空气污染物对兰州市儿童特应性皮炎门诊人次的影响

李璨 王菲 何苑 石春蕊

摘要：目的 分析兰州市空气污染物与儿童特应性皮炎门诊人次的关系，为患儿的生活指导和相关部门的疾病预防提供科学依据。方法 采用广义相加模型在控制长期趋势、假期效应、星期几效应和气象因素等混杂因素的基础上，分析兰州市空气污染物对儿童特应性皮炎门诊人次的影响和滞后效应。结果 NO2、PM2.5、PM10、SO2对儿童特应性皮炎门诊人次的影响在滞后当天（Lag0）最显著，但均无统计学意义（P均>0.05）；CO也在Lag0影响最显著，其浓度每升高10 μg/m3，儿童特应性皮炎门诊人次增加的超额危险度（ER）值为0.05%（95% CI=0～0.10%，P=0.049）；O3在累积滞后第7天（Lag07）影响最显著，其浓度每升高10 μg/m3，儿童特应性皮炎门诊人次增加的ER值为7.40%（95% CI=5.31%～9.53%，P<0.001）。年龄分层显示，0～3岁特应性皮炎患儿对CO最敏感，其浓度每升高10 μg/m3，门诊人次增加的ER值为0.09%（95% CI=0.04%～0.15%，P<0.001）；7～14岁特应性皮炎患儿对O3最敏感，其浓度每升高10 μg/m3，门诊人次增加的ER值为8.26%（95% CI=4.99%～11.64%，P<0.001）。季节分层显示，CO在夏季和秋季对儿童特应性皮炎门诊人次的影响较强，ER值分别为0.45%和0.16%（P均<0.001）；而O3在冬季对门诊人次影响明显，ER值为20.48%（P<0.001）。结论 兰州市空气污染物CO、O3日平均浓度的升高与儿童特应性皮炎的门诊人次呈正相关，具有显著的季节效应和年龄分层敏感性。

关键词：特应性皮炎；空气污染物；广义相加模型

中图分类号： R758.2  文献标识码： A  文章编号：1000-503X（2024）03-0361-09

DOI：10.3881/j.issn.1000-503X.15902

Impact of Air Pollutants on Outpatient Visits for Pediatric Atopic Dermatitis in Lanzhou

LI Can WANG Fei2，HE Yuan3，SHI Chunrui4

1Department of Dermatovenereology，The First School of Clinical Medicine，Lanzhou University，Lanzhou 730000，China

2Department of Dermatovenereology，West China School of Medicine，Sichuan University，Chengdu 61004 China

3Department of Dermatology，Lanzhou University Second Hospital，Lanzhou 730030，China

4Department of Dermatology，The First Hospital of Lanzhou University，Lanzhou 730000，China

Corresponding author：SHI Chunrui Tel：0931-8356092，E-mail：shichr@lzu.edu.cn

ABSTRACT：Objective To analyze the correlation between air pollutants and pediatric atopic dermatitis outpatient visits in Lanzhou，and provide scientific insights for the life guidance of the affected children and disease prevention by relevant departments.Methods A generalized additive model was employed to analyze the effects and lagged effects of air pollutants on pediatric atopic dermatitis outpatient visits in Lanzhou while controlling for confounding factors such as long-term trends，holiday effects，day of the week effects and meteorological factors.Results The effects of NO2，PM2.5，PM10，and SO2 on pediatric atopic dermatitis outpatient visits were most significant on the current day（Lag0），but were not statistically significant （all P>0.05）；CO also had the most significant effect on Lag0，and for every 10 μg/m3 increase in its concentration，the excess risk （ER） for pediatric atopic dermatitis outpatient visits was 0.05% （95%CI=0-0.10%，P=0.049）；and O3 exhibited the most significant effect on day 7 of the cumulative lag （Lag07），with a statistically significant increase in the ER for each 10 μg/m3 increase in its concentration of 7.40% （95%CI=5.31%-9.53%，P<0.001） for pediatric atopic dermatitis outpatient visits.Age stratification showed that children aged 0-3 years with atopic dermatitis were the most sensitive to CO，with an increased ER of 0.09% （95%CI=0.04%-0.15%，P<0.001） for every 10 μg/m3 increase in concentration，and children aged 7-14 years with atopic dermatitis were the most sensitive to O3，with an increased ER of 8.26% （95%CI=4.99%-11.64%，P<0.001）  for every 10 μg/m3 increase in concentration.Seasonal stratification showed that CO exerted a stronger effect on pediatric atopic dermatitis outpatient visits in summer and fall，with ER values of 0.45% and 0.16% （both P<0.001），respectively，while O3 had a significant effect on outpatient visits in winter，with an ER value of 20.48% （P<0.001）.Conclusion Elevated daily average concentrations of air pollutants CO and O3 in Lanzhou were positively correlated with the number of outpatient visits for atopic dermatitis in children，with significant seasonal effects and age-stratified sensitivities.

Key words：atopic dermatitis；air pollutants；generalized additive model

Acta Acad Med Sin，2024，46（3）：361-369

特应性皮炎以剧烈瘙痒、皮肤干燥和复发性湿疹病变为特征，是全球最常见的慢性炎症性系统性皮肤疾病［1］。特应性皮炎最早可发生于婴幼儿时期，横断面研究表明，近几十年儿童特应性皮炎发病率持续增长，常合并呼吸道、胃肠道过敏性疾病和精神疾病等多种并发症，严重影响患儿的身心健康和生活质量，加重家庭经济负担［2］。特应性皮炎的病因和发病机制不清，已知的影响因素包括遗传易感性、皮肤屏障功能障碍、免疫紊乱、微生物菌群失调和环境暴露等。儿童因其免疫器官和系统尚处于生长发育阶段，皮肤屏障功能相对脆弱，极易受到外界环境暴露的影响。而空气污染物作为环境暴露的主要因素之一，与特应性皮炎之间的关系目前仍存在争议。越来……