目的 评估2019年深圳市生活饮用水13项化学指标的人群健康风险.方法 共纳入173个监测点在丰水期和枯水期开展生活饮用水监测,选取常规指标中13种化学指标,采用"四步法"进行健康风险评估,并对不同性别、水样类型和水期类型进行分层分析.结果 深圳市总人群经饮水途径暴露的六价铬、砷、三氯甲烷的致癌风险都介于10-6～10-4之间,存在一定致癌风险.组间对比显示,女性风险普遍高于男性,砷的致癌风险在二次供水中显著大于其他水样,砷和三氯甲烷的致癌风险在丰水期大于枯水期(P<0.05).慢性非致癌风险值均小于1,为可接受范围.结论 2019年深圳市生活饮用水可能存在一定致癌健康风险,其中六价铬、砷和三氯甲烷为主要风险化学物质.

外泌体是分泌的膜结合囊泡,其中包含大量可以改变受体细胞中基因表达的核酸、蛋白质和脂质.毒物可以改变外泌体的合成及其生物活性内含物的成分,因此外泌体可以作为暴露与效应的生物标志.尽管人体和动物研究已确认器官毒性的外泌体生物标志,而体外模型是研究外泌体功能生物学机制的理想选择,在此领域进一步使用体外模型对于探索外泌体生物学在毒理学中的潜在应用至关重要.本文对外泌体在毒理学研究中的重要性,外泌体体外模型的应用及其在暴露相关疾病中的作用综述如下.

自2016年以来,深圳作为广东省4个监测城市之一参加公共场所健康危害因素监测项目工作.一直按照国家方案要求,编制实施方案,开展人员培训,完成现场调查与监测、数据上报与审核,并对数据进行汇总分析,完成技术总结报告.现将5年来深圳市公共场所健康危害因素监测工作情况进行总结,针对发现的问题提出对策与建议.

[背景]金属暴露可能与动脉粥样硬化(AS)发生有关,关于多金属暴露与AS风险关系的研究结论存在争议.[目的]探讨深圳市中老年体检人群中血浆多种金属水平与AS风险之间的关联.[方法] 664名研究对象均来自2012-2017年于中山大学附属第八人民医院接受常规健康体格检查的中老年人群.通过问卷调查、体格检查等收集研究对象的人口学特征、生活方式及生理生化指标;采集研究对象的血浆,采用电感耦合等离子体质谱仪检测13种金属的质量浓度(后称浓度);采用颈动脉彩色超声测量颈总动脉内膜中层厚度,确定是否有AS.采用Iogistic回归模型和限制性立方样条图分析血浆金属浓度与AS风险的关联以及剂量-反应关系.[结果]研究对象的平均年龄为(64.41±7.23)岁,男性占比52.26％ (347/664),AS检出率为45.33％.校正混杂因素后,单金属logistic回归模型结果显示:与第一分位组相比,血浆铁、硒、镉的第四分位组AS风险下降,OR (95％ CI)分别为0.50 (0.29～0.88)、0.59 (0.36～0.96)和0.54 (0.33～0.90);而血浆铊的第三分位组AS风险上升[OR (95％ CI):1.75 (1.08～2.83)].进一步采用多金属logistic逐步回归后发现,与第一分位组相比:血浆铁的第四分位组AS风险下降[OR (95％ CI):0.47 (0.28～0.79)],而血浆铊的第三分位组AS风险上升[OR (95％ CI):1.81(1.11～2.99)];且随着铊浓度的升高,AS风险亦逐渐增加(P趋势=0.046).限制性立方样条分析结果表明,血浆铁浓度增加与AS风险下降有关,两者之间呈现非线性剂量-反应关系(非线性关联P=0.043,剂量-反应关系P=0.022).[结论]血浆铁浓度的增加可能与AS风险下降有关,而血浆铊浓度增加可能与AS风险增加有关.

BACKGROUND:Metal exposures are suspected to associate with the risk of hyperuricemia (HUA), but the current results are still conflicting. OBJECTIVE:To investigate the associations between multiple plasma metal exposures and HUA risk. METHODS:A cross-sectional study was conducted in 1406 Chinese Han adults who underwent routine physical examination in the Eighth Affiliated Hospital of Sun Yat-Sen University in Shenzhen. The plasma levels of 13 metals were measured by the inductively coupled plasma mass spectrometry (ICP-MS). Multivariable logistic, linear regression models, least absolute shrinkage and selection operator (LASSO) penalized regression analysis, and restricted cubic spline (RCS) models were applied to assess the associations. RESULTS:The median plasma uric acid concentration in HUA group (434 μmol/L) was significantly higher than that in non-HUA group (305 μmol/L). The multivariate-adjusted odds ratios (95% confidence intervals) of HUA were 1.62(1.08-2.43) for magnesium, 1.61(1.05-2.47) for copper, 1.62(1.06-2.49) for zinc, 1.87(1.26-2.81) for arsenic, 1.50(1.01-2.23) for selenium, and 1.70(1.16-2.49) for thallium based on the single-metal logistic regression models, comparing the highest versus the lowest quartile of metal levels. Further multi-metal logistic, linear regression models and the LASSO analysis all indicated positive associations of zinc, arsenic with HUA risk or uric acid levels. RCS model indicated an inverted V-shaped positive association between zinc levels and HUA risk (p for non-linearity = 0.048, p for overall association = 0.022), while arsenic levels showed a positive and linear dose-response relationship with HUA risk (p for non-linearity = 0.892, p for overall association<0.001). CONCLUSIONS:Higher plasma levels of zinc and arsenic might increase HUA risk and showed positive dose-response relationships. Further cohort studies in larger population are required to testify our findings.

目的 了解深圳市公共场所卫生状况,为开展公共场所卫生监督管理提供依据.方法 根据公共场所随机监督抽查的要求,2018-2019年共抽检597家公共场所.按照国家标准对抽检场所空气、游泳池水和用品用具微生物指标、化学指标等卫生指标进行检测.结果 抽检的公共场所合格率为78.73％,卫生指标合格率为96.88％;合格率偏低的公共场所是公共浴室和美容美发场所,分别为46.67％、60.84％;卫生指标合格率较低的是游泳池水细菌总数、游离性余氯和美容美发用品用具细菌总数,分别为88.28％、89.27％、89.14％.结论 部分公共场所的卫生指标不合格,应加强对公共浴室、美容美发场所、文化娱乐场所和游泳场所的卫生监督管理.

Previous studies have demonstrated the characteristics of patients with 2019 novel coronavirus disease (COVID-19). However, the effect of non-pharmaceutical interventions on the epidemic in Shenzhen, China remains unknown. Individual data of 417 cases were extracted from the epidemiological investigations and the National Infectious Disease Information System between January 1, 2020 and February 29, 2020. On the basis of important interventions, the epidemic was divided into four periods (January 1-15, January 16-22, January 23-February 5 and after February 6). We used a susceptible-exposed-infectious-asymptomatic-recovered model to evaluate the effect of interventions. Results suggested that about 53.7% were imported from Wuhan. The median age was 47 years and 52.8% were women. Severity risk increased with age and associated with male and co-existing disorders. The attack rate peaked in the third period and drastically decreased afterwards across sex, age groups and geographic regions. Children younger than 5 years showed a higher attack rate than those aged of 6~19. The effective reproductive number decreased from 1.44 to 0.05 after the highest level emergency response since January 23. Overall, the non-pharmaceutical interventions have effectively mitigated the COVID-19 outbreak in Shenzhen, China. These findings may facilitate the introduction of public health policies in other countries and regions.

The potential health hazards of trihalomethanes (THMs) contamination in drinking water in Shenzhen were estimated.The concentrations of THMs in drinking water from 13 centralized water supply systems were determined from Jan 2015 to Dec 2016 in Shenzhen.The water environmental health risk assessment model recommended by USEPA was established based on the water monitoring data of THMs.Preliminary health risks of THMs through ingestion of drinking water were assessed.The median concentrations of THMs, TCM, DBCM, BDCM and TBM in drinking water were 37.0, 24.5, 2.3, 7.8 and 0.3 μg/L respectively.The values of carcinogenic risks for THMs, TCM, DBCM, BDCM, and TBM to the individual per year in drinking water were 4.52 × 10 -5 , 2.38 × 10 -5 , 6.07 × 10 -6 , 1.52 × 10 -5 and 7.45 × 10 -8 respectively.The values of non-carcinogenic risks for THMs, TCM, DBCM, BDCM and TBM to the individual per year in drinking water were 9.32 × 10 -2 , 7.68 × 10 -2 , 3.61 × 10 -3 , and 1.23 × 10 -2 and 4.71 × 10 -4 respectively.The health risk caused by THMs to the individual through ingestion of drinking water was in the order of TCM, BDCM, DBCM and TBM from high to low.The carcinogenic risks induced by THMs through ingestion of drinking water are acceptable with tolerable value offered by USEPA (1.0 × 10 -6 -1.0 × 10 -4 ), but reached to the tolerable value (5.0 × 10 -5 ) by International Commission on Radiological Protection (ICRP).The non-carcinogenic risk of THMs is tolerable (HI < 1).

目的 了解深圳2014-2018年间公共场所空调系统微生物污染状况.方法 对深圳市117家公共场所空调系统风管内表面、送风中及冷却水、冷凝水进行卫生学调查,运用卡方检验对检测结果进行统计分析.结果 2014-2018年117家不同公共场所集中空调通风系统的检测结果显示:风管内表面细菌总数、真菌总数的合格率分别为93.8％和93.3％,空调送风中细菌总数、真菌总数、β-溶血性链球菌的合格率分别为72.0％、80.6％和98.6％;冷却水、冷凝水嗜肺军团菌的检出率分别为11.7％和1.1％.空调送风中微生物合格率低于风管内表面微生物合格率之间,冷却水嗜肺军团菌检出率逐年下降.各年间风管内表面细菌总数、真数总数、空调送风中真菌总数、冷却水嗜肺军团菌合格率间差异有统计学意义(x2分别为33.066和102.314、23.512、22.744,P＜0.05).结论 针对深圳市公共场所空调系统微生物污染情况,应加大对空调系统微生物监测的力度,加强对经营场所加强空调系统的清洗消毒、日常运行的卫生管理等工作的指导.

目的 布草中微生物污染和洗涤引起的pH值超标直接影响消费者人身健康和安全.本研究分析深圳市住宿场所布草卫生状况及清洗质量状况,为住宿场所卫生监督提供依据.方法 2016-2017年采用方便抽样的方法,在深圳市区选择住宿场所共144家,对其布草细菌总数、大肠菌群、金黄色葡萄球菌及pH值进行检测.结果 毛巾和床单的金黄色葡萄球菌全部合格,细菌总数、大肠菌群仅有少量不合格,毛巾和床单细菌总数合格率分别为98.17％和99.59％,毛巾的大肠菌群合格率为99.39％;毛巾和床单pH值合格率分别为62.45％和60.26％.毛巾和床单pH值(t=3.145,P＜0.01),不同星级住宿场所毛巾pH值(t=4.442,P＜0.05),不同星级住宿场所床单pH值(t=4.390,P＜0.001)比较,差异均有统计学意义,并且三星级以下住宿场所布草pH值水平高于三星级及以上住宿场所.结论 深圳市住宿场所布草卫生状况整体上较好,但清洗质量有待提高,未来应加强对住宿场所布草清洗质量的监督管理.

随着城市现代化交通网络的不断发展,被誉为"绿色交通"的轨道交通因其速度快、容量大和污染小的优点,已逐步成为国内外大、中型城市公交系统的重要组成部分.我国城市轨道交通起步较晚,但发展迅速.据交通运输部统计,截止2017年底,全国内地开通运营城市轨道交通的城市共33个,开通线路150多条,运营里程超过4 500km;而21世纪初,全国仅有4城市共7条地铁线路,总里程146km.按照国务院颁布的《"十三五"现代综合交通运输体系发展规划》,到2020年全国城市轨道交通运营总里程预计达到6 000km.在城市轨道交通大发展时期需要规范公共交通场所卫生,以便于引导和规范我国城市轨道交通健康发展,为了保障轨道交通乘客身体健康和保障轨道交通的可持续发展,从公共卫生角度建立健全城市轨道交通相关法规、标准,满足轨道交通公共场所项目预防性卫生学评价的技术需求,特向原卫生部卫生标准专业委员会申请立项制定本标准— ——《城市轨道交通公共场所预防性卫生学评价规范》(简称"标准" ).

目的 由于公共场所的卫生学特点,存在着危害健康的不利因素,影响从业人员的身体健康.本研究对酒店公共场所从业人员的健康状况进行调查分析,旨在提高从业人员的自我保护意识.方法 选取 2016-2017年深圳市区144京酒店住宿场所,并对其从业人员发放调查问卷,问卷内容主要包括从业人员个人基本情况、卫生知识知晓情况、采取的防护措施及健康状况等.结果 共发放问卷 760份,收回 754份,回收率 99.2％.不同性 别从业人员工作期间,眼部症状(1=0.365,P=0.546)、呼吸系统症状(1 =0.865,P=0.352)、皮肤症状(1 =0.390,P=0.532)及其他症状(x2 = 1.069,P=0.301)发生率,差异均无统计学意义.不同工龄从业人员,呼吸系统症状发生率差异有统计学意义,χ2=13.157,P=0.004;眼部症状、皮肤症状和其他症状发生率,差异均无统计学意义,均 P＞0.05.不同性别从业人员,使用防护用品方面差异无,统计学意义,x2=3.144,P=0.076;使用洗手液或肥皂洗手(x2 = 7.082,P=0.00的、关注工作场所健康影响(x2=9.531,P=0.002)及获得工作场所健康知识(x2=5.182,P=0.023)方面,差异有统计学意义.不同工龄从业人员对个人防护及认知情况,差异均无统计学意义,均 P＞0.05.结论 酒店公共场所从业人员不良症状有一定的发生率,应当加强对公共场所卫生的监督管理;同时要加强从业人员的健康教育,提高其自我保护意识.

目的 评价深圳市地铁7号线站厅站台集中空调通风排气设施及其卫生质量.方法 依据《公共交通等候室卫生标准》(GB 9672-1996)、《公共场所集中空调通风系统卫生规范》(WS 394-2012)、《地铁设计规范》(GB 50157-2013)的要求,对深圳市地铁7号线25座新建地铁站集中空调通风设施及通风管道卫生质量进行现场调查、检测与评价.结果 调查发现,2座冷却塔位于新风亭上风侧,且与冷却塔距离较近;3处新风亭地面未硬底化或绿化,2个新风道内设有开放式排水道,垃圾废弃物未清理.经检测,冷却水、冷凝水嗜肺军团菌未检出,风管内表面积尘量合格率100.0％,细菌总数合格率95.69％,真菌总数合格率99.69％.结论 23座车站集中空调卫生状况良好,2座车站新风口存在军团菌污染风险,针对发现的问题提出了整改意见.

卤代苯醌(HBQs)是近年来发现的一类新型的未受监管的消毒副产物,广泛存在于经过处理的饮用水和游泳池水中.定量结构毒性关系分析预测HBQs是潜在的膀胱致癌物,因此近年来其逐渐引起人们的重视.本文将对卤代苯醌的化学特征、环境暴露和毒性评估作一综述,为进一步研究其毒理学机制、人群暴露水平,以及充分了解由HBQ暴露引起的潜在不良健康影响和癌症风险提供参考.

目的 建立高温热浪健康风险指数及应对体系,为深圳市预测与合理应对高温热浪天气可能对市民造成的健康风险提供科学依据.方法 收集深圳市历年的空气污染物、气象、人口、死亡数据,以及医院门、急诊资料,以历史数据为基础,建立高温热浪健康风险预警模型,设计开发预警软件系统,确定风险评估指标及指标评判的内容与依据,并于2017年夏季(6～9)月开始正式向公众发布高温热浪健康风险指数,同时比较预警信号与试点医院同期门急诊、住院病例的相关性.结果 将高温热浪引起发病的易感程度以“高温热浪健康风险指数”表示,按照发病风险(以百分数表示,表示发病的概率,即引起发病的可能性)的大小建立深圳市Ⅰ～Ⅳ级高温热浪健康风险指数等级;Ⅱ级预警的儿童呼吸系统疾病门急诊就诊人数与0级差异有统计学意义.结论 预警系统信号发出及时,运行状况良好,高温热浪健康风险指数及应对体系在预测与合理应对高温热浪天气对市民造成的健康风险中起到了重要作用.

Objective To investigate the factors influencing the drinking water quality in Shenzhen City in 2016.Methods According to the Standard testing methods for drinking water (GB/T 5750-2006),101 samples of finished water,218 of tap water,and 20 of secondary water supply were collected in the city in 2016 (totally 339 samples) and the qualities of these samples were detected and evaluated according to the Standard for drinking water quality (GB 5749-2006).The results were analyzed by using SPSS 18.0.Results The qualified rate of the drinking water samples was 94.39％,and the qualified rate of the testing items was 99.86％.The single and multiple factor analyses showed that the water source types,water period,supply capacities of water plants,disinfection methods,water advanced treatment and special treatment,and quantity of testing items of water samples were the vital influencing factors of drinking water quality (P ＜ 0.05).Among these factors,the value of odds ratio of the disinfection methods in the water making process was 3.246,which had the greatest impact on the water quality.Conclusion From the water source to tap water,there are repeated pollution risks.Many factors influence the qualification of water quality.Therefore,we should enhance the systematization and comprehensive management of drinking water to ensure its quality.

目的 分析大气颗粒污染与居民脑卒中死亡和发作存在的Meta关系.方法 通过文献数据库,选择7个符合大气颗粒物和居民脑卒中死亡或是发作关系的研究标准进行Meta定量分析.选择随机效应和固定效应模型,采集大气中每升高10颗粒物,分析空气颗粒对脑卒中死亡产生的危险度(OR)效应值.结果 PM1.0每次上升10,居民发作脑卒中就增加1.09％(OR =1.005,95％CI:1.007～ 1.009),死亡是OR=1.003,95％ CI:0.993～1.012;说明大气中PM1.0上升居民脑卒中发作或是死亡会增多.结论 根据结果,发现空气污染PM1.0会增加居民脑卒中死亡和发作次数,PM2.5增长对脑卒中死亡和发作影响没有统计学意义.

Extreme temperature has been reported to be associated with an increase in acute disease incidence in several cities. However, few similar studies were carried out in Shenzhen, which is a subtropical city located in the southern China. This study explored the relationship between the emergency incidences and extreme temperatures, and investigated the role of air pollutants played in the temperature-related effects on human health in Shenzhen. We conducted a distributed lag nonlinear model study on the effect of extreme temperatures on emergency incidences in Shenzhen city during 2013–2017. Here, only the total emergency incidences, emergency incidences for respiratory diseases, and cardiovascular diseases were taken into consideration. Air pollution, subgroups, and seasons were adjusted to investigate the impacts of extreme temperatures on emergency incidences. Relative risk (RR) and 95% confidence intervals were calculated with the R software. From lag 0 to 21 days, the RR of temperature-total emergency department visits, temperature-cardiovascular, and temperature-respiratory diseases was 1.09 (95% CI: 0.98–1.20), 1.22 (95% CI: 0.96–1.56), and 1.06 (95% CI: 0.70–1.60) at extremely low temperature (first percent of temperature, 10 °C), respectively. During the same lag days, the RR was 1.02 (95 % CI: 0.92–1.14), 0.64 (95% CI: 0.49–0.86), and 0.92 (95% CI: 0.56–1.53) between extremely high temperature and total emergency department visits, cardiovascular, and respiratory diseases, respectively. The cumulative effects gradually went up with time for all types of emergency incidences in warm seasons (5 days moving average of temperature < 22 °C). However, the cumulative effects of total emergency incidences and Cvd emergency incidences were increased within the first lag 5 days, and then decreased until lag 21 in hot seasons (5 days moving average of temperature ≥ 22 °C). The cumulative effects of Res emergency incidences showed a declined trend from lag 0 to lag 21. The elderly (≥ 65, P1: RR = 1.49, 95% CI (1.30, 1.71); P99: RR = 0.86, 95% CI (0.71, 1.04)) and men (P1: RR = 1.27, 95% CI (1.14, 1.42)) seemed to be more vulnerable to extreme temperature than the younger (≤ 64, P1: RR = 1.19, 95% CI (1.08, 1.32); P99: RR = 1.00, 95% CI (0.89, 1.12)) and women (P1: RR = 1.17, 95%CI (1.06, 1.30)). The effects of extremely low temperature on all types of emergency incidences were stronger than those of extremely high temperature in the whole year. In addition, impacts of cold weather lasted about several days while those of hot weather were acute and rapid. An increased frequency of emergency incidences is predicted by rising temperatures variations. These results have clinical and public health implications for the management of emergency incidences.

Purification of surface water is widely practiced with conventional water treatment processes like coagulation-flocculation, sedimentation, filtration,and disinfection. Some reports have specified that conventional wastewater purification processes do not effectively remove many chemical contaminants,

目的 了解游泳池的氯化消毒剂的消毒效果和游泳池氧化还原电位(ORP)的水平.方法 2016-2017年,采用方便抽样的方法,在深圳市区选择游泳池共48家,对其139个监测点数进行氧化还原电位的检测,同时检测浑浊度、pH值、尿素和消毒剂余量等指标.结果 2016-2017年,深圳市游泳池水不合格指标主要包括:pH值、尿素和氧化还原电位,并且ORP全部低于标准值,两年的氧化还原电位水平没有差异,池水pH值与氧化还原电位关联性分析发现,pH值与氧化还原电位相关系数为-0.414(P＜0.01).结论 深圳市游泳池水的水质和氯化消毒剂的消毒效果还有待改善,需进一步探索游泳池水ORP的影响因素,从而改善氯化消毒剂的消毒能力.