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Article(id=1322609149842673761, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202506216, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1749744000000, receivedDateStr=2025-06-13, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793264194212, onlineDateStr=2026-10-29, pubDate=1764000000000, pubDateStr=2025-11-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793264194212, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793264194212, creator=13701087609, updateTime=1793264194212, updator=13701087609, issue=Issue{id=1322609030938346427, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='22', pageStart='4033', pageEnd='4224', issueExtLink='null', onlineDate='null', pubDate='1764000000000', pubDateStr='2025-11-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793264165863, creator='13701087609', updateTime=1793264299902, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322609593264489401, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322609593264489402, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=4078, endPage=4083, ext={EN=ArticleExt(id=1322609150132080738, articleId=1322609149842673761, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Impact of green space exposure on adverse treatment outcomes among newly treated pulmonary tuberculosis patients, Suzhou, 2014-2021, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the impact of green space exposure on adverse treatment outcomes among newly diagnosed pulmonary tuberculosis patients in Suzhou.

Methods

Data from 18 502 newly treated pulmonary TB patients in Suzhou between January 1, 2014 and December 31, 2021 were collected. Green space exposure was quantified using the Normalized Difference Vegetation Index（NDVI）within 250-meter and 500-meter buffer zones around residential addresses. Cox proportional hazards regression models were applied to assess associations between green space exposure and adverse outcomes, adjusting for individual- and environmental-level covariates.

Results

Among patients residing in high nighttime light（NTL）intensity areas, those in the highest quartiles（Q4 and Q5）of green space exposure within the 250-meter buffer exhibited significantly lower risks of adverse outcomes after covariate adjustment, with hazard ratios（HRs）of 0.692（95% CI: 0.487-0.984）and 0.353（95% CI: 0.183-0.683）, respectively. In the 500-meter buffer, stronger protective effects were observed, with HRs of 0.587（95% CI: 0.396-0.869）for Q4 and 0.212（95% CI: 0.078-0.582）for Q5. Wald tests for linear trends confirmed a dose-response relationship（Ptrend<0.05）. Subgroup analyses revealed greater benefits of green space exposure for females, younger patients, indoor workers, urban residents, and clinically diagnosed cases.

Conclusion

Increased green space exposure is associated with reduced risks of adverse treatment outcomes among newly diagnosed PTB patients in high-NTL areas, underscoring its potential public health significance in tuberculosis management.

, authors=Wei-wei LIU, Xiao-long ZHANG, Cai-yan CUI, Ying FU, Yu WANG, Jun JIANG, authorsList=Wei-wei LIU, Xiao-long ZHANG, Cai-yan CUI, Ying FU, Yu WANG, Jun JIANG, authorCompany=null, correspAuthors=Jun JIANG, 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=1322609152740937832, articleId=1322609149842673761, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=2014—2021年苏州市绿地暴露对初治肺结核患者不良治疗结局的影响, columnId=1228016571273113811, journalTitle=现代预防医学, columnName=环境与职业卫生, runingTitle=null, highlight=null, articleAbstract=
目的

探讨苏州市绿地暴露对初治肺结核患者不良治疗结局的影响。

方法

收集苏州市2014年1月1日—2021年12月31日的18 502例初治肺结核患者数据，结合患者居住地250 m和500 m缓冲区范围内归一化差异植被指数，通过Cox回归模型评估绿地暴露对初治肺结核患者不良治疗结局的影响。

结果

高夜间灯光强度区域的初治肺结核患者，在250 m缓冲区内，调整个体层面和环境层面的协变量，Q4和Q5组的HR值和95% CI分别为0.692（0.487~0.984）和0.353（0.183~0.683）。在500 m缓冲区内，相应 Q4和Q5组的HR值和95% CI分别为0.587（0.396~0.869）和0.212（0.078~0.582），表现出更强的保护效应。Wald线性趋势检验表明存在线性关系。亚组分析结果表明绿地暴露对女性、年轻患者、室内工作者、城市居民、临床诊断病例更为有益。

结论

在高夜间灯光强度区域居住的初治肺结核患者中，增加绿地暴露可降低初治肺结核患者不良治疗结局的发生。

, authors=刘威威, 张晓龙, 崔彩岩, 傅颖, 王禹, 蒋骏, authorsList=刘威威, 张晓龙, 崔彩岩, 傅颖, 王禹, 蒋骏, authorCompany=null, correspAuthors=蒋骏, authorNote=

刘威威（1995—），男，硕士，医师，研究方向：结核病防制工作

, correspAuthorsNote=
蒋骏，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=w5oIAp20Wrtx5Wuqsr5+GQ==, magXml=cTFRChlF7ehKGsZQh45X/w==, pdfUrl=null, pdf=oiWUEiTBCXNk0tBN1z295w==, pdfFileSize=851674, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=1Ucu/zDG3clo+NhWKoH/rg==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=Eei/yuQzPemKh7ir32fT0A==, mapNumber=null, fund=null)}, authors=[Author(id=1322609153034539117, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, 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=1322609153135202415, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, authorId=1322609153034539117, language=EN, stringName=Wei-wei LIU, firstName=Wei-wei, middleName=null, lastName=LIU, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Department of Tuberculosis, Center for Disease Control and Prevention of Suzhou, Suzhou, Jiangsu 215317, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322609153202311280, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, authorId=1322609153034539117, language=CN, stringName=刘威威, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=苏州市疾病预防控制中心结核病防制所，江苏　苏州　215317, bio={"content":"

刘威威（1995—），男，硕士，医师，研究方向：结核病防制工作

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Disease Surveillance, 2023, 38 (8): 934-938.（In Chinese）, articleTitle=Treatment outcome and influencing factors of elderly pulmonary tuberculosis patients in Qinghai province from 2015 to 2019, refAbstract=null), Reference(id=1322609161532199106, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, doi=null, pmid=null, pmcid=null, year=2023, volume=50, issue=22, pageStart=4039, pageEnd=4045, 4051, url=null, language=null, rfNumber=[21], rfOrder=28, authorNames=严菁敏, 陈莹, 于洁, journalName=现代预防医学, refType=null, unstructuredReference=严菁敏，陈莹，于洁, 等. 基于LASSO-logistic回归的TB/HIV患者抗结核治疗结局影响因素研究 [J]. 现代预防医学, 2023, 50 (22): 4039-4045, 4051., articleTitle=基于LASSO-logistic回归的TB/HIV患者抗结核治疗结局影响因素研究, refAbstract=null), Reference(id=1322609161599307971, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, doi=null, pmid=null, pmcid=null, year=2023, volume=50, issue=22, pageStart=4039, pageEnd=4045, 4051, url=null, language=null, rfNumber=[21], rfOrder=29, authorNames=Yan JM, Chen Y, Yu J, journalName=Modern Preventive Medicine, refType=null, unstructuredReference=Yan JM, Chen Y, Yu J, et al. 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Modern Preventive Medicine, 2023, 50 (22): 4039-4045, 4051.（In Chinese）, articleTitle=Influencing factors of anti-tuberculosis treatment outcome in TB/HIV co-infected patients based on LASSO-logistic regression model, refAbstract=null)], funds=[Fund(id=1322609157652467874, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, awardId=FLKT202407, language=CN, fundingSource=江苏省防痨协会科研课题(FLKT202407), fundOrder=null, country=null), Fund(id=1322609157744742563, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, awardId=QNGG2022031, language=CN, fundingSource=苏州市卫生青年骨干人才“全国导师制”培训项目(QNGG2022031), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322609152954847337, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, xref=null, ext=[AuthorCompanyExt(id=1322609152963235946, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, companyId=1322609152954847337, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Tuberculosis, Center for Disease Control and Prevention of Suzhou, Suzhou, Jiangsu 215317, China), AuthorCompanyExt(id=1322609152971624555, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, companyId=1322609152954847337, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=苏州市疾病预防控制中心结核病防制所，江苏　苏州　215317)])], figs=[ArticleFig(id=1322609155056193682, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, language=EN, label=Fig.1, caption=Distribution of green space exposure and newly treated pulmonary tuberculosis patients（Approval No.: Su E（2025）No. 0247）, figureFileSmall=yLtNyXlDVxM3ZPiLGVtSgg==, figureFileBig=1Ucu/zDG3clo+NhWKoH/rg==, tableContent=null), ArticleFig(id=1322609155114913939, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, language=CN, label=图1, caption=绿地暴露与初治肺结核患者的分布（审图号：苏E审（2025）0247号）, figureFileSmall=yLtNyXlDVxM3ZPiLGVtSgg==, figureFileBig=1Ucu/zDG3clo+NhWKoH/rg==, tableContent=null), ArticleFig(id=1322609156859744408, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, language=EN, label=Fig.2, caption=Exposure-response curve for green space exposure and adverse treatment outcomes in newly treated pulmonary tuberculosis patients, figureFileSmall=grJHEsuH6WDHycdKwkSboQ==, figureFileBig=zVqWtXZF21DZnZmCYu6Hzg==, tableContent=null), ArticleFig(id=1322609156931047577, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, language=CN, label=图2, caption=绿地暴露与初治肺结核患者不良治疗结局之间的暴露-反应曲线, figureFileSmall=grJHEsuH6WDHycdKwkSboQ==, figureFileBig=zVqWtXZF21DZnZmCYu6Hzg==, tableContent=null), ArticleFig(id=1322609157010739354, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, language=EN, label=Table 1, caption=

General demographic characteristics of newly treated pulmonary tuberculosis patients

, figureFileSmall=null, figureFileBig=null, tableContent=
变量500 m缓冲区内NDVI暴露统计量P值
低暴露（9 251）高暴露（9 251）
性别[n（%）]4.6580.031
女性2 804（30.3）2 670（28.9）
男性6 447（69.7）6 581（71.1）
年龄（岁）[n（%）]115.770<0.001
<657 582（82.0）6 983（75.5）
≥651 669（18.0）2 268（24.5）
工作环境[n（%）]137.007<0.001
室内5 084（55.0）4 288（46.4）
室外4 167（45.0）4 963（53.6）
居住地[n（%）]392.984<0.001
城市5 890（63.7）4 553（49.2）
农村3 361（36.3）4 698（50.8）
患者来源[n（%）]0.6680.414
被动9 148（98.9）9 136（98.8）
主动103（1.1）115（1.2）
诊断结果[n（%）]0.6550.418
临床诊断病例4 835（52.3）4 780（51.7）
确诊病例4 416（47.7）4 471（48.3）
糖尿病[n（%）]9.2990.002
无8 953（96.8）9 022（97.5）
有298（3.2）229（2.5）
PM2.5（μg/m2）[M（IQR）]42.0（17.8）42.0（17.2）1.0310.303
道路密度[M（IQR）]5.552（2.234）4.461（2.587）51.368<0.001
NTL[M（IQR）]29.690（20.035）16.548（24.015）44.081<0.001
), ArticleFig(id=1322609157086236827, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, language=CN, label=表1, caption=

初治肺结核患者的一般人口学资料

, figureFileSmall=null, figureFileBig=null, tableContent=
变量500 m缓冲区内NDVI暴露统计量P值
低暴露（9 251）高暴露（9 251）
性别[n（%）]4.6580.031
女性2 804（30.3）2 670（28.9）
男性6 447（69.7）6 581（71.1）
年龄（岁）[n（%）]115.770<0.001
<657 582（82.0）6 983（75.5）
≥651 669（18.0）2 268（24.5）
工作环境[n（%）]137.007<0.001
室内5 084（55.0）4 288（46.4）
室外4 167（45.0）4 963（53.6）
居住地[n（%）]392.984<0.001
城市5 890（63.7）4 553（49.2）
农村3 361（36.3）4 698（50.8）
患者来源[n（%）]0.6680.414
被动9 148（98.9）9 136（98.8）
主动103（1.1）115（1.2）
诊断结果[n（%）]0.6550.418
临床诊断病例4 835（52.3）4 780（51.7）
确诊病例4 416（47.7）4 471（48.3）
糖尿病[n（%）]9.2990.002
无8 953（96.8）9 022（97.5）
有298（3.2）229（2.5）
PM2.5（μg/m2）[M（IQR）]42.0（17.8）42.0（17.2）1.0310.303
道路密度[M（IQR）]5.552（2.234）4.461（2.587）51.368<0.001
NTL[M（IQR）]29.690（20.035）16.548（24.015）44.081<0.001
), ArticleFig(id=1322609157149151388, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, language=EN, label=Table 2, caption=

Distribution of NDVI by buffer zones and quintiles

, figureFileSmall=null, figureFileBig=null, tableContent=
绿地暴露例数平均值中位数四分位间距最小值最大值
250 m缓冲区
Q13 6950.1850.1930.035-0.0850.218
Q23 7060.2410.2420.0210.2180.263
Q33 7000.2840.2840.0200.2630.305
Q43 7010.3330.3320.0280.3060.365
Q53 7000.4400.4220.0860.3650.766
Q1-Q518 5020.2970.2840.115-0.0860.766
500 m缓冲区
Q13 7010.2020.2100.033-0.0980.234
Q23 7070.2520.2520.0190.2340.270
Q33 6930.2900.2920.0180.2700.309
Q43 7010.3340.3320.0280.3100.368
Q53 7000.4440.4270.0910.3680.769
Q1-Q518 5020.3050.2920.105-0.0990.769
), ArticleFig(id=1322609157233037469, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, language=CN, label=表2, caption=

按缓冲区和五分位数划分的NDVI统计

, figureFileSmall=null, figureFileBig=null, tableContent=
绿地暴露例数平均值中位数四分位间距最小值最大值
250 m缓冲区
Q13 6950.1850.1930.035-0.0850.218
Q23 7060.2410.2420.0210.2180.263
Q33 7000.2840.2840.0200.2630.305
Q43 7010.3330.3320.0280.3060.365
Q53 7000.4400.4220.0860.3650.766
Q1-Q518 5020.2970.2840.115-0.0860.766
500 m缓冲区
Q13 7010.2020.2100.033-0.0980.234
Q23 7070.2520.2520.0190.2340.270
Q33 6930.2900.2920.0180.2700.309
Q43 7010.3340.3320.0280.3100.368
Q53 7000.4440.4270.0910.3680.769
Q1-Q518 5020.3050.2920.105-0.0990.769
), ArticleFig(id=1322609157304340638, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, language=EN, label=Table 3, caption=

Cox regression analysis of the effect of PM2.5 exposure on adverse treatment outcomes in newly diagnosed pulmonary tuberculosis patients, stratified by green space exposure groups and adjusted for other relevant exposures

, figureFileSmall=null, figureFileBig=null, tableContent=
NDVI低夜间灯光（9 246）
模型一HR值（95% CI）模型二HR值（95% CI）模型三HR值（95% CI）
250 m
Q11.0001.0001.000
Q20.979（0.714~1.343）0.982（0.716~1.348）0.976（0.711~1.340）
Q31.020（0.748~1.391）1.024（0.751~1.396）0.999（0.731~1.365）
Q41.081（0.797~1.465）1.085（0.800~1.472）1.036（0.759~1.415）
Q51.185（0.901~1.560）1.190（0.904~1.566）1.095（0.813~1.474）
Wald0.1010.0970.422
500 m
Q11.0001.0001.000
Q20.959（0.672~1.369）0.963（0.675~1.374）0.963（0.675~1.374）
Q31.147（0.820~1.605）1.152（0.823~1.612）1.143（0.816~1.601）
Q41.202（0.879~1.645）1.208（0.882~1.654）1.186（0.862~1.633）
Q51.396（1.048~1.860）1.403（1.053~1.870）1.353（0.991~1.847）
Wald0.0030.0020.019
NDVI高夜间灯光（9 246）
模型一HR值（95% CI）模型二HR值（95% CI）模型三HR值（95% CI）
250 m
Q11.0001.0001.000
Q20.966（0.710~1.312）0.959（0.706~1.303）0.957（0.705~1.301）
Q30.856（0.615~1.191）0.850（0.611~1.182）0.845（0.607~1.176）
Q40.712（0.504~1.006）0.709（0.502~1.003）0.692（0.487~0.984）
Q50.367（0.191~0.706）0.363（0.188~0.699）0.353（0.183~0.683）
Wald0.0010.0010.001
500 m
Q11.0001.0001.000
Q20.907（0.672~1.226）0.907（0.671~1.226）0.904（0.669~1.222）
Q30.946（0.693~1.290）0.947（0.694~1.292）0.928（0.677~1.271）
Q40.600（0.408~0.884）0.602（0.408~0.887）0.587（0.396~0.869）
Q50.220（0.081~0.600）0.221（0.081~0.602）0.212（0.078~0.582）
Wald0.0010.0010.001
), ArticleFig(id=1322609157388226719, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, language=CN, label=表3, caption=

绿地暴露不同分组中，PM2.5与其它相关暴露校正后对初治肺结核患者不良治疗结局影响的Cox回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
NDVI低夜间灯光（9 246）
模型一HR值（95% CI）模型二HR值（95% CI）模型三HR值（95% CI）
250 m
Q11.0001.0001.000
Q20.979（0.714~1.343）0.982（0.716~1.348）0.976（0.711~1.340）
Q31.020（0.748~1.391）1.024（0.751~1.396）0.999（0.731~1.365）
Q41.081（0.797~1.465）1.085（0.800~1.472）1.036（0.759~1.415）
Q51.185（0.901~1.560）1.190（0.904~1.566）1.095（0.813~1.474）
Wald0.1010.0970.422
500 m
Q11.0001.0001.000
Q20.959（0.672~1.369）0.963（0.675~1.374）0.963（0.675~1.374）
Q31.147（0.820~1.605）1.152（0.823~1.612）1.143（0.816~1.601）
Q41.202（0.879~1.645）1.208（0.882~1.654）1.186（0.862~1.633）
Q51.396（1.048~1.860）1.403（1.053~1.870）1.353（0.991~1.847）
Wald0.0030.0020.019
NDVI高夜间灯光（9 246）
模型一HR值（95% CI）模型二HR值（95% CI）模型三HR值（95% CI）
250 m
Q11.0001.0001.000
Q20.966（0.710~1.312）0.959（0.706~1.303）0.957（0.705~1.301）
Q30.856（0.615~1.191）0.850（0.611~1.182）0.845（0.607~1.176）
Q40.712（0.504~1.006）0.709（0.502~1.003）0.692（0.487~0.984）
Q50.367（0.191~0.706）0.363（0.188~0.699）0.353（0.183~0.683）
Wald0.0010.0010.001
500 m
Q11.0001.0001.000
Q20.907（0.672~1.226）0.907（0.671~1.226）0.904（0.669~1.222）
Q30.946（0.693~1.290）0.947（0.694~1.292）0.928（0.677~1.271）
Q40.600（0.408~0.884）0.602（0.408~0.887）0.587（0.396~0.869）
Q50.220（0.081~0.600）0.221（0.081~0.602）0.212（0.078~0.582）
Wald0.0010.0010.001
), ArticleFig(id=1322609157459529888, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, language=EN, label=Table 4, caption=

Adjusted hazard ratios and confidence intervals for green space exposure in high NTL areas

, figureFileSmall=null, figureFileBig=null, tableContent=
变量例数250 m缓冲区
HR值（95% CI）		500 m缓冲区
HR值（95% CI）
总体9 2470.063（0.011~0.373）0.028（0.003~0.237）
性别
女性2 9180.009（0.000~0.488）0.000（0.000~0.042）
男性6 3290.117（0.016~0.856）0.102（0.010~1.056）
年龄（岁）
<657 9110.041（0.002~0.744）0.010（0.000~0.363）
≥651 3360.067（0.007~0.637）0.040（0.003~0.561）
工作环境
室内5 9650.005（0.000~0.081）0.003（0.000~0.074）
室外3 2820.542（0.050~5.929）0.210（0.012~3.759）
居住地
城市6 8720.038（0.004~0.365）0.027（0.002~0.406）
农村2 3750.139（0.008~2.352）0.029（0.001~0.924）
诊断结果
临床诊断病例4 8580.053（0.002~1.382）0.005（0.000~0.277）
确诊病例4 3890.072（0.009~0.606）0.060（0.005~0.758）
PM2.5
低暴露5 3090.103（0.010~1.079）0.029（0.002~0.485）
高暴露3 9380.038（0.002~0.598）0.035（0.001~0.965）
), ArticleFig(id=1322609157547610273, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609149842673761, language=CN, label=表4, caption=

高NTL区域，绿地暴露的校正风险比与置信区间

, figureFileSmall=null, figureFileBig=null, tableContent=
变量例数250 m缓冲区
HR值（95% CI）		500 m缓冲区
HR值（95% CI）
总体9 2470.063（0.011~0.373）0.028（0.003~0.237）
性别
女性2 9180.009（0.000~0.488）0.000（0.000~0.042）
男性6 3290.117（0.016~0.856）0.102（0.010~1.056）
年龄（岁）
<657 9110.041（0.002~0.744）0.010（0.000~0.363）
≥651 3360.067（0.007~0.637）0.040（0.003~0.561）
工作环境
室内5 9650.005（0.000~0.081）0.003（0.000~0.074）
室外3 2820.542（0.050~5.929）0.210（0.012~3.759）
居住地
城市6 8720.038（0.004~0.365）0.027（0.002~0.406）
农村2 3750.139（0.008~2.352）0.029（0.001~0.924）
诊断结果
临床诊断病例4 8580.053（0.002~1.382）0.005（0.000~0.277）
确诊病例4 3890.072（0.009~0.606）0.060（0.005~0.758）
PM2.5
低暴露5 3090.103（0.010~1.079）0.029（0.002~0.485）
高暴露3 9380.038（0.002~0.598）0.035（0.001~0.965）
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2014—2021年苏州市绿地暴露对初治肺结核患者不良治疗结局的影响
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刘威威 , 张晓龙 , 崔彩岩 , 傅颖 , 王禹 , 蒋骏
现代预防医学 | 环境与职业卫生 2025,52(22): 4078-4083
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现代预防医学 |环境与职业卫生 2025 , 52 (22) : 4078 -4083
2014—2021年苏州市绿地暴露对初治肺结核患者不良治疗结局的影响
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刘威威, 张晓龙, 崔彩岩, 傅颖, 王禹, 蒋骏
作者信息
  • 苏州市疾病预防控制中心结核病防制所，江苏　苏州　215317
通讯作者:
蒋骏，E-mail：
作者简介:

刘威威（1995—），男，硕士，医师，研究方向：结核病防制工作

Impact of green space exposure on adverse treatment outcomes among newly treated pulmonary tuberculosis patients, Suzhou, 2014-2021
Wei-wei LIU, Xiao-long ZHANG, Cai-yan CUI, Ying FU, Yu WANG, Jun JIANG
Affiliations
  • Department of Tuberculosis, Center for Disease Control and Prevention of Suzhou, Suzhou, Jiangsu 215317, China
出版时间: 2025-11-25 doi: 10.20043/j.cnki.MPM.202506216
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摘要
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目的

探讨苏州市绿地暴露对初治肺结核患者不良治疗结局的影响。

方法

收集苏州市2014年1月1日—2021年12月31日的18 502例初治肺结核患者数据，结合患者居住地250 m和500 m缓冲区范围内归一化差异植被指数，通过Cox回归模型评估绿地暴露对初治肺结核患者不良治疗结局的影响。

结果

高夜间灯光强度区域的初治肺结核患者，在250 m缓冲区内，调整个体层面和环境层面的协变量，Q4和Q5组的HR值和95% CI分别为0.692（0.487~0.984）和0.353（0.183~0.683）。在500 m缓冲区内，相应 Q4和Q5组的HR值和95% CI分别为0.587（0.396~0.869）和0.212（0.078~0.582），表现出更强的保护效应。Wald线性趋势检验表明存在线性关系。亚组分析结果表明绿地暴露对女性、年轻患者、室内工作者、城市居民、临床诊断病例更为有益。

结论

在高夜间灯光强度区域居住的初治肺结核患者中，增加绿地暴露可降低初治肺结核患者不良治疗结局的发生。

绿地暴露  /  肺结核  /  不良结局  /  Cox回归
Objective

To investigate the impact of green space exposure on adverse treatment outcomes among newly diagnosed pulmonary tuberculosis patients in Suzhou.

Methods

Data from 18 502 newly treated pulmonary TB patients in Suzhou between January 1, 2014 and December 31, 2021 were collected. Green space exposure was quantified using the Normalized Difference Vegetation Index（NDVI）within 250-meter and 500-meter buffer zones around residential addresses. Cox proportional hazards regression models were applied to assess associations between green space exposure and adverse outcomes, adjusting for individual- and environmental-level covariates.

Results

Among patients residing in high nighttime light（NTL）intensity areas, those in the highest quartiles（Q4 and Q5）of green space exposure within the 250-meter buffer exhibited significantly lower risks of adverse outcomes after covariate adjustment, with hazard ratios（HRs）of 0.692（95% CI: 0.487-0.984）and 0.353（95% CI: 0.183-0.683）, respectively. In the 500-meter buffer, stronger protective effects were observed, with HRs of 0.587（95% CI: 0.396-0.869）for Q4 and 0.212（95% CI: 0.078-0.582）for Q5. Wald tests for linear trends confirmed a dose-response relationship（Ptrend<0.05）. Subgroup analyses revealed greater benefits of green space exposure for females, younger patients, indoor workers, urban residents, and clinically diagnosed cases.

Conclusion

Increased green space exposure is associated with reduced risks of adverse treatment outcomes among newly diagnosed PTB patients in high-NTL areas, underscoring its potential public health significance in tuberculosis management.

Green space exposure  /  Pulmonary tuberculosis  /  Adverse outcomes  /  Cox regression
刘威威, 张晓龙, 崔彩岩, 傅颖, 王禹, 蒋骏. 2014—2021年苏州市绿地暴露对初治肺结核患者不良治疗结局的影响. 现代预防医学, 2025 , 52 (22) : 4078 -4083 . DOI: 10.20043/j.cnki.MPM.202506216
Wei-wei LIU, Xiao-long ZHANG, Cai-yan CUI, Ying FU, Yu WANG, Jun JIANG. Impact of green space exposure on adverse treatment outcomes among newly treated pulmonary tuberculosis patients, Suzhou, 2014-2021[J]. Modern Preventive Medicine, 2025 , 52 (22) : 4078 -4083 . DOI: 10.20043/j.cnki.MPM.202506216
正文
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结核病是一种由结核分枝杆菌感染引起的慢性传染性疾病。根据《2024年全球结核病报告》，在30个结核病高负担国家里面，我国结核病发病数排第3位，约占全球发病总数的6.8%[1]。2023年全球结核病死亡人数为125万，重返全球单一传染病死因首位[1]。因此，识别结核病治疗期间对治疗结局可能的影响因素，减少结核病患者疾病负担和改善预后十分必要。目前，除了营养不良、糖尿病等公认的个体因素外，环境因素对结核病预后的影响也逐渐受到重视，但是很少有研究探索结核病治疗期间的环境保护因素。
绿地指城市公园、道路绿化等植被覆盖的区域[2]，通常被认为是多种疾病的环境保护因素，通过多种机制（如减少空气污染暴露、调节气温、缓解精神心理压力等）对健康产生积极作用[3-5]。本研究通过大样本回顾性队列，尝试多尺度缓冲区分析，探讨绿地暴露与初治肺结核患者不良治疗结局的剂量-反应关系，为政府公共卫生干预策略提供参考依据。
1　资料与方法
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1.1　资料来源
苏州市初治肺结核患者数据来自中国疾病预防控制信息系统的结核病管理信息系统。收集2014年1月1日—2021年12月31日登记为初治肺结核患者的病案信息，包括基本信息，诊断情况，治疗及转归情况。本研究为回顾性队列研究，排除了基线信息缺失患者、复治患者、耐药患者、流动人口患者，以及居住地址缺乏空气污染物等暴露数据者。
1.2　相关定义
所有参与研究的患者均符合《WS 288-2008肺结核诊断》[6]和《WS 196-2017肺结核分类》[7]标准。根据《中国结核病防治工作技术指南（2021版）》[8]，患者的治疗转归分为成功治疗和不良治疗结局两类。其中，成功治疗包括治愈和完成疗程；不良治疗结局则包括死亡和治疗失败。
1.3　暴露评估
绿地暴露的评估是基于归一化植被指数（normalized difference vegetative index，NDVI）进行。研究数据从国家生态科学数据中心（https://nesdc.org.cn）上获得。夜间灯光数据（The nighttime light，NTL）作为区域城市化、人类行为和经济水平的代理指标，用以校正个体的社会经济水平与居住环境[9-10]。研究数据来自网站（https://eogdata.mines.edu）的公开数据集。细颗粒物（Particulate Matter 2.5，PM2.5）数据来自中国高分辨率高质量近地表空气污染物数据集（https://tapdata.org.cn)。道路密度数据来源于中国科学院资源环境科学数据中心（https://www.resdc.cn）。
将研究对象的“ID号”作为唯一识别符，对其确诊登记时的居住地址进行地理编码获取经纬度坐标。脱敏处理后，利用ArcGIS 10.8将NDVI、NTL、PM2.5和道路密度估计值分配给每一位研究对象。其中，绿地暴露与初治肺结核患者居住地址的分布，见图1。
1.4　统计学分析
描述性分析中，偏态分布的计量资料表示为“中位数（四分位间距）”，计数资料表示为“频数”和“构成比”。组间差异比较采用独立样本t检验或χ2检验。
为更好地满足风险函数假设，将NDVI转换为五分位数，并采用Wald检验分析各分位数间的线性趋势。根据单变量Cox模型判断与结局事件发生的关联性，筛选个体协变量（P值<0.2）作为潜在混杂因素纳入多变量Cox回归模型，并以敏感性分析验证稳健性。为控制城市化水平对绿地暴露效应估计的干扰，按NTL分层，层内调整其他协变量。NDVI分别针对250 m和500 m缓冲区，对与初治肺结核患者不良治疗结局的相关性进行分析，以P值<0.05为显著性阈值。研究构建三个模型来评估绿地暴露对初治肺结核患者不良治疗结局的影响。模型一纳入了患者的个人特征和治疗相关因素，模型二在模型一的基础上纳入环境相关因素PM2.5，模型三在模型二的基础上进一步纳入交通相关因素道路密度。通过亚组分析评估性别、年龄、工作环境、居住地、诊断结果和PM2.5对效应值的修饰作用。针对每个亚组分别建立最终的多变量Cox回归模型，并报告具有统计学意义（P值<0.05）的分层特异性效应。
最后，使用限制性立方样条（Restricted Cubic Spline，RCS）对高夜间灯光强度暴露下NDVI与初治肺结核患者不良治疗结局的暴露-反应关系进行检验。以绿地暴露水平的第10、50和90百分位数值点作为RCS模型拟合的三个节点位置，并通过Wald统计检验非线性。
2　结果
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2.1　描述性分析
18 502例初治肺结核患者中，累计随访11 122人年，平均每位患者随访219±68天，中位数194天。其中，13 028例（70.41%）为男性，3 937例（21.28%）年龄在65岁以上，9 130例（49.34%）工作在室外，8 059例（43.56%）在农村，527例（2.84%）为糖尿病患者。按照患者随访期间居住地址500 m缓冲区内NDVI中位数0.292作为分界值划分高低暴露，居住于绿地高暴露区域的初治肺结核患者相比低暴露区域患者而言，男性更为居多、老龄化、工作在室外、居住在农村、夜间灯光强度以及道路密度较低，见表1。
研究对象及其随访期间居住地周围250 m和500 m缓冲区内绿地暴露五分位数间的分布情况，见表2。在250 m和500 m缓冲区内，NDVI的平均值分别为0.297和0.305，中位数和四分位区间分别为0.284（IQR=0.115）和0.292（IQR=0.105）；500 m缓冲区内的绿地暴露水平在各五分位相较于250 m略高。此外，相关性分析结果显示，250 m缓冲区和500 m缓冲区范围内NDVI与道路密度、NTL之间呈现负相关性。
2.2　治疗转归的影响因素分析
个人潜在混杂因素经过单因素Cox回归分析，年龄、性别、工作环境、居住地、患者来源、诊断结果和糖尿病与初治肺结核患者不良治疗结局发生相关（P值<0.2）。以是否发生不良治疗结局为因变量（0=成功治疗，1=不良结局），将上述差异具有统计学意义的个人潜在混杂因素作为协变量纳入到多因素Cox回归分析。
分析结果表明：在高夜间灯光强度区域及250 m缓冲区内绿地暴露情况下，模型三Q4和Q5组的HR值和95% CI分别为0.692（0.487~0.984）和0.353（0.183~0.683）。Wald线性趋势检验显示绿地暴露与不良治疗结局存在线性关系。在高夜间灯光强度区域及500 m缓冲区内绿地暴露情况下，模型三Q4和Q5组的HR值和95% CI分别为0.587（0.396~0.869）和0.212（0.078~0.582）。Wald线性趋势检验显示绿地暴露与不良治疗结局依旧存在线性关系。此外，研究发现500 m缓冲区内绿地暴露的保护效应更强。然而，研究未观察到低夜间灯光强度区域在250 m和500 m缓冲区内绿地暴露与初治肺结核患者不良治疗结局的发生存在关联。见表3。
2.3　亚组分析
通过对高夜间灯光强度区域患者的性别、年龄、工作环境、居住地、诊断结果以及PM2.5进行亚组分析。分析结果显示：绿地暴露分别是女性、较年轻患者（<65岁）、室内工作者、城市居民以及临床诊断病例的保护因素；相较于250 m缓冲区，500 m缓冲区的绿地暴露显著降低初治肺结核患者不良治疗结局的发生。见表4。
2.4　暴露反应关系
通过模型拟合，RCS采用三节点（第10、50和90百分位点）嵌套Cox比例风险回归模型进行，展示暴露-反应曲线及其95%上下置信区间。结果表明，在夜间灯光强度较强区域，绿地暴露与初治肺结核患者不良治疗结局之间存在非线性关系。见图2。
3　讨论
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苏州市临界区域是结核病的重点防控区域，提高道路交通网络建设，重视绿色空间建设，对于降低苏州市结核病发病率起着重要作用[11]。本次研究揭示了绿地暴露对初治肺结核患者治疗结局的保护效应。高夜间灯光强度区域的初治肺结核患者，在绿地暴露250 m缓冲区内，Q4和Q5组的HR值和95% CI分别为0.692（0.487~0.984）和0.353（0.183~0.683）。而在500 m缓冲区内，相应 Q4和Q5组的HR值和95% CI分别为0.587（0.396~0.869）和0.212（0.078~0.582），提示绿地暴露对初治肺结核患者的治疗结局可能存在保护性关联效应。
国内外既往研究[12-13]与本研究结果类似，Ge等在耐多药结核队列中发现绿地削弱了PM2.5与死亡率的关联，佐证了绿地可通过提高空气质量，间接改善结核病预后结局。Ge等进一步证明低NTL区NDVI（500 m范围）同样降低耐药结核患者死亡风险（HR=0.690），与本研究发现的500 m缓冲区更强效应互为支撑。此外，空间尺度（500 m>250 m）的保护梯度揭示了社区级绿地的关键作用，这可能与患者日常活动的主要覆盖范围，城市居民行为模式直接关联。提示无论初治或耐药结核患者，绿地暴露均是独立的保护因素，其效应在高城市化水平下更为显著，为通过城市规划干预结核病防控提供了科学依据。
多项研究[14-16]揭示了绿地暴露对肺结核预后影响的可能性生物学机制。首先，植被通过沉降PM2.5、吸收氮氧化物等污染物，可降低肺部持续炎症损伤和氧化应激水平，减轻结核病灶进展风险。其次，绿地暴露显著缓解心理压力，通过下调HPA轴活性和皮质醇分泌，增强CD4+T细胞应答能力。动物模型证实压力可抑制Th1免疫，从而提升机体清除结核分枝杆菌的效能。也有研究表明，高绿地覆盖率促进患者户外康复活动，间接改善治疗依从性。
本研究亚组分析发现，绿地暴露对男性的保护性作用更弱，这与王玥等[17]的研究结果一致，可能与男性作为主要劳动力，社交活动面大，多有不良生活行为习惯有关[18]。年龄≥65岁患者获益有限，源于免疫衰老削弱环境增益效果[19]。确诊病例不良结局风险较大，与马斌忠等[20]的研究结果一致，病原学阳性患者携带大量结核分枝杆菌，病情严重，治疗难度大，且容易出现就诊延迟[21]。室外工作患者风险更大，源于这些患者经济收入较低，环境卫生条件较差，结核病防治知识不足。城市地区居民中保护作用更强，表明绿地暴露通过降低空气污染和减轻压力产生更大效益。在绿地暴露的不同缓冲区内，PM2.5的高低暴露效应不一致。既往流行病学研究[14，16]证实，交通相关空气污染与结核病发病率呈负相关。绿色植通过吸收空气中的悬浮颗粒、促进植物表面对气态污染物的吸附来降低污染物浓度。这些研究表明绿化程度、空气污染和结核发病之间可能存在非线性暴露-反应关系。
本次研究存在局限性。首先，研究基于卫星综合模型并以村级居住地址匹配绿地以及相关环境因素暴露水平，不完全反映个体真实暴露情况；其次，虽然已排除缺乏居住地信息或空气污染和绿地暴露数据的流动人口与本地患者，但错误分类和选择偏倚的可能性仍不能完全排除。
综上所述，绿地暴露与初治肺结核患者不良治疗结局存在负向关联，需关注绿色环境空间建设，以降低初治肺结核患者不良治疗结局。
基金
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  • 江苏省防痨协会科研课题(FLKT202407)
  • 苏州市卫生青年骨干人才“全国导师制”培训项目(QNGG2022031)
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2025年第52卷第22期
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doi: 10.20043/j.cnki.MPM.202506216
  • 接收时间：2025-06-13
  • 首发时间：2026-10-29
  • 出版时间：2025-11-25
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  • 收稿日期：2025-06-13
基金
江苏省防痨协会科研课题(FLKT202407)
苏州市卫生青年骨干人才“全国导师制”培训项目(QNGG2022031)
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    苏州市疾病预防控制中心结核病防制所，江苏　苏州　215317

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2种不同金属材料的力学参数
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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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