【作者】 王金玉；

【导师】 王式功；

【作者基本信息】 兰州大学 ， 环境科学， 2014， 博士

【摘要】 沙尘天气除了造成严重的气象灾害之外,还是一种流动的沙尘污染源,对相关地区造成严重的颗粒物污染。近年来,大量流行病学研究发现沙尘污染易造成人体以呼吸系统为主的多系统损伤,如长期生活在沙尘环境中的居民的呼吸系统会受到慢性损伤,甚至发展成沙漠尘肺。然而,大量的研究报道主要关注急性健康损伤,对慢性损伤关注不够,就沙漠尘肺研究而言,目前也主要限于对检出率的报道,而缺乏对其临床特点的研究与总结,可能导致误诊、漏诊。我国是世界上沙尘暴危害最严重的国家之一,其中民勤县是主要的沙尘源区之一。因此,本研究分别选择甘肃省民勤县和平凉市为沙尘污染区和对照区,通过对沙尘污染组和对照组人群呼吸系统疾病和症状发生状况、肺功能结果、胸透及x线胸片检查结果的分析,初步揭示了沙尘污染对人群呼吸系统的慢性损伤及沙漠尘肺的临床特点,为政府采取预防和控制措施,促进当地居民保健意识与理念,保护呼吸健康提供科学依据。本文的主要研究结果如下：1、民勤县非吸烟农民慢性鼻炎、慢性支气管炎、慢性咳嗽、慢性咳痰的发生率分别较平凉市升高9.6%、8.5%、11.9%、11.2%(p<O.05),提示沙尘污染是导致相关人群部分呼吸系统患病率和症状发生率升高的主要因素。沙尘污染对不同年龄人群均有显著影响,其中,40-59岁者为主要受害者。沙尘污染对男、女性人群均有显著影响,但该影响并无显著性别差异。另外,民勤县慢性支气管炎患者平均发病年龄较平凉市年轻了3.5岁,提示沙尘污染可能导致相关人群慢性支气管炎发病趋向年轻化。2、民勤县非吸烟农民FEV1%、FEV1/FVC%较平凉市分别降低了4.3%、6.6%,肺功能异常率升高了9.5%(p<O.05),提示沙尘污染是导致相关人群肺通气功能受损的主要因素。民勤县非吸烟者中以肺功能轻度受损的发生率最高(20.1%),主要表现为阻塞性通气功能障碍(18.8%)。沙尘污染对不同年龄段人群肺功能均有影响,均以轻度损伤为主,主要表现为阻塞性通气功能障碍；但随着年龄增长,肺功能中度损伤和混合性通气功能障碍发生率逐渐升高。沙尘污染对男、女性相关人群肺功能均有影响,均以轻度损伤为主,主要表现为阻塞性通气功能障碍。3、民勤县非吸烟农民胸透异常率较平凉市升高40.5%(p<O.05),提示沙尘污染是导致相关人群胸透异常率升高的主要因素；其中胸透异常主要表现为肺纹理增强(42.5%)。沙尘污染对不同年龄人群均有显著影响,且胸透异常率与年龄呈正相关Q<0.05),反映其累积损伤效应。沙尘污染对民勤县男、女性人群均有显著影响；其中男性胸透异常率较女性升高17.1%(p<0.05),出现显著性别差异。4、沙漠尘肺是长期沙尘污染的最重结果。本研究发现民勤县沙漠附近农民的沙漠尘肺检出率为1.7%,其中以壹期尘肺为主(85.7%)。60岁以上人群是沙漠尘肺的主要患病人群(85.7%),但无显著性别差异。沙漠尘肺患者胸片主要表现为双肺野或双肺中上野弥漫类圆形小阴影,以q影为主(71.4%)；其中壹期尘肺患者中,80%以上总体密度级为1级的小阴影分布范围超过2个肺区。慢性咳嗽、咳痰是沙漠尘肺的主要临床症状,患者可合并肺结核、慢性支气管炎等疾病。超过40%患者出现肺功能降低,为轻度或中度损伤,表现为阻塞性或混合性通气功能障碍。更多还原

【Abstract】 Dust weather event is a kind of disastrous weather that is common in arid, semi-arid or desert areas. Dust weather event is a floating dust source, which leads severe particle matters (PM) pollution to related regions. In recent years, many epidemiology researches have found that dust pollution caused mainly respiratory system injure. People, who have lived in desertification areas for a long time, might be attacked by desert lung. However, these studies focused primarily on the acute adverse health effects of dust on human. While researchers did not pay enough attention to the chronic adverse health effects of dust. For desert lung, the current studies were limited to the report of incidence of the disease. The clinic character of desert lung has not been summarized systematically, which may lead to misdiagnose or missed diagnosis. Minqin County, Gansu Province is one of the most serious desertification regions in China. While, Pingliang City, Gansu Province belongs to warm and semi-moist agricultural area and influences rarely by dust events. Therefore, Minqin and Pingliang were selected as dust pollution area and control region, respectively. Through comparing analyze to the incidence of respiratory system diseases and symptoms, the status of lung function and the results of chest X-ray between the dust pollution group and the control group, we revealed preliminarily the chronic adverse health effects of dust on human and the clinical characteristics of desert lung. The results will promote the forming of health care ideas and benefit the health of whole population who lived in desertification regions. The main study results as follows: 1.The results revealed that the incidences of chronic rhinitis, chronic bronchitis, chronic cough and chronic sputum were increased of9.6%,8.5%,11.9%and11.2%among non-smokers in Minqin in comparison with Pingliang, respectively; and the differences were significant. Therefore, we concluded that the increasing incidence of some respiratory system diseases and symptoms might relate to long-term dust exposure. It was also displayed that dust pollution had adverse effects on different age people, and those people aged40-59years maybe the major victims. The results also showed that the incidence of the above four diseases and symptoms were ascendant in both males and females in Minqin compared with those of Pingliang, and the differences were significant. However, there were no significant gender different for the incidence in Minqin. In addition, we found that an younger age at onset of chronic bronchitis has been observed in Minqin.2. In comparison with Pingliang, the values of FEV1%and FEV1/FVC%were significant decreased of4.3%and6.6%for non-smokers in Minqin, and the incidence of abnormal lung function was increased of9.5%(p<0.05), respectively. Therefore, we concluded that the decreased lung function might relate to dust pollution. The results also showed that the incidence of mild lung dysfunction was20.1%in Minqin, and it was higher than that of medium or severe pulmonary function injure. The incidence of obstructive pulmonary dysfunction was18.8%, which was the highest ratio among the three types of abnormal lung function. For three different age groups in Minqin, they suffered mainly mild damage of lung function and obstructive pulmonary dysfunction. However, the older the people, the higher incidence of medium injure of lung function and combined pulmonary dysfunction. The results also revealed that the higher incidence of mild injure of lung function and obstructive pulmonary dysfunction were observed both in males and females in Minqin in comparison with Pingliang (p<0.05). However, there was no significant gender different for the incidence of pulmonary dysfunction in Minqin.3. For non-smokers, compared with Pingliang, the incidence of abnormal Chest X-rays were apparent increased of40.5%in Minqin (p<0.05); and the abnormal result of Chest X-rays mainly showed as lung markings. A positive correlation were found between age and incidence of abnormal Chest X-rays in Minqin, which reflected the cumulative injury effects of dust. The results also showed that the higher incidence of abnormal Chest X-rays were observed both in males and females in Minqin in comparison with Pingliang (p<0.05). However, the incidence was increased of17.1%among males in Minqin compared with the females, and the difference was significant.4. Desert lung was the serve outcome of the chronic adverse health effects of dust. The results showed that the prevalence of desert lung was1.7%in Minqin, and there was no significant gender different for the prevalence. The ratio of pneumoconiosis I was85.7%(6/7). All patients were beyond50years. The relation was not been observed between smoking and desert lung. The results of chest X-ray showed that circular small opacities spread all the bilateral lung fields, and the ratio of opacity q was71.4%. The results also displayed that the major clinic symptoms of desert lung were chronic cough and chronic sputum, and it was possible for these patient complicated with some respiratory system diseases such as chronic bronchitis and tuberculosis. We also found that the incidence of lung dysfunction was over40percent in7desert lung patients, whose lung injure belonged to mild or medium damage, and showed obstructive or combined pulmonary dysfunction.更多还原