Liu Yu-Wei, Kao Chieh-Ni, Ho Chi-Chang, Chou Shah-Hwa, Chen Pau-Chung, Huang Shu-Hung
PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan.
Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Respir Res. 2025 May 9;26(1):176. doi: 10.1186/s12931-025-03254-1.
Surgery is one of the preferred primary treatments for primary spontaneous pneumothorax (PSP); however, postoperative recurrent pneumothorax (PORP), defined as recurrence on the same side, occurs in 3-13% of cases. While environmental factors have been implicated in PSP occurrence, their role in PORP remains unclear. This study aimed to investigate the impact of environmental factors on the onset of PSP and PORP in the same patient population.
Between 2009 and 2019, a total of 442 patients (aged ≤ 40 years) underwent 486 surgeries for PSP, with 43 patients (8.8%) experiencing a first PORP. Management of PORP included reoperation (29 patients), pleural drainage with chemical pleurodesis (4 patients), and conservative observation (10 patients). In this case-crossover study, the day of symptom onset for PSP and PORP was designated as the "case day." To evaluate potential lag effects, the days leading up to symptom onset, ranging from 1 day prior (lag day 1) to 7 days prior (lag day 7), were also analyzed as "case days." Unidirectional matched control days were selected 14-21 days before the case day (lag day 0).
Elevated PM levels were significantly associated with PSP onset at lag day 0 and lag day 1, with increased odds observed at these time points (p = 0.04 and p = 0.02, respectively). No such association was found for PORP patients. Meteorological factors did not appear to influence PSP or PORP risk. Seasonally, both the PSP incidence and the PORP incidence were significantly greater in autumn and spring than in summer and winter (p < 0.001).
PSP and PORP demonstrate seasonal clustering, with higher incidences in autumn and spring. Elevated PM levels appear to contribute to PSP onset but not PORP, suggesting that air pollution may be a potential trigger for PSP. Further research is needed to clarify environmental influences and optimize tailored management strategies.
Not applicable.
手术是原发性自发性气胸（PSP）首选的主要治疗方法之一；然而，术后复发性气胸（PORP），即同侧复发，发生率为3%-13%。虽然环境因素与PSP的发生有关，但其在PORP中的作用仍不清楚。本研究旨在调查环境因素对同一患者群体中PSP和PORP发病的影响。
2009年至2019年期间，共有442例年龄≤40岁的患者接受了486次PSP手术，其中43例（8.8%）经历了首次PORP。PORP的治疗包括再次手术（29例）、化学胸膜固定术胸腔引流（4例）和保守观察（10例）。在这项病例交叉研究中，将PSP和PORP症状发作日指定为“病例日”。为了评估潜在的滞后效应，症状发作前1天（滞后日1）至7天（滞后日7）的天数也作为“病例日”进行分析。单向匹配对照日选择在病例日（滞后日0）前14-21天。
滞后日0和滞后日1时，PM水平升高与PSP发病显著相关，在这些时间点观察到比值增加（分别为p=0.04和p=0.02）。PORP患者未发现此类关联。气象因素似乎不影响PSP或PORP风险。季节性方面，PSP发病率和PORP发病率在秋季和春季均显著高于夏季和冬季（p<0.001）。
PSP和PORP表现出季节性聚集，秋季和春季发病率较高。PM水平升高似乎导致PSP发病，但与PORP无关，这表明空气污染可能是PSP的潜在触发因素。需要进一步研究以阐明环境影响并优化定制的管理策略。
不适用。
