某市级医院呼吸科门诊冬季患者疾病结构与空气质量相关性
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摘要
目的和意义
近年来,随着中国经济水平的高速发展,空气污染问题越来越突出。尤其是2012年冬季北方大面积的雾霾天气,更引起了人们对空气质量的关注。呼吸系统每天吸入和呼出大量气体,因此呼吸系统疾病与空气环境和气象变化之间可能存在一定的关联。系统收集中国北方某市级医院2012年冬季呼吸科门诊就诊患者的病历资料和当地空气质量与气象条件资料,分析呼吸系统疾病门诊患者就诊的主要临床症状和初步诊断的疾病、空气质量和天气变化特征和规律,探讨其相互联系,为出现类似空气质量和天气状况时如何预防和诊治呼吸系统疾病提供一定参考依据。
方法
1系统收集2012年11月1日-2013年02月28日某三级甲等医院呼吸科门诊所有患者病历记录资料；并在当地环境保护部门和气象部门分别收集同期空气质量和天气气象状况资料。
2对上述资料分别进行整理。计算该时间段呼吸系统疾病门诊患者总就诊人数,就诊时出现主要呼吸系统症状(咳嗽、咳痰、气喘、胸痛、咯血、发热、咽部不适)的人数,门诊初步诊断疾病病种(上呼吸道感染、鼻窦炎、支气管炎、支气管哮喘、慢性阻塞性肺疾病(COPD).支气管扩张、肺炎、胸膜炎、阻塞性睡眠呼吸暂停低通气综合征(OSAHS)肺部肿块)的人数。同期当地环境保护部门公布的空气质量报告,分析空气污染指数(API)的数值变化,出现不同空气质量的天数。同期气象部门公布的气象状况每日报表资料,分析气温的变化,出现阴晴雨雪雾的天数,出现大于3级风风速的天数。
3将API和气温与呼吸科门诊的患者人数、患者主要症状和疾病诊断进行相关性分析。
4统计分析方法。使用SPSS12.0软件进行数据录入与统计分析,检验水准α取0.05。
结果
1临床资料2012年11月1日～2013年02月28日门诊患者总数为2052人次,年龄12～91(46.6±6.3)岁,男女比为1.02：1。呼吸科门诊患者就诊症状前3位为咳嗽、咳痰、气喘。呼吸科门诊初步诊断疾病病种前6位为上呼吸道感染、鼻窦炎、支气管炎、支气管哮喘、COPD、肺炎。
2空气质量空气质量最好的月份为11月,最差的月份为1月。
3气象温度最高的月份为11月,最低的月份为1月。
4相关性分析API分别和咳嗽、咳痰和气喘进行相关性分析,发现API与咳嗽,pearson相关系数为0.146,P>0.05; API与咳痰、气喘pearson相关系数分别为0.287和0.277,其P值均＜0.01。API与上呼吸道感染、支气管炎、支气管哮喘和肺炎相关性分析,得出pearson相关系数分别为0.184、0.251、0.301和0.227,P<0.05; API与鼻窦炎和COPD相关性分析,发现pearson相关系数分别为0.159和0.154,P＞0.05。气温与就诊人数进行相关性分析,相关系数为-0.224,P＞0.05；将气温与滞后1天和3天就诊人数进行偏相关性分析,相关系数为-0.122和-0.193,P＞0.05。将气温分别与咳嗽、咳痰和气喘进行相关性分析,气温与咳痰pearson相关系数为-0.191,P＜0.05；气温与咳嗽、气喘相关性分析,发现pearson相关系数分别为-0.096和-0.179,P＞0.05。将气温与上呼吸道感染、支气管、肺炎、COPD相关性分析,pearson相关系数分别为-0.169、-0.077,-0.122和-0.107,P＞0.05；气温与鼻窦炎和支气管哮喘pearson相关系数分别为-0.194和-0.383,P＜0.05。
结论
1该地区冬季呼吸科门诊患者就诊时呼吸系统疾病的主要症状是咳嗽,初步诊断以鼻窦炎和上呼吸道感染为最多。
2该地区冬季呼吸道疾病的就诊人数与空气质量有关,呼吸系统疾病门诊患者总就诊人数随着空气污染指数增加而增多。
Objective and Significance
In recent years, with the rapid development of China's economy, the problem of air pollution becomes increasingly evident. The fog and haze which blanketed the most parts of northern China in the winter of2012, has made people pay more attention to air quality. As the respiratory system performs gas exchange and we inhale and exhale large amounts of gas every day, the occurrence of respiratory diseases is closely related with air conditions and meteorological changes. In order to explore the effects of ambient air quality and meteorological changes on the main clinical symptoms and diagnoses of respiratory diseases, we collected the medical records of outpatients with respiratory diseases from a first-class hospital in a northern city of our country in the winter of2012, combined with the local air quality and meteorological data. The results of the study can provide reference for the prevention and treatment of respiratory diseases under the similar air quality and climate conditions.
Method
1The medical records of outpatients with respiratory diseases from a first-class hospital, local air quality and meteorological data from the local environmental protection department and the meteorological departments were collected from November1,2012to February28,2013.
2We analyse these data and find out the changes respectively. We analyse the total number of respiratory outpatients during the certain period, the main respiratory symptoms (cough, expectoration, wheeze, chest pain, hemoptysis, fever, pharyngeal discomfort) and the number of each primary diagnosis (cold, sinusitis, bronchitis, bronchial asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, pneumonia, pleurisy, obstructive sleep apnea hypopnea syndrome (OSAHS), pulmonary mass.). We analyse the change of the air pollution index (API) value as well as the number of days of different air quality according to the air quality reports released by the local environmental protection department in the corresponding period. Analyse the change in temperaturem，the number of days of various weather (cloudy, sunny, rainny, snowy, hazy) and the number of windy days (wind speed>12mph) according to the daily meteorological data released by the meteorological department in the corresponding period.
3We analyse the correlations between the API and the number of respiratory outpatients, the main respiratory symptoms, the diagnoses of respiratory diseases. Analyze the correlations between temperature and the number of respiratory outpatients, the main respiratory symptoms, the diagnoses of respiratory diseases.
4Statistical analysis Using SPSS12.0software for data entry and statistics analysis, inspection level takes0.05alpha.
Result
1Clinical data A total of2052overall admissions for respiratory diseases occured in the study period which is from November1,2012to February28,2013. The age was12-91(46.6±6.3) years and the ratio of males to females was1.02:1.2. The top three symptoms of respiratory outpatients were cough,expectoration,wheeze. The top six primary diagnoses of respiratory outpatients were Upper Respiratory Tract Infection, sinusitis, bronchitis, bronchial asthma, COPD and pneumonia.
2Air Quality The best month of air quality was November, and the worst was January.
3Meteorological data The highest month of temperature was November, and the lowest was January.
4Correlation analysis API with cough, expectoration, wheeze do Correlation analysis respectively, the analysis showed that Pearson correlation coefficient of API with cough was0.146, P>0.05; and Pearson correlation coefficient of API with expectoration was0.287, Pearson correlation coefficient of API with wheeze was0.227, P<0.001. API with Upper Respiratory Tract Infection, sinusitis, bronchitis, bronchial asthma, COPD and pneumonia do Correlation analysis respectively, the analysis showed that Pearson correlation coefficient of API with Upper Respiratory Tract Infection,bronchitis, bronchial asthma and pneumonia were0.184,0.251,0.301and0.227, P<0.05. API with sinusitis and COPD do Correlation analysis respectively, the analysis showed that Pearson correlation coefficient of API with sinusitis and COPD were0.159and0.154, P>0.05. temperature with patients do Correlation analysis respectively, the analysis showed that Pearson correlation coefficient of temperature with patients was-0.224, P>0.05. temperature with cough, expectoration, wheeze do Correlation analysis respectively, the analysis showed that Pearson correlation coefficient of temperature with expectoration was-0.191, P<0.05; The analysis showed that Pearson correlation coefficient of temperature with cough and wheeze were-0.096and-0.179, P>0.05. temperature with Upper Respiratory Tract Infection, bronchitis,COPD and pneumonia do Correlation analysis respectively, the analysis showed that Pearson correlation coefficient were-0.169、-0.077，-0.122and-0.107, P>0.05; the analysis showed that Pearson correlation coefficient of temperature with sinusitis and bronchial asthma were-0.194and-0.383,P<0.05.
Conclusion
1The most common symptom of respiratory outpatients is cough and the primary diagnoses are mostly sinusitis and cold in winter in the area.
2The incidence of respiratory diseases is associated with air quality and weather. The total number of respiratory outpatients grow with the increase of air pollution index in winter in the area.
近年来,随着中国经济水平的高速发展,空气污染问题越来越突出。尤其是2012年冬季北方大面积的雾霾天气,更引起了人们对空气质量的关注。呼吸系统每天吸入和呼出大量气体,因此呼吸系统疾病与空气环境和气象变化之间可能存在一定的关联。系统收集中国北方某市级医院2012年冬季呼吸科门诊就诊患者的病历资料和当地空气质量与气象条件资料,分析呼吸系统疾病门诊患者就诊的主要临床症状和初步诊断的疾病、空气质量和天气变化特征和规律,探讨其相互联系,为出现类似空气质量和天气状况时如何预防和诊治呼吸系统疾病提供一定参考依据。
方法
1系统收集2012年11月1日-2013年02月28日某三级甲等医院呼吸科门诊所有患者病历记录资料；并在当地环境保护部门和气象部门分别收集同期空气质量和天气气象状况资料。
2对上述资料分别进行整理。计算该时间段呼吸系统疾病门诊患者总就诊人数,就诊时出现主要呼吸系统症状(咳嗽、咳痰、气喘、胸痛、咯血、发热、咽部不适)的人数,门诊初步诊断疾病病种(上呼吸道感染、鼻窦炎、支气管炎、支气管哮喘、慢性阻塞性肺疾病(COPD).支气管扩张、肺炎、胸膜炎、阻塞性睡眠呼吸暂停低通气综合征(OSAHS)肺部肿块)的人数。同期当地环境保护部门公布的空气质量报告,分析空气污染指数(API)的数值变化,出现不同空气质量的天数。同期气象部门公布的气象状况每日报表资料,分析气温的变化,出现阴晴雨雪雾的天数,出现大于3级风风速的天数。
3将API和气温与呼吸科门诊的患者人数、患者主要症状和疾病诊断进行相关性分析。
4统计分析方法。使用SPSS12.0软件进行数据录入与统计分析,检验水准α取0.05。
结果
1临床资料2012年11月1日～2013年02月28日门诊患者总数为2052人次,年龄12～91(46.6±6.3)岁,男女比为1.02：1。呼吸科门诊患者就诊症状前3位为咳嗽、咳痰、气喘。呼吸科门诊初步诊断疾病病种前6位为上呼吸道感染、鼻窦炎、支气管炎、支气管哮喘、COPD、肺炎。
2空气质量空气质量最好的月份为11月,最差的月份为1月。
3气象温度最高的月份为11月,最低的月份为1月。
4相关性分析API分别和咳嗽、咳痰和气喘进行相关性分析,发现API与咳嗽,pearson相关系数为0.146,P>0.05; API与咳痰、气喘pearson相关系数分别为0.287和0.277,其P值均＜0.01。API与上呼吸道感染、支气管炎、支气管哮喘和肺炎相关性分析,得出pearson相关系数分别为0.184、0.251、0.301和0.227,P<0.05; API与鼻窦炎和COPD相关性分析,发现pearson相关系数分别为0.159和0.154,P＞0.05。气温与就诊人数进行相关性分析,相关系数为-0.224,P＞0.05；将气温与滞后1天和3天就诊人数进行偏相关性分析,相关系数为-0.122和-0.193,P＞0.05。将气温分别与咳嗽、咳痰和气喘进行相关性分析,气温与咳痰pearson相关系数为-0.191,P＜0.05；气温与咳嗽、气喘相关性分析,发现pearson相关系数分别为-0.096和-0.179,P＞0.05。将气温与上呼吸道感染、支气管、肺炎、COPD相关性分析,pearson相关系数分别为-0.169、-0.077,-0.122和-0.107,P＞0.05；气温与鼻窦炎和支气管哮喘pearson相关系数分别为-0.194和-0.383,P＜0.05。
结论
1该地区冬季呼吸科门诊患者就诊时呼吸系统疾病的主要症状是咳嗽,初步诊断以鼻窦炎和上呼吸道感染为最多。
2该地区冬季呼吸道疾病的就诊人数与空气质量有关,呼吸系统疾病门诊患者总就诊人数随着空气污染指数增加而增多。
Objective and Significance
In recent years, with the rapid development of China's economy, the problem of air pollution becomes increasingly evident. The fog and haze which blanketed the most parts of northern China in the winter of2012, has made people pay more attention to air quality. As the respiratory system performs gas exchange and we inhale and exhale large amounts of gas every day, the occurrence of respiratory diseases is closely related with air conditions and meteorological changes. In order to explore the effects of ambient air quality and meteorological changes on the main clinical symptoms and diagnoses of respiratory diseases, we collected the medical records of outpatients with respiratory diseases from a first-class hospital in a northern city of our country in the winter of2012, combined with the local air quality and meteorological data. The results of the study can provide reference for the prevention and treatment of respiratory diseases under the similar air quality and climate conditions.
Method
1The medical records of outpatients with respiratory diseases from a first-class hospital, local air quality and meteorological data from the local environmental protection department and the meteorological departments were collected from November1,2012to February28,2013.
2We analyse these data and find out the changes respectively. We analyse the total number of respiratory outpatients during the certain period, the main respiratory symptoms (cough, expectoration, wheeze, chest pain, hemoptysis, fever, pharyngeal discomfort) and the number of each primary diagnosis (cold, sinusitis, bronchitis, bronchial asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, pneumonia, pleurisy, obstructive sleep apnea hypopnea syndrome (OSAHS), pulmonary mass.). We analyse the change of the air pollution index (API) value as well as the number of days of different air quality according to the air quality reports released by the local environmental protection department in the corresponding period. Analyse the change in temperaturem，the number of days of various weather (cloudy, sunny, rainny, snowy, hazy) and the number of windy days (wind speed>12mph) according to the daily meteorological data released by the meteorological department in the corresponding period.
3We analyse the correlations between the API and the number of respiratory outpatients, the main respiratory symptoms, the diagnoses of respiratory diseases. Analyze the correlations between temperature and the number of respiratory outpatients, the main respiratory symptoms, the diagnoses of respiratory diseases.
4Statistical analysis Using SPSS12.0software for data entry and statistics analysis, inspection level takes0.05alpha.
Result
1Clinical data A total of2052overall admissions for respiratory diseases occured in the study period which is from November1,2012to February28,2013. The age was12-91(46.6±6.3) years and the ratio of males to females was1.02:1.2. The top three symptoms of respiratory outpatients were cough,expectoration,wheeze. The top six primary diagnoses of respiratory outpatients were Upper Respiratory Tract Infection, sinusitis, bronchitis, bronchial asthma, COPD and pneumonia.
2Air Quality The best month of air quality was November, and the worst was January.
3Meteorological data The highest month of temperature was November, and the lowest was January.
4Correlation analysis API with cough, expectoration, wheeze do Correlation analysis respectively, the analysis showed that Pearson correlation coefficient of API with cough was0.146, P>0.05; and Pearson correlation coefficient of API with expectoration was0.287, Pearson correlation coefficient of API with wheeze was0.227, P<0.001. API with Upper Respiratory Tract Infection, sinusitis, bronchitis, bronchial asthma, COPD and pneumonia do Correlation analysis respectively, the analysis showed that Pearson correlation coefficient of API with Upper Respiratory Tract Infection,bronchitis, bronchial asthma and pneumonia were0.184,0.251,0.301and0.227, P<0.05. API with sinusitis and COPD do Correlation analysis respectively, the analysis showed that Pearson correlation coefficient of API with sinusitis and COPD were0.159and0.154, P>0.05. temperature with patients do Correlation analysis respectively, the analysis showed that Pearson correlation coefficient of temperature with patients was-0.224, P>0.05. temperature with cough, expectoration, wheeze do Correlation analysis respectively, the analysis showed that Pearson correlation coefficient of temperature with expectoration was-0.191, P<0.05; The analysis showed that Pearson correlation coefficient of temperature with cough and wheeze were-0.096and-0.179, P>0.05. temperature with Upper Respiratory Tract Infection, bronchitis,COPD and pneumonia do Correlation analysis respectively, the analysis showed that Pearson correlation coefficient were-0.169、-0.077，-0.122and-0.107, P>0.05; the analysis showed that Pearson correlation coefficient of temperature with sinusitis and bronchial asthma were-0.194and-0.383,P<0.05.
Conclusion
1The most common symptom of respiratory outpatients is cough and the primary diagnoses are mostly sinusitis and cold in winter in the area.
2The incidence of respiratory diseases is associated with air quality and weather. The total number of respiratory outpatients grow with the increase of air pollution index in winter in the area.
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[32]Ning Y,Imrich A,Goldsmith CA,et al.Alveolar macrophage cytokine production in response to our parients in vitro:role of endotoxin[J].J Toxicol Environ Health A,2000,59:165-180.
[33]Elder A,Oberdorster GTranslocation and effects of ultrafine particles outside of the lung[J]. Clin Occup Environ Med.2006,5:785-796.
[34]Li Z,Hyseni X,Carter JD,et al.Pollutant particles enhanced H2O2 production from NAD(P)H oxidase and mitochondria in human pulmonary artery endothelial cells [J]. Am J Physiol Cell Physiol,2006.291:C357-C365.
[35]Boutten A,Goven D,Boczkowski J,et al.Oxidative stress targets in pulmonary emphysema: focus on the Nrf2 pathway [J]. Expert Opin Ther Targets,2010,14:329-346.
[36]程红娟,张连众,张陈兵,等.稳态条件下气溶胶粒子在口腔模型中的沉淀率[J].应用力学学报,2007,24：196-199.
[37]Salma I,Balashazy I,Hofmann W,et al. Effect of physical exertion on the deposition of urban aerosols in the human respiratory system[J]. Aerosol Science,2002,33:983-997.
[38]Kim CS,Kang TC. Comparative measurement of lung deposition of inhaled fine particles in normal subjects and patients with obstructive airway disease[J]. Respiratory and Critical Care Medicine,1997,3:899-905.
[39]Anderson PJ,Wilson JD,Hiller FC.Respiratory tract deposition of ultrafine particles in subjecs with obstructive or restrictive lung disease[J].Chest,1990,97:1115-1120.
[40]Svartengren M, Falk R,Linnman L,et al.Deposition of large particles in human lung[J]. Exp Lung Respiratory,1987,12:75-88.
[41]Leitte AM,Petrescu C,Franck u,et al.Respiratory health,effects of ambient air pollution and its modification by air humidity in Drobeta-Turnu Severin,Romania [J]. Sci Total Environ,2009,407(13):4004-4011.
[42]J￠rgen Vestbo, Suzanne S Hurd, Roberto Rodriguez-Roisin代表慢性阻塞性肺疾病全球创议科学委员会.慢性阻塞性肺疾病全球创议(2011年修订版)概述[J].中华医学杂志,2012,92(14)：937-938.
[43]Edvardsen A,Aker￠ A,Hardie JA.et al.High prevalence of respiratory symptoms during air travel in patients with COPD [J].RespirMed,2011,105 (1):50-56.
[44]McCunney RJ.Asthma,genes,and air pollution[J].JOccup Environ Med,2005,47(12):1285-1291.
[45]Sunyer J,Anto Jm,Murillo C,et al.Effects of urban air pollution on emergency room admissions for chronic obstructive pulmonary disease [J].Am J Epidemiol,1991,134 (3):277-286.
[46]Al-Afaleg NO,Al-Senaidy A. El-Ansary A.Oxidative stress and antioxidant status in Saudi asthmatic patients [J].ClinBiochem,2011,44 (8-9).612-617.
[47]Cho YS. Moon HB.The role of oxidative stress in the pathogenesis of asthma [J].Allergy Asthma Immunol Res,2010,2(3):183-187.
[48]Zeyrek D,Cakmak A,Atas A,et al.DNA damage in children with asthma bronchiale and its association with oxidative and antioxidative measurements [J].Pediatr Allergy Immunol, 2009,20 (4):370-376.
[49]Laumbach Rl. Air pollution and patient health [J]. American Family Physician,2010,81(2): 175-180.
[1]程红娟,张连众,张陈兵,等.稳态条件下气溶胶粒子在口腔模型中的沉淀率[J].应用力学学报,2007,24:196-199.
[2]Salma I,Balashazy I,Hofinann W,et aLEffect of physical exertion on the deposition of urban aerosols in the human respiratory system[J].Aerosol Science,2002,33:983-997.
[3]Kim CS.Kang TC.Comparative measurement of lung deposition of inhaled fine particles in normal subjects and patients with obstructive airway disease[J].Respiratory and Critical Care Medicine,1997,3:899-905.
[4]Anderson PJ,Wilson JD,Hiller FC.Respiratory tract deposition of ultrafine particles in subjecs with obstructive or restrictive lung disease[J].Chest,1990,97:1115-1120.
[5]Svartengren M, Falk R,Linnman L,et al.Deposition of large particles in human lung[J]. Exp Lung Respiratory,1987,12:75-88.
[6]金银龙,程义斌,王汉章,等.煤烟型大气污染对成人呼吸系统症状及其症状影响的研究[J].卫生研究,2001,30(4)：241-246.
[7]BrunekreefB,Holgate ST.Air pollution and health [J]. Lancet,2002,360:1233-1242.
[8]陆再英,钟南山.内科学(第七版)[M].北京：人民卫生出版社,2008,5-10.
[9]Pope CA 3rd, Burmett RT, Thun MJ. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution[J]. JAMA,2002,6:287(9):1132-1141.
[10]Samet JM,Dominici F,Curriero FC,et al.Fine particulate air pollution and mortality in 20 U.S. cities.1987-1994[J]. N Engl J Med,2000,343:1742-1749.
[11]Wong CM,Atkinson RM,Anderson HR,et al.A tale of two citis:effects of air pollution on hospital admissions in Hong Kong and London compared[J]. Environ Health Perspect,2002, 110:67-77.
[12]张晓明.空气污染流行病学研究[J].环境与健康杂志,2000,17(1)：9-12.
[13]Shi T.Duffin R,Borm PJ.et al.Hydroxyl-radical-dependent DNA damage by ambient particulate matter from contrasting sampling locations[J]. Environ Res,2006.101:18-24.
[14]Alberg AJ,Brock MV,Samet JM.Epidemiology of lung cancer:looking to the future[J]. J Clin Oncol,2005,23 (14):3175-3185.
[15]World Health Organization, International Agency for Research on Cancer (IARC). World Cancer Report [R].Lyon, France:IARC Press,2003:12-19.
[16]Beeson WL,Abbey DE,Knutsen SF.Long term concentrations of ambient air pollution and incident lung cancer in California adults:Results from the ASHSMOG study, adventist health study on smog [J].Environ Health Perspect,1998,106 (12):813-823.
[17]Jedrychowski W, Flank E, Mraz E.The adverse effect of low levels of ambient air pollutants on lung function growth in preadolescent children.Environ [J].Health Prospect,1999,107 (8):669-674.
[18]Dominici F.Peng RD,Bell ML.et al.Fine particulate air pollution and hospital admission for cardiovascular and respairtory disease[J].JAMA,2006,295:l127-1134.
[19]Ko FW,Tam W,Wong TW,et al.Temporal relationship between air pollutions and hospital admissions for chronic obstructive pulmonary disease in Hong Kong[J].Thorax,2007.62: 780-785.
[20]Clarke RW, Coull B, Reinisch U, et al. Inhaled concentrated ambient particles are associated with hematologic and bronchoalveolar lavage changes in canines [J].Environ Health Perspect,2000,108:1179-1187.
[21]Squadrito GL, Cueto R, Dellinger B, et al. Quinoid redox cycling as a mechanism for sustained free radical generation by inhaled airborne particulate matter [J].Free Radic Boil Med,2001,31:1132-1138.
[22]Donaldson K, Beswick PH, Gilmour PS.Free radical activity associated with the surface of particles:a unifying factor in determining biological activity? [J].Toxicol Lett.1996,88: 293-298.
[23]Ning Y, Imrich A, Goldsmith CA,et al.Alveolar macrophage cytokine production in response to our patients in vitro:role of endotoxin [J] J Toxicol Environ Health A,2000,59:165-180.
[24]Elder A, Oberdorster G.Translocation and effects of ultrafine particles outside of the lung [J]. Clin Occup Environ Med.2006,5:785-796.
[25]Li Z, Hyseni X,Carter JD, et al.Pollutant particles enhanced H2O2 production from NAD(P)H oxidase and mitochondria in human pulmonary artery endothelial cells [J]. Am J Physiol Cell Physiol,2006.291:C357-C365.
[26]Boutten A, Goven D, Boczkowski J,et aLOxidative stress targets in pulmonary emphysema: focus on the Nrf2 pathway [J]. Expert Opin Ther Targets,2010,14:329-346.
[27]Rison L,Moller P,Loft S.Oxidative stress-induced DNA damage by particulate air pollution[J]. Mutat Res,2005,592:119-137.
[28]Avogbe PH, Ayi-Fanou L, Autrup H, et al. Ultrafine particulate matter and high-level benzene urban air pollution in relation to oxidative DNA damage [J]. Carcinogenesis,2005,26: 613-620.
[29]Watterson TL, Hamilton B,Martin R,et al.Urban particulate matter causes ER stress and the unfolded protein response in human lung cells[J]. Toxicol Sci,2009,112:111-122.
[30]Takafuji S, Nakagawa T.Air pollution and allergy [J] J Investigol Clin Immunol.2000,10 (1):5-10.
[31]黄慧,邵池,徐作军.美国胸科协会官方指南-支气管肺泡灌洗液的细胞学分析在间质性肺疾病中的临床应用(摘译本)[J].中华结核和呼吸杂志,2012,35(9)：650-654.
[32]Polosa R.The interaction between particulate air pollution and allergens in enhancing allergic and airway response [J].Curr Allergy Asthma Rep,2001,1 (2):102-107.
[33]Baginski TK,Dabbagh K,Satjawatcharaphong C, et al. Cigarette smoke synergistically enhances respiratory mucin induction by proinflammatory stimuli [J]. Am J Respir Cell MolBiol,2006,35:165-174.
[34]Newland N,Richter A,Agents associated with lung inflammation induce similar response in NCI-H292 lung epithelial cells[J]. Toxicol In Vitro,2008,22:1782-1788.
[35]卫生部医政司.慢性阻塞性肺疾病诊疗规范(2011年版)[J].中国医学前沿杂志(电子版),2012,4(1)：69-76.
[36]Bargagli E, Olivieri C, Bennett D, et al.Oxidative stress in the pathogenesis of diffuse lung diseases:a review [J].Respir Med,2009,103 (9):1245-1256.
[37]Rita G,Christophe P.Interactions genes-environnement au cours de la bronchopneumopathie chronique obstructive et l'asthme. Relations avec la composition corporelle [J].Nutrition Clinique et metabolisme.2006,20:185-189.
[38]Koehler C, Ginzkey C, Friehs G, et al.Aspects of nitrogen dioxide toxicity in environmental urban concentrations in human nasal epithelium[J].Toxicol Appl Pharmacol,2010,245(2): 219-225.
[39]Wagner U.Staats P,Fehmann HC,et al.Analysis of airway secretions in a model of sulfur dioxide induced chronic obstructie pulmonary disease (COPD) [J]. J Occup Med Toxicol,2006,1:12.
[40]YangQ, ChenY, KrewskiD. etal.Effect of short-term exposure to low levels of gaseous pollutants on chronic obstructive pulmonary disease hospitalizations [J].Environ Res, 2005,99 (1):99-105.
[41]Schwartz J.Short term fluctuations in air pollution and hospital admissions of the elderly for respiratory disease [J].Thorax,1995,50 (5):531-538.
[42]Official Statement of American Thoracic Society. What constitutes an adverse health effect of air pollution? [J]. Am J Respire Crit Care Med.2000,161:665-673.
[43]韩逸群,王洪源,张志刚.等.北京城区大气PM1o对呼吸系统疾病日就诊人次的影响[C].2008年毒理学会环境与生态毒理学委员会成立大会.
[44]施海龙,曲波,郭海强,等.干旱地区呼吸道传染病气象因素及发病预测[J].中国公共卫生,2006,22(4)：417-418.
[45]顾志伟,金玫华,韩健康,等.上呼吸道感染性疾病与气象条件的关系及预报研究[J].浙江预防医学,2008,20(9)：13-16.
[46]McCunney RJ.Asthma,genes,and air pollution [J]. Joccup Environ Med,2005,47(12): 1285-1291.
[47]Sunyer J, Anto Jm, Murillo C, et al.Effects of urban air pollution on emergency room admissions for chronic obstructive pulmonary disease [J].Am J Epidemiol,1991,134 (3): 277-286.
[48]Al-Afaleg NO,A1-Senaidy A, El-Ansary A.Oxidative stress and antioxidant status in Saudi asthmatic patients [J].Clin Biochem,2011,44 (8-9):612-617.
[49]Cho YS, Moon HB.The role of oxidative stress in the pathogenesis of asthma [J].Allergy Asthma Immunol Res,2010,2(3):183-187.
[50]Zeyrek D,Cakmak A,Atas A,et al.DNA damage in children with asthma bronchiale and its association with oxidative and antioxidative measurements [J].Pediatr Allergy Immunol, 2009,20 (4):370-376.
[51]Leitte AM,Petrescu C,Franck u,et al.Respiratory health, effects of ambient air pollution and its modification by air humidity in Drobeta-Turnu Severin, Romania [J].Sci Total Environ,2009,407(13):4004-4011.
[52]Edvardsen A,Aker￠ A,Hardie JA,et al.High prevalence of respiratory symptoms during air travel in patients with COPD [J].Respir Med,2011,105 (1):50-56.
[2]蔡后荣,李惠萍.实用间质性肺疾病[M].北京：人民卫生出版社,2010.20-29.
[3]Rison L,Moller P,Loft S.Oxidative stress-induced DNA damage by particulate air pollution [J].MutatRes,2005,592:119-137.
[4]Avogbe PH,Ayi-Fanou L,Autrup H,et al.Ultrafine particulate matter and high-level benzene urban air pollution in relation to oxidative DNA damage [J].Carcinogenesis,2005,26:613-620.
[5]Watterson TL,Hamilton B,Martin R,et al.Urban particulate matter causes ER stress and the unfolded protein response in human lung cells [J]. Toxicol Sci,2009,112:111-122.
[6]史海萍,秦爱民,康秀青,等.气象要素与呼吸系统预报研究[J].实用预防医学.2009,16(2)：619-620.
[7]谈建国,袁东.基于天气气候的健康气象预测研究展望[J].环境与职业医学,2012,39(3)：129-131.
[8]莫运政,郑亚安,陶辉等.日均气温与呼吸系统疾病急诊人次相关性的时间序列分析[J].北京大学学报(医学版),2012,44(3)：416-420.
[9]中华医学会呼吸病学分会哮喘学组.咳嗽的诊断与治疗指南(2009版)[J].中华结核和呼吸杂志,2009,32(6)：407-413.
[10]施海龙,曲波,郭海强,等.干旱地区呼吸道传染病气象因素及发病预测[J].中国公共卫生,2006,22(4)：417-418.
[11]顾志伟,金玫华,韩健康,等.上呼吸道感染性疾病与气象条件的关系及预报研究[J].浙江预防医学,2008,20(9)：13-16.
[12]金银龙,程义斌,王汉章,等.煤烟型大气污染对成人呼吸系统症状及其症状影响的研究[J].卫生研究,2001,30(4)：241-246.
[13]BargagliE, OlivieriC. Bennett D,et al.Oxidative stress in the pathogenesis of diffuse lung diseases:areview [J].RespirMed.2009,103 (9):1245-1256.
[14]Rita QChristophe P.Interactions genes-environnement au cours de la bronchopneumopathie chronique obstructive et l'asthme. Relations avec la composition corporelle [J].Nutrition Clinique et metabolisme,2006,20:185-189.
[15]Koehler C,Ginzkey C,Friehs G,et al. Aspects of nitrogen dioxide toxicity in environmental urban concentrations in human nasal epithelium [J]. Toxicol Appl Pharmacol,2010,245 (2):219-225.
[16]Wagner U,Staats P,Fehmann HC,et al.Analysis of airway secretions in a model of sulfur dioxide induced chronic obstructie pulmonary disease (COPD) [J] JOccup Med Toxicol,2006,1:12.
[17]Yang Q. ChenY, KrewskiD, et al.Effect of short-term exposure to low levels of gaseous pollutants on chronic obstructive pulmonary disease hospitalizations [J].Environ Res, 2005,99 (1):99-105.
[18]Schwartz J.Short term fluctuations in air pollution and hospital admissions of the elderly for respiratory disease [J].Thorax.1995,50 (5):531-538.
[19]Official Statement of American Thoracic Society. What constitutes an adverse health effect of air pollution? Am J Respire Crit Care Med.2000,161:665-673.
[20]Brunekreef B,Holgate ST.Air pollution and health [J] Xancet,2002,360:1233-1242.
[21]Alberg AJ,Brock MV,Samet JM.Epidemiology of lung cancenlooking to the future[J].J Clin Oncol,2005,23 (14):3175-3185.
[22]World Health Organization, International Agency for Research on Cancer(IARC). World Cancer Report [R]. Lyon,France:IARC Press,2003:12-19.
[23]Pope CA 3rd.Burnett RT,Thun MJ.Lung cancer,cardiopulmonary mortality,and long-term exposure to fine particulate air pollution [J].JAMA,2002,6:287 (9):1132-1141.
[24]Beeson WL,Abbey DE,Knutsen SF.Long term concentrations of ambient air pollution and incident lung cancer in California adults:Results from the ASHSMOG study,adventist health study on smog [J].Environ Health Perspect,1998,106 (12):813-823.
[25]Jedrychowski W,Flank E,Mraz E.The adverse effect of low levels of ambient air pollutants on lung function growth in preadolescent children.Environ [J].Health Prospect,1999,107 (8):669-674.
[26]TakafujiS, Nakagawa T.Air pollution and allergy [J] JInvestigolClinImmunol.2000,10 (1):5-10.
[27]黄慧,邵池,徐作军.美国胸科协会官方指南-支气管肺泡灌洗液的细胞学分析在间质性肺疾病中的临床应用(摘译本).中华结核和呼吸杂志,2012,35(9)：650-654.
[28]Polosa R.The interaction between particulate air pollution and allergens in enhancing allergic and airway response [J].Curr Allergy Asthma Rep,2001,1 (2):102-107.
[29]Clarke RW,Coull B,Reinisch U,et al. Inhaled concentrated ambient particles are associated with hematologic and bronchoalveolar lavage changes in canines [J]. Environ Health Perspect,2000,108:1179-1187.
[30]Squadrito GL,Cueto R,Dellinger B,et al.Quinoid redox cycling as a mechanism for sustained free radical generation by inhaled airborne particulate matter [J].Free Radic Boil Med,2001,31:1132-1138.
[31]Donaldson K,Beswick PH,Gilmour PS.Free radical activity associated with the surface of particles:a unifying factor in determining biological activity? [J].Toxicol Lett.1996,88: 293-298.
[32]Ning Y,Imrich A,Goldsmith CA,et al.Alveolar macrophage cytokine production in response to our parients in vitro:role of endotoxin[J].J Toxicol Environ Health A,2000,59:165-180.
[33]Elder A,Oberdorster GTranslocation and effects of ultrafine particles outside of the lung[J]. Clin Occup Environ Med.2006,5:785-796.
[34]Li Z,Hyseni X,Carter JD,et al.Pollutant particles enhanced H2O2 production from NAD(P)H oxidase and mitochondria in human pulmonary artery endothelial cells [J]. Am J Physiol Cell Physiol,2006.291:C357-C365.
[35]Boutten A,Goven D,Boczkowski J,et al.Oxidative stress targets in pulmonary emphysema: focus on the Nrf2 pathway [J]. Expert Opin Ther Targets,2010,14:329-346.
[36]程红娟,张连众,张陈兵,等.稳态条件下气溶胶粒子在口腔模型中的沉淀率[J].应用力学学报,2007,24：196-199.
[37]Salma I,Balashazy I,Hofmann W,et al. Effect of physical exertion on the deposition of urban aerosols in the human respiratory system[J]. Aerosol Science,2002,33:983-997.
[38]Kim CS,Kang TC. Comparative measurement of lung deposition of inhaled fine particles in normal subjects and patients with obstructive airway disease[J]. Respiratory and Critical Care Medicine,1997,3:899-905.
[39]Anderson PJ,Wilson JD,Hiller FC.Respiratory tract deposition of ultrafine particles in subjecs with obstructive or restrictive lung disease[J].Chest,1990,97:1115-1120.
[40]Svartengren M, Falk R,Linnman L,et al.Deposition of large particles in human lung[J]. Exp Lung Respiratory,1987,12:75-88.
[41]Leitte AM,Petrescu C,Franck u,et al.Respiratory health,effects of ambient air pollution and its modification by air humidity in Drobeta-Turnu Severin,Romania [J]. Sci Total Environ,2009,407(13):4004-4011.
[42]J￠rgen Vestbo, Suzanne S Hurd, Roberto Rodriguez-Roisin代表慢性阻塞性肺疾病全球创议科学委员会.慢性阻塞性肺疾病全球创议(2011年修订版)概述[J].中华医学杂志,2012,92(14)：937-938.
[43]Edvardsen A,Aker￠ A,Hardie JA.et al.High prevalence of respiratory symptoms during air travel in patients with COPD [J].RespirMed,2011,105 (1):50-56.
[44]McCunney RJ.Asthma,genes,and air pollution[J].JOccup Environ Med,2005,47(12):1285-1291.
[45]Sunyer J,Anto Jm,Murillo C,et al.Effects of urban air pollution on emergency room admissions for chronic obstructive pulmonary disease [J].Am J Epidemiol,1991,134 (3):277-286.
[46]Al-Afaleg NO,Al-Senaidy A. El-Ansary A.Oxidative stress and antioxidant status in Saudi asthmatic patients [J].ClinBiochem,2011,44 (8-9).612-617.
[47]Cho YS. Moon HB.The role of oxidative stress in the pathogenesis of asthma [J].Allergy Asthma Immunol Res,2010,2(3):183-187.
[48]Zeyrek D,Cakmak A,Atas A,et al.DNA damage in children with asthma bronchiale and its association with oxidative and antioxidative measurements [J].Pediatr Allergy Immunol, 2009,20 (4):370-376.
[49]Laumbach Rl. Air pollution and patient health [J]. American Family Physician,2010,81(2): 175-180.
[1]程红娟,张连众,张陈兵,等.稳态条件下气溶胶粒子在口腔模型中的沉淀率[J].应用力学学报,2007,24:196-199.
[2]Salma I,Balashazy I,Hofinann W,et aLEffect of physical exertion on the deposition of urban aerosols in the human respiratory system[J].Aerosol Science,2002,33:983-997.
[3]Kim CS.Kang TC.Comparative measurement of lung deposition of inhaled fine particles in normal subjects and patients with obstructive airway disease[J].Respiratory and Critical Care Medicine,1997,3:899-905.
[4]Anderson PJ,Wilson JD,Hiller FC.Respiratory tract deposition of ultrafine particles in subjecs with obstructive or restrictive lung disease[J].Chest,1990,97:1115-1120.
[5]Svartengren M, Falk R,Linnman L,et al.Deposition of large particles in human lung[J]. Exp Lung Respiratory,1987,12:75-88.
[6]金银龙,程义斌,王汉章,等.煤烟型大气污染对成人呼吸系统症状及其症状影响的研究[J].卫生研究,2001,30(4)：241-246.
[7]BrunekreefB,Holgate ST.Air pollution and health [J]. Lancet,2002,360:1233-1242.
[8]陆再英,钟南山.内科学(第七版)[M].北京：人民卫生出版社,2008,5-10.
[9]Pope CA 3rd, Burmett RT, Thun MJ. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution[J]. JAMA,2002,6:287(9):1132-1141.
[10]Samet JM,Dominici F,Curriero FC,et al.Fine particulate air pollution and mortality in 20 U.S. cities.1987-1994[J]. N Engl J Med,2000,343:1742-1749.
[11]Wong CM,Atkinson RM,Anderson HR,et al.A tale of two citis:effects of air pollution on hospital admissions in Hong Kong and London compared[J]. Environ Health Perspect,2002, 110:67-77.
[12]张晓明.空气污染流行病学研究[J].环境与健康杂志,2000,17(1)：9-12.
[13]Shi T.Duffin R,Borm PJ.et al.Hydroxyl-radical-dependent DNA damage by ambient particulate matter from contrasting sampling locations[J]. Environ Res,2006.101:18-24.
[14]Alberg AJ,Brock MV,Samet JM.Epidemiology of lung cancer:looking to the future[J]. J Clin Oncol,2005,23 (14):3175-3185.
[15]World Health Organization, International Agency for Research on Cancer (IARC). World Cancer Report [R].Lyon, France:IARC Press,2003:12-19.
[16]Beeson WL,Abbey DE,Knutsen SF.Long term concentrations of ambient air pollution and incident lung cancer in California adults:Results from the ASHSMOG study, adventist health study on smog [J].Environ Health Perspect,1998,106 (12):813-823.
[17]Jedrychowski W, Flank E, Mraz E.The adverse effect of low levels of ambient air pollutants on lung function growth in preadolescent children.Environ [J].Health Prospect,1999,107 (8):669-674.
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