暖季就诊人数多于冷季。
如表2所示,研究期间对石家庄市空气污染物和气象因素的基本描述中,NO2和SO2的浓度中位数分别为44.7 μg/m3和20.7 μg/m3;气象条件描述结果显示,日均温度的中位数是15.9℃,相对湿度的中位数则是57%。
如表3所示,Spearman相关分析结果,除O3浓度与各污染物浓度呈负相关关系外,其他空气污染物之间均呈正相关关系,且具有统计学意义。这表明了在分析污染物与门诊量的关系时,其他空气污染物是混杂因素。因此本研究在拟合双污染物模型时,剔除了相关系数大于0.7的污染物。
2013—2021年石家庄市空气中NO2浓度变化对儿童神经疾病门诊量的影响在累积滞后第五d时(lag05)效应最强,空气中NO2浓度每上升10 μg/m3,儿童神经疾病门诊就诊风险相应增加1.445%(95%CI:0.980%~1.911%);石家庄市空气中SO2浓度变化对儿童神经疾病门诊量的影响在污染物暴露当天时效应最大,空气中SO2浓度每升高10 μg/m3,儿童神经疾病门诊就诊风险增加0.408%(95%CI:0.161%~0.655%)。见图1。
分别在最强滞后效应期下分析石家庄市NO2(lag05)和SO2(lag0)对不同性别、年龄以及不同季节儿童神经系统疾病门诊量的影响,结果见表4。NO2与不同性别以及不同年龄段儿童的神经疾病门诊量的关系均为正相关且具有统计学意义。SO2对女性以及7~14岁年龄段儿童神经疾病门诊的超额就诊风险分别为0.714%(95%CI:0.324%~1.105%)和0.921%(95%CI:0.393%~1.452%)。按冷暖季分层分析结果显示,NO2和SO2对儿童神经疾病门诊量的影响在冷季时更明显,空气中NO2和SO2浓度每增加10 μg/m3,儿童神经疾病就诊风险分别增加2.464%(95%CI:1.912%~3.018%)和0.604%(95%CI:0.335%~0.087 5%)
如表5所示,在单污染物模型中确定的最强效应期下,根据Spearman相关分析结果,将|rs|<0.7的空气污染物纳入双污染物模型。经过对PM2.5、SO2和O3的分别调节后,NO2对儿童神经疾病门诊量的影响仍然具有显著性。在经过对PM2.5和CO的分别调节后,SO2对儿童神经疾病门诊量影响的效应无统计学意义;将NO2纳入双污染物模型后,结果变为负效应;将O3纳入双污染模型时,SO2对儿童神经疾病门诊量的影响依然具有统计学意义。
作为空气污染的主要组成成分,已有大量证据显示,气态污染物能够通过气血屏障进入人体血液循环,最终到达神经系统,这些污染物可以通过氧化应激与炎症反应的机制对神经系统造成伤害,从而引发神经系统疾病的产生与发展[11-15]。本研究发现,在NO2暴露累积滞后第5 d时,空气中NO2的浓度每升高10 μg/m3,儿童神经疾病就诊风险增加1.445%,说明NO2是儿童神经系统疾病的危险因素,并且对儿童神经系统具有潜在长期影响。国内一项研究表明,NO2浓度升高会导致居民神经系统疾病门诊量增加[16];波兰一项研究发现长期暴露于NO2中与儿童注意力较差相关[17],与本研究的结论一致。SO2对儿童神经系统门诊量的影响在暴露当天效应值最大,说明SO2是儿童神经系统疾病的危险因素,并且具有急性效应。这与一些研究结论相一致:重庆一项时间序列研究[18]表明,SO2在暴露当天时浓度每增加1 μg/m3,帕金森门诊就诊风险增加2.34%(95%CI : 0.88%~3.80%);韩国16个地区调查结果显示[19],短期接触SO2可能是青少年因注意力缺陷多动障碍疾病住院的危险因素;上海一项出生队列研究表明,产前NO2以及SO2暴露导致幼儿神经系统损伤,进而影响神经发育[20]。
分性别分析发现,在最佳效应期下,NO2对男童和女童神经系统门诊量的影响均呈正相关并且具有统计学意义;SO2对女童神经系统门诊量的影响大于对男童神经系统疾病门诊量的影响,提示女童的神经系统对气态污染物浓度的变化可能更加敏感。这与武汉一项时间序列研究结果类似[21],但也有研究表明男性对空气污染的敏感性更高[22]。这可能是由于男女的生理结构、代谢差异、激素水平不同以及地区差异等原因导致的。
与0~6岁年龄组相比,NO2和SO2暴露浓度变化对7~14岁儿童神经系统疾病门诊量影响的效应更强,这可能是由于低年龄段儿童大部分时间待在室内、活动范围和方式相对较小,而高年龄段儿童更频繁地进行户外运动和活动,增加了吸入空气污染物的风险,进而导致机体内污染物累积暴露量更多有关。
冷暖季分析结果表明,NO2和SO2暴露对儿童神经系统疾病就诊风险增加显著相关,说明NO2与SO2对儿童的影响在冷季时更大,这与一些研究结果类似[23-24]。原因可能是由于供暖且污染物不易扩散等原因导致了冷季石家庄市污染物浓度高于暖季,因此增加了儿童神经疾病就诊风险。
双污染物模型结果显示,在分别引入其他污染物后,空气NO2暴露对儿童神经疾病门诊量的影响依旧具有统计学意义,表明NO2对儿童神经健康的影响具有独立效应。此外,在分别将PM2.5、NO2和CO纳入双污染物模型后,SO2浓度变化对儿童神经疾病就诊量的影响结果不再具有统计学意义,在将NO2纳入模型后,SO2对儿童神经疾病就诊量的影响变为负效应,表明SO2可能与其他污染物之间存在着交互效应,NO2对儿童神经系统的影响比SO2带来的的影响效应更强,需要后续更进一步的研究和探讨。
本研究采用病例交叉研究,较时间序列研究方法相比,控制了个体差异、时间趋势、季节趋势等混杂因素带来的偏倚[25-26],分析结果更加可信。同时本研究尚存在一定的局限性:仅选取一所医院的儿童疾病门诊数据进行分析,代表范围具有一定的局限性;其次本研究地区为石家庄市,分析结果仅能代表当地情况。
综上所述,石家庄市主要气态污染物浓度的升高会增加儿童神经系统疾病的就诊风险;其中女童以及7~14岁儿童是气态污染物暴露危害的敏感人群;冷季时气态污染物对儿童神经系统疾病影响的效应更强。有关部门在制定空气污染治理策略和措施时,应加强对气态污染物的重视;加强对儿童健康状况的关注以及保护工作,特别是对女童以及学龄期儿童的健康防护,减少儿童接触空气污染物的机会,以减轻空气污染对儿童健康的危害,保护儿童神经系统健康。

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doi: 10.20043/j.cnki.MPM.202406291
  • 接收时间:2024-06-18
  • 首发时间:2026-10-29
  • 出版时间:2025-01-10
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  • 收稿日期:2024-06-18
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    1.石家庄市疾病预防控制中心,河北省疑难病原重点实验室,河北 石家庄 050011
    2.中国疾病预防控制中心环境与健康研究基地(石家庄),河北 石家庄 050011
    3.河北医科大学公共卫生学院

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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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