2018, Vol. 39
文章信息
- 林江涛, 邢斌, 唐华平, 杨岚, 袁雅冬, 顾玉海, 陈萍, 刘晓菊, 张捷, 刘辉国, 王长征, 周玮, 孙德俊, 陈一强, 陈卓昌, 黄茂, 林其昌, 胡成平, 杨晓红, 霍建民, 叶贤伟, 周新, 蒋萍, 张伟, 黄奕江, 戴路明, 刘荣玉, 蔡绍曦, 许建英, 周建英.
- Lin Jiangtao, Xing Bin, Tang Huaping, Yang Lan, Yuan Yadong, Gu Yuhai, Chen Ping, Liu Xiaoju, Zhang Jie, Liu Huiguo, Wang Changzheng, Zhou Wei, Sun Dejun, Chen Yiqiang, Chen Zhuochang, Huang Mao, Lin Qichang, Hu Chengping, Yang Xiaohong, Huo Jianmin, Ye Xianwei, Zhou Xin, Jiang Ping, Zhang Wei, Huang Yijiang, Dai Luming, Liu Rongyu, Cai Shaoxi, Xu Jianying, Zhou Jianying.
- 我国7个地理区域哮喘急性发作住院患者季节性分布特征
- Seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China
- 中华流行病学杂志, 2018, 39(11): 1477-1481
- Chinese Journal of Epidemiology, 2018, 39(11): 1477-1481
- http://dx.doi.org/10.3760/cma.j.issn.0254-6450.2018.11.011
-
文章历史
收稿日期: 2018-04-01
引用本文
林江涛, 邢斌, 唐华平, 杨岚, 袁雅冬, 顾玉海, 陈萍, 刘晓菊, 张捷, 刘辉国, 王长征, 周玮, 孙德俊, 陈一强, 陈卓昌, 黄茂, 林其昌, 胡成平, 杨晓红, 霍建民, 叶贤伟, 周新, 蒋萍, 张伟, 黄奕江, 戴路明, 刘荣玉, 蔡绍曦, 许建英, 周建英. 我国7个地理区域哮喘急性发作住院患者季节性分布特征[J]. 中华流行病学杂志, 2018, 39(11): 1477-1481 
Lin Jiangtao, Xing Bin, Tang Huaping, Yang Lan, Yuan Yadong, Gu Yuhai, Chen Ping, Liu Xiaoju, Zhang Jie, Liu Huiguo, Wang Changzheng, Zhou Wei, Sun Dejun, Chen Yiqiang, Chen Zhuochang, Huang Mao, Lin Qichang, Hu Chengping, Yang Xiaohong, Huo Jianmin, Ye Xianwei, Zhou Xin, Jiang Ping, Zhang Wei, Huang Yijiang, Dai Luming, Liu Rongyu, Cai Shaoxi, Xu Jianying, Zhou Jianying. Seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China[J]. Chinese Journal of Epidemiology, 2018, 39(11): 1477-1481.
我国7个地理区域哮喘急性发作住院患者季节性分布特征
1. 100029 北京, 中日友好医院呼吸与危重症医学科;
2. 266000 青岛市立医院东院呼吸科;
3. 710061 西安交通大学第一附属医院呼吸与危重症医学科;
4. 050000 石家庄, 河北医科大学第二医院呼吸内科;
5. 810007 西宁, 青海省人民医院呼吸内科;
6. 110016 沈阳军区总医院呼吸内科;
7. 730000 兰州大学第一附属医院呼吸科;
8. 130041 长春, 吉林大学第二医院呼吸与危重症医学科;
9. 430030 武汉, 华中科技大学同济医学院附属同济医院呼吸内科;
10. 400037 重庆, 第三军医大学新桥医院呼吸内科;
11. 750004 银川, 宁夏医科大学总医院呼吸内科;
12. 010017 呼和浩特, 内蒙古自治区人民医院呼吸与危重症医学科;
13. 530021 南宁, 广西医科大学第一附属医院呼吸内科;
14. 450003 郑州, 河南省人民医院呼吸内科;
15. 210029 南京医科大学第一附属医院呼吸与危重症医学科;
16. 350005 福州, 福建医科大学附属第一医院呼吸内科;
17. 410008 长沙, 中南大学湘雅医院呼吸内科;
18. 830001 乌鲁木齐, 新疆维吾尔自治区人民医院呼吸与危重症医学科;
19. 150081 哈尔滨医科大学附属第一医院呼吸内科;
20. 550002 贵阳, 贵州省人民医院呼吸内科;
21. 200025 上海交通大学医学院第一人民医院呼吸科;
22. 300192 天津市第一中心医院呼吸科;
23. 330006 南昌大学附属第一医院呼吸科;
24. 570311 海口, 海南省人民医院呼吸内科;
25. 650032 昆明医科大学第一附属医院呼吸内科;
26. 230022 合肥, 安徽医科大学第一附属医院呼吸内科;
27. 510515 广州, 南方医科大学南方医院呼吸内科;
28. 030032 太原, 山西大医院呼吸内科;
29. 310003 杭州, 浙江大学医学院附属第一医院呼吸内科
2. 266000 青岛市立医院东院呼吸科;
3. 710061 西安交通大学第一附属医院呼吸与危重症医学科;
4. 050000 石家庄, 河北医科大学第二医院呼吸内科;
5. 810007 西宁, 青海省人民医院呼吸内科;
6. 110016 沈阳军区总医院呼吸内科;
7. 730000 兰州大学第一附属医院呼吸科;
8. 130041 长春, 吉林大学第二医院呼吸与危重症医学科;
9. 430030 武汉, 华中科技大学同济医学院附属同济医院呼吸内科;
10. 400037 重庆, 第三军医大学新桥医院呼吸内科;
11. 750004 银川, 宁夏医科大学总医院呼吸内科;
12. 010017 呼和浩特, 内蒙古自治区人民医院呼吸与危重症医学科;
13. 530021 南宁, 广西医科大学第一附属医院呼吸内科;
14. 450003 郑州, 河南省人民医院呼吸内科;
15. 210029 南京医科大学第一附属医院呼吸与危重症医学科;
16. 350005 福州, 福建医科大学附属第一医院呼吸内科;
17. 410008 长沙, 中南大学湘雅医院呼吸内科;
18. 830001 乌鲁木齐, 新疆维吾尔自治区人民医院呼吸与危重症医学科;
19. 150081 哈尔滨医科大学附属第一医院呼吸内科;
20. 550002 贵阳, 贵州省人民医院呼吸内科;
21. 200025 上海交通大学医学院第一人民医院呼吸科;
22. 300192 天津市第一中心医院呼吸科;
23. 330006 南昌大学附属第一医院呼吸科;
24. 570311 海口, 海南省人民医院呼吸内科;
25. 650032 昆明医科大学第一附属医院呼吸内科;
26. 230022 合肥, 安徽医科大学第一附属医院呼吸内科;
27. 510515 广州, 南方医科大学南方医院呼吸内科;
28. 030032 太原, 山西大医院呼吸内科;
29. 310003 杭州, 浙江大学医学院附属第一医院呼吸内科
摘要:
目的
了解我国7个地理区域内哮喘急性发作住院患者的季节性分布特征。方法
对全国7个地理区域（东北、华北、华中、华东、华南、西北、西南）内的29家三甲医院2013－2014年间因哮喘急性发作住院的患者例数及同期该院呼吸内科总住院患者例数进行统计，逐月计算因哮喘急性发作住院患者占总住院患者的比例。对各个地区之间及每个地区不同月份之间哮喘急性发作患者的住院情况进行了统计学分析。结果
在研究的时间范围内，29家医院的呼吸科总住院患者为206 135例次，其中因哮喘急性发作住院患者为6 480例次，占同期总住院数的3.14%。不同地区间因哮喘急性发作住院人数占同期总住院人数的比例差异较大，东北地区比例最高（5.61%），华东地区比例最低（1.97%）。不同地区之间哮喘患者住院比例的差异均有统计学意义（P < 0.000 1）。多数地区因哮喘急性发作住院患者例数及比例都有两个高峰，分别位于2－4月及9－10月，东北、华东及华南地区的春季高峰更为显著，而华北及西南地区的秋季高峰更为明显，西北地区的高峰则位于冬季（12－1月）及夏季（6－8月）。东北、华北及西南地区各月份之间哮喘急性发作住院情况的差异有统计学意义（P < 0.005）。结论
不同地区哮喘急性发作住院患者存在一定的季节波动性，多数地区存在春季及秋季两个高峰。
关键词:
哮喘
住院患者
地理
季节变化
Seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China
1. Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China;
2. Department of Respiration, Qingdao Municipal Hospital, Qingdao 266000, China;
3. Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China;
4. Department of Respiration, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China;
5. Department of Respiration, Qinghai People's Hospital, Xining 810007, China;
6. Department of Respiratory Diseases, The General Hospital of Shenyang Military, Shenyang 110016, China;
7. Department of Respiration, The First Affiliated Hospital of Lanzhou University, Lanzhou 730000, China;
8. Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jilin University, Changchun 130041, China;
9. Department of Respiration, Tongji Hospital, Wuhan 430030, China;
10. Department of Respiration, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China;
11. Department of Respiration, General Hospital of Ningxia Medical University, Yinchuan 750004, China;
12. Department of Pulmonary and Critical Care Medicine, Inner Mongolia People's Hospital, Hohhot 010017, China;
13. Department of Respiration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China;
14. Department of Respiration, Henan Provincial People's Hospital, Zhengzhou 450003, China;
15. Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China;
16. Department of Respiration, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China;
17. Department of Respiration, Xiangya Hospital, Changsha 410008, China;
18. Department of Pulmonary and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China;
19. Department of Respiration, The First Affiliated Hospital of Harbin Medical University, Harbin 150081, China;
20. Department of Respiration, Guizhou Provicial People's Hospital, Guiyang 550002, China;
21. Department of Respiration, Shanghai Center Hospital, Shanghai 200025, China;
22. Department of Respiration, Tianjin First Center Hospital, Tianjin 300192, China;
23. Department of Respiration, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China;
24. Department of Respiration, Hainan Provincial People's Hospital, Haikou 570311, China;
25. Department of Respiration, Kunming General Hospital of the People's Liberation Army, Kunming 650032, China;
26. Department of Respiration, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China;
27. Department of Respiration, Nanfang Hospital, Guangzhou 510515, China;
28. Department of Respiration, Shanxi Dayi Hospital, Taiyuan 030032, China;
29. Department of Respiration, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
2. Department of Respiration, Qingdao Municipal Hospital, Qingdao 266000, China;
3. Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China;
4. Department of Respiration, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China;
5. Department of Respiration, Qinghai People's Hospital, Xining 810007, China;
6. Department of Respiratory Diseases, The General Hospital of Shenyang Military, Shenyang 110016, China;
7. Department of Respiration, The First Affiliated Hospital of Lanzhou University, Lanzhou 730000, China;
8. Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jilin University, Changchun 130041, China;
9. Department of Respiration, Tongji Hospital, Wuhan 430030, China;
10. Department of Respiration, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China;
11. Department of Respiration, General Hospital of Ningxia Medical University, Yinchuan 750004, China;
12. Department of Pulmonary and Critical Care Medicine, Inner Mongolia People's Hospital, Hohhot 010017, China;
13. Department of Respiration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China;
14. Department of Respiration, Henan Provincial People's Hospital, Zhengzhou 450003, China;
15. Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China;
16. Department of Respiration, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China;
17. Department of Respiration, Xiangya Hospital, Changsha 410008, China;
18. Department of Pulmonary and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China;
19. Department of Respiration, The First Affiliated Hospital of Harbin Medical University, Harbin 150081, China;
20. Department of Respiration, Guizhou Provicial People's Hospital, Guiyang 550002, China;
21. Department of Respiration, Shanghai Center Hospital, Shanghai 200025, China;
22. Department of Respiration, Tianjin First Center Hospital, Tianjin 300192, China;
23. Department of Respiration, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China;
24. Department of Respiration, Hainan Provincial People's Hospital, Haikou 570311, China;
25. Department of Respiration, Kunming General Hospital of the People's Liberation Army, Kunming 650032, China;
26. Department of Respiration, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China;
27. Department of Respiration, Nanfang Hospital, Guangzhou 510515, China;
28. Department of Respiration, Shanxi Dayi Hospital, Taiyuan 030032, China;
29. Department of Respiration, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
Corresponding author:
Lin Jiangtao, Email:jiangtao_l@263.net
Abstract:
Objective
To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China.
Methods
This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast, north, central, east, south, northwest and southwest). The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded. The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared.
Results
During the study period, 6 480 patients were admitted for asthma exacerbation, accounting for 3.14% of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals. The ratio of asthmatic patients to total inpatients in the northeast area (5.61%) was highest, and the ratio in east area was lowest (1.97%). Statistical analysis showed that the difference among different areas was significant (P < 0.000 1). In most areas, both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October). In the northeast area, east area and south area, the peaks in spring were more obvious, while in the north area and southwest area, the peaks in autumn were more obvious. In the northwest area the peaks occurred in winter (December-January) and summer (June-August), respectively. The differences in hospitalization due to asthma among different months were significant in the northeast, north, and southwest areas (P < 0.005).
Conclusion
The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China. In most areas, more asthmatic patients were admitted to hospitals in spring and autumn.
Key words:
Asthma
Inpatient
Geography
Seasonal distribution
支气管哮喘是一种常见的慢性气道炎症性疾病，近年来，全球范围内哮喘的发病率及患病率均有增加的趋势[1]。哮喘的发病与环境因素密切相关，不同国家及地区间有较大的差异。我国不同地区之间的气候条件及环境因素均有很大差异，各地哮喘发病的情况也有所不同。本文对全国7个地理区域的哮喘急性发作住院的季节性分布情况进行了调查分析，为了解我国不同地区哮喘急性发作的季节性分布特征，更好的进行疾病干预，减少急性发作提供科学依据。
对象与方法1.研究对象：本研究是由全国哮喘研究协作组（China Asthma Research Network）于2015年开展的名为“我国城区哮喘急性发作住院患者费用及相关情况的回顾性调查”（编号CARN-2015-02）的研究。本研究共在全国29个省（自治区、直辖市）的三级甲等医院进行。研究对象为各中心呼吸内科在2013－2014年间因哮喘急性初次或再次发作住院治疗的＞16周岁的患者。哮喘的诊断标准依据全球哮喘防治创议（GINA）2016版[2]。本研究并未对患者的户籍地进行区分。本研究通过中日友好医院伦理委员会批准（编号2015-99）。
2.研究方法：本研究为回顾性调查，通过电子病历系统检索每月因哮喘急性发作住院患者例数及同期呼吸内科总住院患者例数。并按照7个地理区域的划分，分别计算了每个地区每月哮喘急性发作住院患者例数及占同期呼吸内科总住院患者的比例。7个地理区域的划分：东北地区（沈阳、长春、哈尔滨市），华北地区（北京、天津、石家庄、太原、呼和浩特市），华中地区（郑州、武汉、南昌、长沙市），华东地区（济南、南京、上海、合肥、杭州、福州市），华南地区（广州、南宁、海口市），西北地区（银川、兰州、西宁、西安、乌鲁木齐市），以及西南地区（重庆、贵阳、昆明市）。
3.统计学方法：采用SPSS 24.0统计学软件进行数据的统计及分析，数据以例数及比例（%）表示。应用χ2检验对各个地区之间及每个地区不同月份之间因哮喘急性发作住院患者的比例进行分析，以P＜0.05为差异有统计学意义。
结果1.因哮喘急性发作住院患者例数及比例：在研究的时间范围内，29家呼吸内科总住院患者共206 135例次，其中因哮喘急性发作住院患者6 480例次，占同期呼吸内科总住院患者的3.14%。各中心因哮喘急性发作住院例数及所占比例见表 1，各中心差异较大，比例最高为昆明市（10.25%），最低为杭州市（0.55%）。
2.各地区哮喘急性发作住院例数及占同期呼吸内科总住院例数的比例：见表 2。不同地区间差异较大，东北地区比例最高（5.61%），华东地区比例最低（1.97%），且不同地区之间哮喘患者住院比例的差异有统计学意义（P＜0.000 1）。
3.不同地区不同月份哮喘急性发作住院例数及占同期呼吸内科总住院例数的比例：东北及华南地区冬、春季哮喘住院比例较高，而华北及西南地区秋、冬季哮喘住院比例较高。统计学分析显示，东北、华北及西南地区各月份之间哮喘急性发作住院情况的差异有统计学意义（P＜0.05）。东北、华北和西南地区各月份因哮喘急性发作的住院比例之间的差异有统计学意义，东北地区比例最高的为3月（χ2＝46.35，P＜0.000 1），华北地区为9月（χ2＝5.21，P＝0.02）及11月（χ2＝7.10，P＝0.008），西南地区哮喘住院比例最高的为9月（χ2＝8.72，P＝0.003）。见表 3。
哮喘的发病与环境因素关系密切，不同季节、地区间差异都会对哮喘的发病有一定影响。本研究中，哮喘急性发作住院患者占呼吸内科总住院患者的3.14%，低于过往研究结果（5.6%及6.3%）[3-4]，间接提示了我国哮喘总体控制水平的提高[5]。本研究前期数据显示，哮喘急性发作有明显的季节波动性，3月及9月为高峰期[6]，与多项国外流行病学调查的结果一致[7-8]。本研究进一步分析了各个地区哮喘急性发作住院患者与季节的关系，结果显示，不同地区间哮喘急性发作住院患者均有一定的季节波动性且存在地区间差异。
不同季节哮喘发作情况的差异可能与诱发因素的季节性变化有关，而地区间差异可能与地区间季节变化时间不同有关，但具体原因还需进一步研究。国内研究报道，呼吸道感染及天气变化是哮喘急性发作的主要诱因[9-10]。我国地区大部分位于温带，季节差异明显，冬季气温较低，冬、春季交接时温度变化较大，呼吸道感染发生率较高，可能是导致冬春季哮喘急性发作高峰的原因之一。花粉、尘螨等吸入性过敏原也是哮喘急性发作的重要诱发因素。国内多项研究发现，北京地区秋季花粉的高峰出现在8月下旬到9月上旬，且大气中花粉的含量与门诊过敏性鼻炎及哮喘患者症状的出现存在相关性[11-12]。本研究发现，多个地区哮喘急性发作入院患者在9月前后均有高峰，与我国秋季花粉浓度的高峰吻合，提示花粉过敏可能与该时间段哮喘急性发作患者的增多有关。
哮喘急性发作的季节性变化也与年龄相关，国内研究显示，老年哮喘急性发作患者中以急性上呼吸道感染及天气变化为诱因者所占比例均高于中年[10]，国外针对不同年龄的哮喘患者住院情况的分析表明，老年患者冬季入院更多[7-8]，国内尚无全年龄人群研究数据，今后可进一步开展相关分析研究。
本研究为针对哮喘急性发作住院患者的回顾性调查，研究医院均为所在地区三级的甲等医院，尚不能涵盖农村地区及一、二级医院就诊的哮喘患者，且各个医院的床位数及收治患者偏好等因素也会对结果造成一定的影响。本研究也未对住院患者的户籍地进行区分，存在一定的局限性。今后可以开展更为广泛的针对哮喘急性发作患者的前瞻性研究，从而更全面的了解我国各地区哮喘急性发作住院患者的季节性分布特征，并有效的进行急性发作的预防。
利益冲突 无
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