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空气质量改善与儿童肺发育的关系
Association of Improved Air Quality with Lung Development in Children


W. James Gauderman ... 呼吸系统疾病 围产医学和儿科 • 2015.03.05
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治理空气污染可改善儿童肺功能水平


裴正存,詹思延*

北京大学公共卫生学院

*通讯作者

 

中国是世界上最大的发展中国家,随着城市化进程的发展,我国疾病谱已经发生巨大变化,人均期望寿命增加,慢性疾病的疾病负担逐年增高,但同时环境污染问题也愈发显著1。我国空气污染的主要污染源为工业、交通及生物燃料2,污染水平显著高于发达国家。以细颗粒物为例,一项2011~2014年的观察性研究发现,最高年均细颗粒物浓度超过了690.0 μg/m3 3。另一项观察性研究发现,2014~2016年的PM2.5年人均加权平均值依次为65.8 μg/m3、55.0 μg/m3、50.7 μg/m3,虽然呈逐年下降趋势,但实际上我国仅7%人口的生活区域PM2.5水平能够达到中国环境空气质量二级标准4

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摘要


背景

由于空气质量控制政策的实施,加利福尼亚州南部的空气污染水平在过去几十年内呈现逐渐下降的趋势。我们评估了空气污染水平的长期下降是否与儿童呼吸系统健康状况改善有关。

 

方法

作为儿童健康研究的一部分,我们对来自三个不同队列的2,110名儿童分别在三个不同的时间段(即1994~1998年,1997~2001年,2007~2011年)进行了每年1次的肺功能测定。每个队列内儿童的平均年龄在观察期开始时为11岁,结束时为15岁。线性回归模型被用来评估随时间不断降低的污染水平与儿童11~15岁肺功能发育的关系,肺功能发育评估采用的是观察期内第一秒用力呼气量(FEV1)和用力肺活量(FVC)的增长(即FEV1和FVC的4年增长)。

 

结果

在三个队列共13年的观察期间,FEV1和FVC两者的4年增长改善与二氧化氮水平(FEV1和FVC的P<0.001)、空气动力学直径<2.5 μm(FEV1P=0.008,FVC的P<0.001)和<10 μm(FEV1和FVC的P<0.001)的悬浮颗粒物水平降低相关。这些相关性在校正多种潜在混杂因素后仍存在。男孩和女孩、有哮喘和无哮喘的儿童中都观察到了肺功能发育的明显改善。随着空气质量改善,15岁时具有临床上偏低FEV1(定义为<80%预计值)儿童的比例显著下降,在三个观察期内从7.9%降到6.3%再到3.6%(P=0.001)。

 

结论

我们发现空气质量的长期改善对儿童的肺功能发育有统计学显著性和有临床意义的有利影响(由美国健康影响研究所[Health Effects Institute]等资助)。





作者信息

W. James Gauderman, Ph.D., Robert Urman, M.S., Edward Avol, M.S., Kiros Berhane, Ph.D., Rob McConnell, M.D., Edward Rappaport, M.S., Roger Chang, Ph.D., Fred Lurmann, M.S., and Frank Gilliland, M.D., Ph.D.
From the Department of Preventive Medicine, University of Southern California, Los Angeles (W.J.G., R.U., E.A., K.B., R.M., E.R., R.C., F.G.) and Sonoma Technologies, Petaluma (F.L.) — both in California.Address reprint requests to Dr. Gauderman at the Department of Preventive Medicine, University of Southern California, 2001 Soto St., 202-K, Los Angeles, CA 90032, or at jimg@usc.edu.

 

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