山东大学耳鼻喉眼学报 ›› 2026, Vol. 40 ›› Issue (3): 47-54.doi: 10.6040/j.issn.1673-3770.0.2025.393
刘迪1,谢应恒1,2,朱斌1,马霖1,3,关兵1,王莹1,曹清1,焦成1,严齐1,孙海勇1,马伟1,2,3
LIU Di1, XIE Yingheng1,2, ZHU Bin1, MA Lin1,3, GUAN Bing1, WANG Ying1, CAO Qing1, JIAO Cheng1, YAN Qi1, SUN Haiyong1, MA Wei1,2,3
摘要: 目的 探究不同性别未成年人鼻出血发病与环境气象因素的相关性及滞后效应,明确性别特异性影响差异,为制定精准预防策略提供依据。 方法 回顾性分析2015年1月1日至2023年12月31日就诊于江苏省苏北人民医院门急诊的未成年人鼻出血患者临床资料,结合同期空气污染物与气象数据。采用Mann-Whitney U检验分析性别间发病相关指标的差异;采用Spearman秩相关与滞后模型(L0~L7)评估不同性别鼻出血患者日发病例数与环境气象因素的相关性及滞后效应,采用Bonferroni法校正多重检验的显著性水平;运用基于费希尔Z转换的假设检验方法比较两组患者相关系数的差异。 结果 共纳入18 280例患者,其中男12 000例(65.65%)、女6 280例(34.35%),男性发病数高于女性(P<0.001),均以夏季高发。日发病数与O3质量浓度、平均温度呈强正相关,滞后效应持续至L7,男女组间相关系数差异有统计学意义(P<0.05)。PM2.5、PM10及CO的滞后效应存在性别差异,男性对多数污染物的相关系数较高。温差与发病数呈正相关,滞后效应于L2达峰值,女性发病当日温差高于男性(P<0.05)。经Bonferroni校正后,NO2、SO2与发病数无显著相关性(P>0.05),风速影响有限。 结论 未成年人鼻出血存在性别差异及夏季高发特征,其与环境气象因素的相关性及滞后效应具有显著性别特异性,制定预防策略时应充分考虑性别因素。
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| [1] Send T, Bertlich M, Eichhorn KW, et al. Etiology, management, and outcome of pediatric epistaxis[J]. Pediatr Emerg Care, 2021, 37(9): 466-470. doi:10.1097/pec.0000000000001698 [2] Kubba H. Childhood epistaxis[J]. Clin Otolaryngol, 2006, 31(3): 212-213. doi:10.1111/j.1749-4486.2006.01238.x [3] Mohideen RSPM, Thangaraj M. Relationship between temporal pattern perception test and mismatch negativity in children with auditory processing disorder and dyslexia[J]. J Audiol Otol, 2023, 27(1): 16-23. doi:10.7874/jao.2022.00297 [4] Kwak IY, Kim KS, Min HJ. Differential effect of meteorological factors and particulate matter with ≤10-μm diameter on epistaxis in younger and older children[J]. Sci Rep, 2022, 12(1): 21029. doi: 10.1038/s41598-022-25630-3. doi:10.1038/s41598-022-25630-3 [5] 谷庆隆, 高兴强, 罗征秀, 等. 儿童鼻出血诊断与治疗: 临床实践指南(2021年)[J]. 中国实用儿科杂志, 2021, 36(10): 721-724. doi:10.19538/j.ek2021100601 GU Qinglong, Gao Xingqiang, LUO Zhengxiu, et al. Diagnosis and treatment of epistaxis in children-clinical practice guidelines(2021)[J]. Chinese Journal of Practical Pediatrics, 2021, 36(10): 721-724. doi:10.16066/j.1672-7002.2021.06.01 [6] 王梅, 王新兰, 徐百成, 等. 儿童急性扁桃体炎与环境气象因素的相关性研究[J]. 中国耳鼻咽喉头颈外科, 2021, 28(6): 383-386, 390. doi:10.16066/j.1672-7002.2021.06.01 WANG Mei, WANG Xinlan, XU Baicheng, et al. Study on the correlation between acute tonsillitis in children and environmental meteorological factors[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2021, 28(6): 383-386, 390. doi:10.16066/j.1672-7002.2021.06.01 [7] Yu G, Fu Y, Dong C, et al. Is the occurrence of pediatric epistaxis related to climatic variables?[J]. Int J Pediatr Otorhinolaryngol, 2018, 113: 182-187. doi: 10.1016/j.ijporl [8] Yuan WM, Lu YQ, Wei Z, et al. An epistaxis emergency associated with multiple pollutants in elementary students[J]. Biomed Environ Sci, 2016, 29(12): 893-897. doi:10.3967/bes2016.119 [9] Purkey MR, Seeskin Z, Chandra R. Seasonal variation and predictors of epistaxis[J]. Laryngoscope, 2014, 124(9): 2028-2033. doi:10.1002/lary.24679 [10] Mangussi-Gomes J, Enout MJR, de Castro TC, et al. Is the occurrence of spontaneous epistaxis related to climatic variables? A retrospective clinical, epidemiological and meteorological study[J]. Acta Otolaryngol, 2016, 136(11): 1184-1189. doi:10.1080/00016489.2016.1191673 [11] Sowerby LJ, DeSerres JJ, Rudmik L, et al. Role of season, temperature and humidity on the incidence of epistaxis in Alberta, Canada[J]. J Otolaryngol Head Neck Surg, 2014, 43(1): 10. doi: 10.1186/1916-0216-43-10 [12] Bray D, Giddings CEB, Monnery P, et al. Epistaxis: are temperature and seasonal variations true factors in incidence?[J]. J Laryngol Otol, 2005, 119(9): 724-726. doi:10.1258/0022215054798032 [13] Lu YX, Liang JQ, Gu QL, et al. Pediatric epistaxis and its correlation between air pollutants in Beijing from 2014 to 2017[J]. Ear Nose Throat J, 2020, 99(8): 513-517. doi:10.1177/0145561319852581 [14] Szyszkowicz M, Shutt R, Kousha T, et al. Air pollution and emergency department visits for epistaxis[J]. Clin Otolaryngol, 2014, 39(6): 345-351. doi:10.1111/coa.12296 [15] Min SJ, Kang H, Kim KS, et al. Minimal temperature, mean wind speed, and mean relative humidity are associated with spontaneous epistaxis in Seoul, Korea[J]. Auris Nasus Larynx, 2021, 48(1): 98-103. doi:10.1016/j.anl.2020.07.012 [16] Ahn EJ, Min HJ. Age-specific associations between environmental factors and epistaxis[J]. Front Public Health, 2022, 10: 966461. doi: 10.3389/fpubh.2022.966461 [17] Ahn EJ, Min HJ. Environmental factors differentially affect epistaxis among preschool and school-aged children[J]. Front Public Health, 2023, 11: 1178531. doi: 10.3389/fpubh.2023.1178531 [18] Matsumoto S, Ishii R, Kiuchi C, et al. Effect of average relative humidity on epistaxis[J]. Cureus, 2023, 15(3): e36063. doi: 10.7759/cureus.36063 [19] Fishpool SJC, Tomkinson A. Patterns of hospital admission with epistaxis for 26, 725 patients over an 18-year period in Wales, UK[J]. Ann R Coll Surg Engl, 2012, 94(8): 559-562. doi:10.1308/003588412x13373405386691 [20] Shay S, Shapiro NL, Bhattacharyya N. Epidemiological characteristics of pediatric epistaxis presenting to the emergency department[J]. Int J Pediatr Otorhinolaryngol, 2017, 103: 121-124. doi: 10.1016/j.ijporl.2017.10.026 [21] Sharifi A, Hwang PH, Zojaji M, et al. Environmental factors and the incidence of pediatric epistaxis: a systematic review with meta-analysis[J]. Int J Pediatr Otorhinolaryngol, 2024, 186: 112152. doi: 10.1016/j.ijporl.2024.112152 [22] Hachicha A, Chouchane H, Boussafa H, et al. Epistaxis in children with allergic rhinitis: clinical features and risk factors depending on the allergen profile[J]. Tunis Med, 2024, 102(11): 927-932. doi:10.62438/tunismed.v102i11.5129 [23] Seidel DU, Sesterhenn AM, Kostev K. Seasonal variation of epistaxis in Germany[J]. J Craniofac Surg, 2018, 29(4): e365-e367. doi:10.1097/scs.0000000000004351 [24] Wei EX, Green A, Chang MT, et al. Environmental risk factors for pediatric epistaxis vary by climate zone[J]. Laryngoscope, 2024, 134(3): 1450-1456. doi:10.1002/lary.30961 [25] Calderón-Garcidueñas L, Rodríguez-Alcaraz A, Villarreal-Calderón A, et al. Nasal epithelium as a sentinel for airborne environmental pollution[J]. Toxicol Sci, 1998, 46(2): 352-364. doi:10.1006/toxs.1998.2549 [26] 孙娜, 黄昱, 章如新, 等. 臭氧对变应性鼻炎鼻黏膜NF-κB p65核蛋白表达及炎性因子的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 237-244, 253. doi: 10.6040/j.issn.1673-3770.0.2021.564 SUN Na, HUANG Yu, ZHANG Ruxin, et al. Effects of ozone on nuclear protein expression of NF-κB p65 in nasal mucosa and inflammatory factors in a rat model of allergic rhinitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 237-244, 253. doi: 10.6040/j.issn.1673-3770.0.2021.564 [27] Kim K, Kwak IY, Min H. Particulate matter 10(PM10)is associated with epistaxis in children and adults[J]. Int J Environ Res Public Health, 2021, 18(9): 4809. doi: 10.3390/ijerph18094809 [28] Akdo gan MV, Hızal E, Semiz M, et al. The role of meteorologic factors and air pollution on the frequency of pediatric epistaxis[J]. Ear Nose Throat J, 2018, 97(9): E1-E5. doi:10.1177/014556131809700901 [29] 张淼, 杨颖超, 付指辉, 等. 自主神经功能紊乱与鼻科疾病关系研究进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(5): 142-148. doi: 10.6040/j.issn.1673-3770.0.2022.215 ZHANG Miao, YANG Yingchao, FU Zhihui, et al. Research progress in the relationship between autonomic nervous system dysfunction and nasal diseases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(5): 142-148. doi: 10.6040/j.issn.1673-3770.0.2022.215 [30] Giddens WE Jr, Fairchild GA. Effects of sulfur dioxide on the nasal mucosa of mice[J]. Arch Environ Health, 1972, 25(3): 166-173. doi:10.1080/00039896.1972.10666156 |
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