【作者】 赵伯毅；

【导师】 何江；

【作者基本信息】 内蒙古大学 ， 生态学， 2020， 博士

【摘要】 居民健康风险防控是世界公共卫生事业的核心课题,生育健康和婴幼儿健康关乎一个国家的未来与发展,空气污染对孕妇及新生儿健康的影响倍受关注。由于出生缺陷发病率低、病因复杂、混杂因素多,且需要较大范围、长时间样本量积累,空气污染与妊娠期糖尿病、子痫前期、胎儿畸形等妊娠疾病及不良出生结局的关系研究更显重要。本文针对呼和浩特市空气污染特征,以污染生态学、环境地球化学及环境流行病学的理论为指导,以地理信息系统、反距离插值法和Logistic回归模型为手段,以空气污染物对妊娠期并发症、新生儿并发症和胎儿畸形的风险评估为主线,结合典型季节性特征、妊娠等高危因素,以及空气污染物的综合影响,采用成组设计的病例对照法,基于全人群的大样本量围产资料和较长时间跨度的日空气污染物数据;同时将妊娠期高发的其他疾病例如贫血、甲亢、甲减等10余种并发症作为干扰纳入暴露控制模型,统计分析了6种空气污染物与5种妊娠期高危疾病的关联性,既为空气污染与孕妇及新生儿健康关系研究累积了大量实证数据,也为呼和浩特市空气污染的公共卫生预防决策及妊娠期筛查与生殖健康提供参考,为呼包鄂城市群空气污染与健康风险研究积累了基础资料。主要结果如下:1.2013-2016年呼和浩特市六种污染物中,PM₁₀浓度较高,偶伴发高浓度O₃和PM_2.5污染日,SO₂,CO和NO₂污染水平相对稳定,并呈现出一定的季节性波动;五种疾病患病风险均随孕产妇年龄增大而升高,值得注意的是,采暖季受孕人群五种疾病的发病率均显著高于非采暖季受孕人群,与呼和浩特市大气污染的季节性特征相符合。2.研究发现,NO₂、PM₁₀、PM_2.5、O₃对新生儿低体重有负面影响,特别是NO₂对孕晚期影响较大。与新生儿低体重发病具有显著统计学正相关性的污染物（OR,95%CI）有:孕早期PM_2.5在IQR（4.39,2.59-7.43）、IQR3（2.54,1.70-3.79）、IQR4（2.28,1.65-3.14）,PM₁₀在IQR2（1.66,1.01-2.74）;孕中期PM₁₀在IQR3（2.02,1.41-2.89）,O₃在IQR4（1.28,1.01-1.67）;孕晚期O₃在IQR3（1.31,1.01-1.72）,NO₂在IQR2（6.87,3.78-12.50）、IQR3（4.61,2.70-7.85）、IQR4（2.67,1.61-4.45）;整体孕期SO₂在IQR4（1.37,1.01-1.86）,O₃在IQR2（2.11,1.41-3.14）、IQR3（1.72,1.20-2.46）、IQR4（1.50,1.12-2.01）,PM_2.5在IQR2（2.21,1.11-4.40）。3.研究显示,环境空气污染与早产的统计学关系与试管婴儿、妊娠期糖尿病、贫血和甲状腺功能减退等妊娠期并发症有关,对理解城市空气污染与出生结果关联具有重要的实证价值。与早产发病存在正相关性的污染物（OR,95%CI）有:孕早期NO₂在IQR2（1.33,1.10-1.61）、IQR4（1.19,1.05-1.35）;孕中期O₃在IQR2（1.59,1.24-2.04）、IQR3（1.45,1.24-1.70）、IQR4（1.37,1.21-1.54）,PM₁₀在IQR2（1.41,1.15-1.72）、IQR3（1.29,1.08-1.53）,PM_2.5在IQR2（1.42,1.09-1.85）;孕晚期NO₂在IQR2（1.66,1.34-2.06）,O₃在IQR2（1.38,1.11-1.71）、IQR3（1.71,1.50-1.94）;整体孕期O₃在IQR2（6.00,4.53-7.94）,NO₂在IQR2（5.28,3.82-7.30）、IQR3（2.21,1.64-2.99）,PM₁₀在IQR4（1.95,1.61-2.36）,SO₂在IQR2（1.31,1.03-1.68）、IQR4（1.32,1.13-1.55）。研究揭示,不同孕期空气污染物暴露种类对早产风险的敏感性不同,高浓度O₃和NO₂的暴露对早产风险的危害显著高于颗粒物暴露。4.控制妊娠期并发症和其他风险因素后,胎儿畸形风险与妊娠期O₃和NO₂暴露存在显著统计学意义。与其他季节相比,春季大气PM₁₀、PM_2.5等浓度较高,孕早期为胎儿畸形风险最高的敏感时期。孕中期NO₂和PM_2.5暴露可能增加胎儿畸形的发病风险。妊娠糖尿病、子痫前期、甲状腺功能亢进和胎膜早破等妊娠期并发症与胎儿畸形风险显著相关,且随妊娠期延长,效果逐渐消失。本研究提供了孕早期O₃、NO₂和PM_2.5暴露与胎儿畸形风险的实证,为空气污染与出生缺陷的关联性研究积累了重要的基础数据。5.妊娠期糖尿病与污染物暴露相关性分析结果显示,年龄、羊水过少、贫血、甲状腺功能减退等妊娠期并发症,怀孕总天数、季节、温度、湿度和能见度等气象因素与妊娠期糖尿病发病均有统计学意义。在将上述因素纳入回归后的调整模型显示,与妊娠期糖尿病发病存在正相关性的污染物（OR,95%CI）主要为整体孕期中SO₂在IQR4（1.467,1.227-1.754）,CO在IQR4（1.494,1.157-1.93）,O₃在IQR2（1.691,1.225-2.334）,IQR3（1.286,1.025-1.614）,IQR4（1.213,1.001-1.469）。而子痫前期与污染物暴露相关性分析结果显示羊水过少、贫血和年龄等有统计学意义,其受妊娠期并发症及气象因素影响较低。其调整模型显示与子痫前期发病存在正相关性的污染物（OR,95%CI）有:孕早期NO₂在IQR3（1.366,1.062-1.758）和IQR4（1.347,1.064-1.705）,孕中期PM₁₀在IQR3（1.55,1.137-2.114）,孕晚期NO₂在IQR4（1.343,1.124-1.606）。说明子痫前期主要受NO₂和PM₁₀两种污染物暴露影响,且集中在较高暴露浓度范围时会显著增加其发病风险。更多还原

【Abstract】 Health risk prevention and control is the core issue of the world’s public health.Reproductive health and infant health are related to the future and development of a country.The impact of air pollution on the health of pregnant women and newborns has received much attention.Due to the low incidence of birth defects,complex etiology,many confounding factors,and the need for a large range and a long period of sample accumulation,the relationship between air pollution and pregnancy diseases such as gestational diabetes,preeclampsia,fetal malformation,and adverse birth outcomes are quite important.This article aims at the characteristics of air pollution in Hohhot City,taking the theory of pollution ecology,environmental geochemistry and environmental epidemiology as the guide,using geographic information system,inverse distance interpolation method and Logistic regression model in order to study the relationship and risk assement between air pollutants for neonatal complications and fetal malformation,combined with the typical seasonal characteristics,pregnancy,genetic and other high-risk factors,and the comprehensive impact of air pollutants,adopts a group-designed case control method,based on the large population Sample size perinatal data and daily air pollutant data for a long time span;at the same time,more than10 complications such as anemia,hyperthyroidism,hypothyroidism,etc.,which are highly prevalent during pregnancy,were included in the exposure control model as interference,and6 types were statistically analyzed the correlation between air pollutants and five high-risk diseases in pregnancy has accumulated a large amount of empirical data for the study of the relationship between air pollution and the health of pregnant women and newborns,as well as public health prevention decisions for air pollution in Hohhot and screening and reproduction during pregnancy Health provides a reference,and has accumulated basic data for the study of air pollution and health risks in arid and semi-arid areas in northern China.The main results are as follows:1.From 2013 to 2016,among the six pollutants in Hohhot,PM₁₀ has a high concentration,which is occasionally accompanied by high concentration of O₃ and PM_2.5 pollution pollution day.The pollution levels of SO₂,CO and NO₂ are relatively stable and present a certain seasonal fluctuation.The number of people conceiving in winter was the highest,and the incidence of five diseases was higher in winter and spring than in summer and autumn.With the increase of maternal age,the risk of five diseases is on the rise.2.Correlation analysis of risk of low birth weight and pollutant exposure showed that the pollutant exposure concentration in the case group was higher than that in the control group and the difference was statistically significant.The logistic adjusted model showed that the pollutants（OR,95%CI）with positive correlation with LBW were:in 1^st trimester,PM_2.5at IQR（4.39,2.59-7.43）、IQR3（2.54,1.70-3.79）、IQR4（2.28,1.65-3.14）,PM₁₀at IQR2（1.66,1.01-2.74）;in 2^nd trimester,PM₁₀ at IQR3（2.02,1.41-2.89）,O₃ at IQR4（1.28,1.01-1.67）;in 3^rd trimester,O₃at IQR3（1.31,1.01-1.72）,NO₂ at IQR2（6.87,3.78-12.50）、IQR3（4.61,2.70-7.85）、IQR4（2.67,1.61-4.45）;for entire trimester,SO₂ at IQR4（1.37,1.01-1.86）,O₃ at IQR2（2.11,1.41-3.14）、IQR3（1.72,1.20-2.46）、IQR4（1.50,1.12-2.01）,PM_2.5 at IQR2（2.21,1.11-4.40）.3.Studies have shown that the statistical relationship between ambient air pollution and preterm birth is related to pregnancy complications such as IVF,gestational diabetes,anemia,and hypothyroidism,and is of important empirical value in understanding the association between urban air pollution and birth outcomes.Correlation analysis of risk of premature birth and pollutant exposure showed that the pollutant exposure concentration in the case group was higher than that in the control group and the difference was statistically significant.The logistic adjusted model showed that the pollutants（OR,95%CI）with positive correlation with PTB were:in 1^st trimester,NO₂ at IQR2（1.33,1.10-1.61）、IQR4（1.19,1.05-1.35）;in 2^nd trimester,O₃ at IQR2（1.59,1.24-2.04）、IQR3（1.45,1.24-1.70）、IQR4（1.37,1.21-1.54）,PM₁₀0 at IQR2（1.41,1.15-1.72）、IQR3（1.29,1.08-1.53）,PM_2.5.5 at IQR2（1.42,1.09-1.85）;in 3^rd trimester,NO₂ at IQR2（1.66,1.34-2.06）,O₃ at IQR2（1.38,1.11-1.71）、IQR3（1.71,1.50-1.94）;for entire trimester,O₃ at IQR2（6.00,4.53-7.94）,NO₂ at IQR2（5.28,3.82-7.30）、IQR3（2.21,1.64-2.99）,PM₁₀0 at IQR4（1.95,1.61-2.36）,SO₂ at IQR2（1.31,1.03-1.68）、IQR4（1.32,1.13-1.55）4.The study found that there was a significant correlation between exposure to O₃ and NO₂ during pregnancy and the risk of fetal malformation after controlling for gestational complications and other risk factors.Compared with other seasons,the concentrations of PM₁₀ and PM_2.5 in the spring are higher,and the early pregnancy is the sensitive period with the highest risk of CA.Exposure to NO₂ and PM_2.5 during the second trimester may increase the risk of developing CA.Pregnancy comorbidities such as gestational diabetes,preeclampsia,hyperthyroidism and premature rupture of membranes are significantly associated with CA risk,and with the prolongation of pregnancy,the effect gradually disappears.This study provides evidence of O₃,NO₂,and PM_2.5 exposure and CA risk in early pregnancy,and has accumulated important basic data for the study of association between air pollution and birth defects.5.The analysis results of the correlation between gestational diabetes and pollutant exposure showed that age,oligohydramnios,anemia,hypothyroidism and other gestational complications,meteorological factors such as total days of pregnancy,season,temperature,humidity and visibility were all related to the incidence of gestational diabetes Statistically significant.The results of the logistic regression of GDM and IQRs of each pollutant in each trimester after adjusted the risk factors,in which IQR1 was set as reference equals 1.For the entire pregnancy,SO₂ at IQR4（1.467,1.227-1.754）,CO at IQR4（1.494,1.157-1.93）,and O₃ at IQR2（1.691,1.225-2.334）,IQR3（1.286,1.025-1.614）,IQR4（1.213,1.001-1.469）,respectively.The analysis of the correlation between preeclampsia and pollutant exposure showed that oligohydramnios,anemia,and age were statistically significant,which was less affected by complications during pregnancy and meteorological factors.The adjusted model shows that there are contaminants（OR,95%CI）that have a positive correlation with preeclampsia are in 1^st trimester,NO₂ at IQR3（1.366,1.062-1.758）and IQR4（1.347,1.064-1.705）,In 2^nd trimester PM₁₀ at IQR3（1.55,1.137-2.114）,and In 3^rd trimester NO₂ at IQR4（1.343,1.124-1.606）.This shows that preeclampsia is mainly affected by the NO₂ and PM₁₀,and concentration in a higher exposure concentration range will significantly increase its risk of onset.更多还原