大气气态污染物对农村结核分枝杆菌潜伏感染者肺结核发病的影响

doi:10.19982/j.issn.1000-6621.20240061

中国防痨杂志 ›› 2024, Vol. 46 ›› Issue (6): 654-663.doi: 10.19982/j.issn.1000-6621.20240061

大气气态污染物对农村结核分枝杆菌潜伏感染者肺结核发病的影响

田思帆¹, 郭同磊², 陈晨³, 张彬⁴, 辛赫男², 杜江², 曹雪芳², 冯博轩², 何翼君², 何勇鹏², 王大宽⁴, 刘自森⁴, 闫娇霞⁴, 沈玲羽², 邸元植², 陈彦宵⁵, 金奇², 段伟焘⁴, 高磊², 高旭¹()

¹北京大学公共卫生学院劳动卫生与环境卫生学系,北京 100191
²中国医学科学院病原生物学研究所,北京 100730
³中国疾病预防控制中心环境与人群健康重点实验室/中国疾病预防控制中心环境与健康相关产品安全所,北京 100021
⁴河南省郑州市中牟县疾病预防控制中心,郑州 451450
⁵郑州大学公共卫生学院,郑州 450001

收稿日期:2024-02-18 出版日期:2024-06-10 发布日期:2024-06-03
通信作者: 高旭,Email: xu.gao@pku.edu.cn
基金资助:
国家自然科学基金(82304098);国家自然科学基金(42305196);国家自然科学基金(82373647);科技基础资源调查专项(2023FY100603)

Impact of gaseous air pollutants on the risk of incident active pulmonary tuberculosis among rural people with latent tuberculosis infection

Tian Sifan¹, Guo Tonglei², Chen Chen³, Zhang Bin⁴, Xin Henan², Du Jiang², Cao Xuefang², Feng Boxuan², He Yijun², He Yongpeng², Wang Dakuan⁴, Liu Zisen⁴, Yan Jiaoxia⁴, Shen Lingyu², Di Yuanzhi², Chen Yanxiao⁵, Jin Qi², Duan Weitao⁴, Gao Lei², Gao Xu¹()

¹Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
²Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
³Key Laboratory of Environment and Population Health/National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
⁴Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, Henan Province, Zhengzhou 451450, China
⁵College of Public Health, Zhengzhou University, Zhengzhou 450001, China

Received:2024-02-18 Online:2024-06-10 Published:2024-06-03
Contact: Gao Xu, Email: xu.gao@pku.edu.cn
Supported by:
National Natural Science Foundation of China(82304098);National Natural Science Foundation of China(42305196);National Natural Science Foundation of China(82373647);Science & Technology Fundamental Resources Investigation Program(2023FY100603)

摘要/Abstract

摘要：

目的: 探讨主要大气气态污染物对农村地区处于结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)状态的成年人群肺结核发病的影响。方法: 本研究基于2013—2018年在农村地区开展的一项多中心、前瞻性结核分枝杆菌潜伏感染队列(LATENTTB-NSTM),对3866例基线LTBI者季度随访5年,收集新发活动性肺结核病例,根据居住地点和时间匹配气态污染物浓度,利用含时依协变量的Cox比例风险模型分别估计二氧化硫(SO₂)、二氧化氮(NO₂)、臭氧(O₃)和一氧化碳(CO)与研究人群及不同年龄段、性别、受教育程度、家庭收入和生活方式等亚组新发活动性肺结核发病风险之间的关联。结果: 3866例LTBI者,随访中发现新发活动性肺结核58例。6个月的SO₂和CO暴露水平分别每增加10μg/m³和100μg/m³,活动性肺结核发病风险分别增加81.0%(HR=1.810,95%CI:1.153~2.843)和19.6%(HR=1.196,95%CI:1.031~1.388)。SO₂和CO暴露与活动性肺结核发病风险间的关联在老年人群和吸烟人群中更强,但差异均无统计学意义(交互作用P值均>0.05)。结论: 大气气态污染物尤其是SO₂和CO暴露可引起农村地区LTBI者活动性肺结核发病风险升高,大气气态污染的治理对肺结核的控制具有不可忽视的意义。

关键词: 结核,肺, 感染, 空气污染物, 因素分析,统计学

Abstract:

Objective: To investigate the influence of primary atmospheric gaseous pollutants on the incidence of active pulmonary tuberculosis among adults in rural areas with latent tuberculosis infection (LTBI). Methods: This study utilized a multicenter, longitudinal cohort of rural residents with LTBI (LATENTTB-NSTM), spanning from 2013 to 2018, comprising 3866 participants who were monitored quarterly over five years to document new cases of active pulmonary tuberculosis. Concentrations of atmospheric gaseous pollutants such as sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), and carbon monoxide (CO) were precisely matched to the residential locations and periods under review. The association between exposure levels and the emergence of active tuberculosis was analyzed using time-dependent Cox proportional hazards models, stratified by age, sex, educational attainment, family income, and lifestyle factors. Results: Among 3866 individuals diagnosed with latent tuberculosis infection, surveillance identified 58 new cases of active pulmonary tuberculosis. Incremental exposures to SO₂ and CO by 10 μg/m³ and 100 μg/m³, respectively, over a six-month period were associated with a respective 81.0% (HR=1.810, 95%CI: 1.153-2.843) and 19.6% (HR=1.196, 95%CI: 1.031-1.388) increase in the risk of developing active tuberculosis. Notably, these associations appeared more pronounced among older adults and smokers, though the differences did not reach statistical significance (interaction P-values >0.05). Conclusion: Exposure to atmospheric gaseous pollutants, particularly SO₂ and CO, is associated with a heightened risk of developing active pulmonary tuberculosis among individuals with LTBI in rural settings. The management of air quality, therefore, plays a crucial role in the strategic control of tuberculosis.

Key words: Tuberculosis, pulmonary, Infection, Air pollutants, Factor analysis, statistical

中图分类号:

R521

田思帆, 郭同磊, 陈晨, 张彬, 辛赫男, 杜江, 曹雪芳, 冯博轩, 何翼君, 何勇鹏, 王大宽, 刘自森, 闫娇霞, 沈玲羽, 邸元植, 陈彦宵, 金奇, 段伟焘, 高磊, 高旭. 大气气态污染物对农村结核分枝杆菌潜伏感染者肺结核发病的影响[J]. 中国防痨杂志, 2024, 46(6): 654-663. doi: 10.19982/j.issn.1000-6621.20240061

Tian Sifan, Guo Tonglei, Chen Chen, Zhang Bin, Xin Henan, Du Jiang, Cao Xuefang, Feng Boxuan, He Yijun, He Yongpeng, Wang Dakuan, Liu Zisen, Yan Jiaoxia, Shen Lingyu, Di Yuanzhi, Chen Yanxiao, Jin Qi, Duan Weitao, Gao Lei, Gao Xu. Impact of gaseous air pollutants on the risk of incident active pulmonary tuberculosis among rural people with latent tuberculosis infection[J]. Chinese Journal of Antituberculosis, 2024, 46(6): 654-663. doi: 10.19982/j.issn.1000-6621.20240061

图/表 5

表1

人群基线特征在发生肺结核与未发生肺结核的结核分枝杆菌潜伏感染者中的分布情况

特征	合计 (3866例)	未发生肺结核 (3808例)	发生肺结核 (58例)	统计检验值	P值
年龄(岁,$\bar{x}±s$)	55.2±13.8	55.1±13.8	58.2±16.4	t=-1.433	0.157
年龄组[例(构成比,%)]				χ²=4.276	0.118
18~44岁	889(23.0)	877(23.0)	12(20.7)
45~59岁	1470(38.0)	1454(38.2)	16(27.6)
≥60岁	1507(39.0)	1477(38.8)	30(51.7)
性别[例(构成比,%)]				χ²=9.077	0.003
男性	2076(53.7)	2033(53.4)	43(74.1)
女性	1790(46.3)	1775(46.6)	15(25.9)
受教育程度[例(构成比,%)]				χ²=3.860	0.145
小学及以下	2175(56.3)	2137(56.1)	38(65.5)
初中	1262(32.6)	1250(32.8)	12(20.7)
高中及以上	429(11.1)	421(11.1)	8(13.8)
家庭人均年收入[例(构成比,%)]				χ²<0.001	1.000
<6000元	2445(63.2)	2408(63.2)	37(63.8)
≥6000元	1421(36.8)	1400(36.8)	21(36.2)
体质量[例(构成比,%)]					0.031^a
正常	1985(51.3)	1950(51.2)	35(60.4)
过低	163(4.2)	157(4.1)	6(10.3)
超重	1254(32.4)	1242(32.6)	12(20.7)
肥胖	464(12.1)	459(12.1)	5(8.6)
吸烟[例(构成比,%)]					0.013^a
从不	2398(62.0)	2369(62.2)	29(50.0)
正在	1367(35.4)	1343(35.3)	24(41.4)
已戒	101(2.6)	96(2.5)	5(8.6)
饮酒[例(构成比,%)]				χ²=2.827	0.093
否	2870(74.2)	2833(74.4)	37(63.8)
是	996(25.8)	975(25.6)	21(36.2)
结核病患者密切接触史[例(构成比,%)]					0.399^a
无	3451(89.3)	3401(89.4)	50(86.3)
有	240(6.2)	234(6.1)	6(10.3)
不确定	175(4.5)	173(4.5)	2(3.4)
免疫功能失调[例(构成比,%)]					0.272^a
无	3798(98.2)	3742(98.3)	56(96.6)
有	68(1.8)	66(1.7)	2(3.4)
2型糖尿病[例(构成比,%)]					0.015^a
无	3603(93.2)	3554(93.3)	49(84.5)
有	263(6.8)	254(6.7)	9(15.5)
肺炎[例(构成比,%)]					0.250^a
无	3847(99.5)	3790(99.5)	57(98.3)
有	19(0.5)	18(0.5)	1(1.7)
慢性肺部疾病[例(构成比,%)]					0.304^a
无	3705(95.8)	3651(95.9)	54(93.1)
有	161(4.2)	157(4.1)	4(6.9)
心血管疾病[例(构成比,%)]					0.796^a
无	3602(93.2)	3547(93.1)	55(94.8)
有	264(6.8)	261(6.9)	3(5.2)
恶性肿瘤[例(构成比,%)]					1.000^a
无	3843(99.4)	3785(99.4)	58(100.0)
有	23(0.6)	23(0.6)	0(0.0)
省份[例(构成比,%)]				χ²=3.599	0.308
湖南	1171(30.3)	1154(30.3)	17(29.3)
甘肃	842(21.8)	829(21.8)	13(22.4)
江苏	1052(27.2)	1041(27.3)	11(19.0)
河南	801(20.7)	784(20.6)	17(29.3)

表1

图1

表2

图2

表3

结核分枝杆菌潜伏感染者气态污染物暴露6个月与活动性肺结核发病风险的亚组分析

特征	潜伏感染者 (例)	肺结核患者 (例)	O₃		NO₂		SO₂		CO
特征	潜伏感染者 (例)	肺结核患者 (例)	HR(95%CI)值	P_交互值	HR(95%CI)值	P_交互值	HR(95%CI)值	P_交互值	HR(95%CI)值	P_交互值
全人群	3866	58	1.151 (0.815~1.624)		1.542 (0.858~2.772)		1.810 (1.153~2.843)		1.196 (1.031~1.388)
年龄组(岁)				0.557		0.137		0.080		0.055
18~44	889	12	1.124 (0.412~3.063)		1.468 (0.318~6.770)		1.057 (0.355~3.151)		1.009 (0.708~1.439)
45~59	1470	16	1.392 (0.723~2.680)		1.617 (0.488~5.354)		1.206 (0.415~3.503)		1.086 (0.786~1.501)
≥60	1507	30	1.078 (0.620~1.872)		1.573 (0.665~3.720)		2.091 (1.166~3.750)		1.275 (1.044~1.557)
性别				0.746		0.859		0.731		0.971
男性	2076	43	1.306 (0.878~1.943)		1.757 (0.836~3.695)		1.674 (0.986~2.843)		1.184 (0.994~1.410)
女性	1790	15	0.799 (0.414~1.539)		1.072 (0.424~2.709)		2.068 (0.886~4.827)		1.185 (0.896~1.566)
受教育程度				0.134		0.693		0.661		0.950
小学及以下	2175	38	0.977 (0.672~1.422)		1.203 (0.656~2.204)		1.844 (1.058~3.212)		1.185 (0.988~1.422)
初中	1262	12	1.513 (0.698~3.282)		NA		2.100 (0.683~6.458)		1.299 (0.927~1.821)
高中及以上	429	8	1.575 (0.429~5.782)		1.552 (0.224~10.750)		1.455 (0.306~6.923)		1.059 (0.634~1.767)
家庭人均年收入(元)				0.491		0.629		0.828		0.904
<6000	2445	37	1.214 (0.813~1.813)		1.528 (0.747~3.127)		1.962 (1.024~3.759)		1.273 (1.028~1.576)
≥6000	1421	21	1.289 (0.564~2.945)		2.821 (0.500~15.918)		2.196 (1.038~4.646)		1.223 (0.970~1.543)
体质量				0.455		0.771		0.706		0.420
正常	1985	35	1.088 (0.758~1.561)		1.464 (0.771~2.778)		1.617 (0.941~2.779)		1.132 (0.957~1.339)
过低	163	6	NA		NA		NA		NA
超重	1254	12	2.014 (0.572~7.095)		NA		1.690 (0.552~5.180)		1.432 (0.929~2.207)
肥胖	464	5	2.468 (0.124~49.273)		0.110 (0.001~9.921)		22.154 (0.467~1051.583)		1.856 (0.811~4.249)
吸烟				0.947		0.693		0.408		0.446
从不	2398	29	1.247 (0.745~2.087)		1.607 (0.721~3.581)		1.722 (0.907~3.268)		1.189 (0.959~1.474)
正在	1367	24	1.091 (0.667~1.784)		1.371 (0.631~2.978)		2.006 (1.011~3.982)		1.261 (1.006~1.581)
已戒	101	5	NA		NA		NA		NA
饮酒				0.581		0.104		0.491		0.739
否	2870	37	1.341 (0.892~2.015)		1.830 (0.920~3.638)		1.681 (0.991~2.851)		1.139 (0.957~1.355)
是	996	21	0.838 (0.506~1.386)		0.956 (0.411~2.225)		2.405 (0.970~5.962)		1.405 (1.032~1.912)

表3

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暴露窗口	O₃		NO₂		SO₂		CO
暴露窗口	HR(95%CI)值	P值	HR(95%CI)值	P值	HR(95%CI)值	P值	HR(95%CI)值	P值
1个月	1.092(0.970~1.229)	0.145	1.008(0.698~1.456)	0.966	1.209(0.700~2.087)	0.496	1.044(0.859~1.268)	0.668
2个月	1.073(0.931~1.236)	0.334	0.955(0.661~1.379)	0.804	1.093(0.648~1.841)	0.739	0.947(0.749~1.195)	0.644
3个月	1.060(0.895~1.256)	0.499	0.975(0.689~1.378)	0.884	1.080(0.678~1.721)	0.745	1.060(0.897~1.253)	0.494
6个月	1.151(0.815~1.624)	0.425	1.542(0.858~2.772)	0.148	1.810(1.153~2.843)	0.010	1.196(1.031~1.388)	0.018
12个月	0.549(0.287~1.051)	0.070	0.536(0.140~2.048)	0.362	1.714(0.921~3.189)	0.089	1.202(1.009~1.433)	0.039

大气气态污染物对农村结核分枝杆菌潜伏感染者肺结核发病的影响

Impact of gaseous air pollutants on the risk of incident active pulmonary tuberculosis among rural people with latent tuberculosis infection

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