中国循证医学杂志

中国循证医学杂志

重庆市学龄儿童 25 年前后呼吸系统疾病患病率和肺功能的变化及其原因分析

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目的了解 2018 年重庆市学龄儿童呼吸系统疾病和肺功能现况,并与 25 年前重庆市儿童比较,探讨学龄儿童呼吸系统疾病和肺功能变化产生的可能原因。方法根据重庆市 1998~2016 年空气质量数据,绘制空气质量优良天数和污染物浓度年际变化图。采用随机整群抽样抽取重庆市两区 2 126 名学龄儿童进行问卷调查,从问卷调查的儿童中分层随机抽取 771 名进行肺功能测试,并与 25 年前学龄儿童结果比较。结果近 20 年间,重庆市空气优良天数逐年增加;SO2 浓度下降明显,空气污染构成由以 SO2 为主转向以 PM10、PM2.5 为主。本次调查儿童支气管炎(P<0.05)患病率高于 25 年前。多因素 logistic 回归模型调整混杂因素的结果显示,与 25 年前相比,本次调查儿童支气管炎发生的 OR 值为 1.667(P<0.05)。多重线性回归结果表明本次调查对象肺功能指标 FVC、FEV1、PEF 和 FEV3 低于 25 年前的测试儿童。在本次调查中,水果和乳制品类食物食用频次不同的儿童肺功能指标有差异(P<0.05),高频次食用者高于低频次。在运动时间上,也表现为运动≥1 h/天的儿童的 FVC、FEV3 值大于运动<1 h/天的儿童(P<0.05)。结论1998~2016 年重庆市整体空气质量好转,空气污染构成由以 SO2 为主转向以 PM10、PM2.5 为主,但儿童呼吸系统健康状况较 25 年前下降。空气污染物的构成变化可能危害儿童呼吸系统健康,食用水果和乳制品类食物、运动可能是儿童呼吸系统健康的保护因素。

ObjectivesTo investigate the prevalence of respiratory diseases and lung function of school-age children in Chongqing and to compare them with that of children in 25 years ago and to explore the possible causes of this change.MethodsAccording to the air quality data of Chongqing from 1998 to 2016, the annual variation of air quality days and pollutant concentrations were plotted. 2 126 school-age children in two districts of Chongqing were selected by random cluster sampling for questionnaires. 771 children were randomly selected from the children who completed the questionnaire for pulmonary function tests. The results were compared with that of 25 years ago.ResultsFrom 1998 to 2016, the number of days with good air quality in Chongqing increased annually, and the concentration of SO2 decreased significantly. The main air pollution composition changed from SO2 to PM10 and PM2.5. The prevalence of bronchitis (P<0.05) was higher than that of 25 years ago. After adjusting for confounding factors by multivariate logistic regression, the OR value of bronchitis in children was 1.667 (P<0.05) compared with 25 years ago. After adjusting for age, sex, height and weight by multiple linear regression, the results showed that the subjects' lung function indexes (FVC, FEV1, PEF and FEV3) were lower than that of 25 years ago. In this survey, there were differences in lung function indexes between children with different frequency of eating fruits and dairy products (P<0.05), and those with high frequency consumption were higher than low frequency. In terms of exercise time, subjects exercising ≥1 hour/day had greater FVC and FEV3 values than those exercising <1 hour/day (P<0.05).ConclusionsThe overall air quality in Chongqing has improved from 1998 to 2016; The respiratory health of children has decreased when compared with that of 25 years ago. Changes in the composition of air pollutants may endanger children's respiratory health, and fruit and dairy foods and exercise may be protective factors for children's respiratory health.

关键词: 空气质量; 营养和运动; 儿童; 呼吸健康; 肺功能; 问卷调查

Key words: Air quality; Nutrition and exercise; Children; Respiratory disease; Pulmonary function; Survey

引用本文: 李文艳, 刘琴, 陈奕文, 杨博, 黄欣, 李月月, ZHANGJunfeng. 重庆市学龄儿童 25 年前后呼吸系统疾病患病率和肺功能的变化及其原因分析. 中国循证医学杂志, 2019, 19(3): 281-286. doi: 10.7507/1672-2531.201811027 复制

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