山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (12): 101-109.doi: 10.6040/j.issn.1671-7554.0.2021.1201
萧阳1,陶宇1,王方怡1,梁俞秀1,张晋1,季晓康1,2,王志萍1,2
XIAO Yang1, TAO Yu1, WANG Fangyi1, LIANG Yuxiu1, ZHANG Jin1, JI Xiaokang1,2, WANG Zhiping1,2
摘要: 目的 探讨孕妇在孕前及孕期细颗粒物(PM2.5)和可吸入颗粒物(PM10)暴露与妊娠期糖尿病(GDM)发生风险的关系,并进一步分析其敏感暴露窗口。 方法 基于山东大学健康医疗大数据研究院山东省平台数据库孕产妇医疗数据,选取2018~2020年期间孕产妇资料;收集山东省64个监测站公布的PM2.5、PM10、NO2和SO2的逐日监测资料,选取研究对象各暴露时间段内的空气监测数据;根据孕妇家庭住址和监测站地址的经纬度坐标,采用反距离加权法(IDW)计算每位研究对象暴露时间段内逐日个体暴露浓度,进而获得每位研究对象在孕前期、孕早期和孕中期每个暴露窗口期内的平均暴露浓度;采用Logistic回归方法探讨PM2.5和PM10暴露与GDM发生风险的关系;进一步通过分布滞后非线性模型(DLNM)分析PM2.5和PM10的敏感暴露窗口。 结果 (1)符合纳入排除标准的研究对象18 407名,其中1 020例孕妇患有GDM,基于本健康医疗大数据GDM患病率为5.54%。(2)PM2.5在孕中期的平均暴露浓度为(52.45±18.26)μg/m3,高于其在孕前期[(50.71±16.98)μg/m3]及孕早期[(51.08±17.15)μg/m3]的平均暴露浓度,差异有统计学意义(F=21.98,P<0.001);PM10在孕前、孕早及孕中期的暴露浓度差异无统计学意义(F=2.36, P=0.124)。(3)调整协变量后,PM2.5和PM10在孕中期的平均暴露浓度与GDM发生风险呈正向关联,暴露浓度每增加10 μg/m3,GDM发生风险分别增加18%和15%(OR=1.18,95%CI: 1.07~1.31; OR=1.15,95%CI: 1.09~1.21)。(4)DLNM分析结果显示,PM2.5和PM10暴露导致GDM发生风险增加的敏感窗口期分别在第18~24孕周和第14~22孕周。 结论 孕中期PM2.5和PM10暴露明显增加GDM发生风险。
中图分类号:
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