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游泳池水CYA/FC比值与ORP对HPC超标的筛查价值：基于GEE的聚集效应校正分析
彭飞, 李方茹, 刘军
安徽预防医学杂志 ›› 2026, Vol. 32 ›› Issue (3) : 252-257.
PDF(948 KB)
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游泳池水CYA/FC比值与ORP对HPC超标的筛查价值：基于GEE的聚集效应校正分析
Screening utility of the cyanuric acid/free chlorine ratio and oxidation-reduction potential for heterotrophic plate count exceedance in swimming pools: a clustered data analysis using generalized estimating equations
目的 评估亳州市游泳池水质监督监测数据的聚集效应，并在广义估计方程（generalized estimating equations, GEE）校正后，探索氰尿酸/游离性余氯（cyanuric acid/free chlorine, CYA/FC）比值及氧化还原电位（oxidation-reduction potential, ORP）对菌落总数（heterotrophic plate count, HPC）超标的筛查应用价值。方法 采集2024年7月及2025年6—7月亳州市游泳场所水样。采用混合线性模型估计组内相关系数（intraclass correlation coefficient, ICC），采用GEE开展关联分析，以场所为单位的整群Bootstrap法估计比值比（odds ratio, OR）及受试者工作特征曲线（receiver operating characteristic curve, ROC）曲线下面积（area under curve, AUC）的95%置信区间（confidence interval, CI）。结果 共在40家游泳场所采集水样231份。各指标ICC在0.191~0.780之间（P均<0.05），HPC ICC为0.297，提示存在显著聚集效应。FC合格率为21.65%，其中超过上限者占66.67%。GEE分析显示，CYA/FC>20与HPC超标呈正相关（OR=2.690，95%CI：1.348~10.283），并在高FC组（FC>1.0 mg/L）展现出最佳筛查效能（AUC=0.918，阴性预测值=0.974）。ORP在不同切点下的95%CI均包含1，未显示统计学显著性。结论 亳州市游泳池水质监测数据存在显著聚集效应，小簇样本条件下结合整群Bootstrap法可提高统计推断的稳健性。CYA/FC比值>20与HPC超标风险相关，尤其在高FC场所具有较好的排除式筛查潜力；ORP未显示出具有统计学显著性的筛查价值。上述发现需在更大样本中进一步验证。
Objective To assess clustering effects in routine swimming pool water quality surveillance data from Bozhou, and to evaluate the screening utility of the cyanuric acid/free chlorine (CYA/FC) ratio and oxidation-reduction potential (ORP) for heterotrophic plate count (HPC) exceedance after adjustment for clustering using generalized estimating equations (GEE). Methods The water samples were collected from swimming facilities in Bozhou in July 2024 and June-July 2025. Intraclass correlation coefficients (ICCs) were estimated using a linear mixed model. Associations of the CYA/FC ratio and ORP with HPC exceedance were assessed using GEE, and cluster-level bootstrap (1 000 replications) was applied to estimate 95% confidence interval (CI) for odds ratio (OR) and area under the receiver operating characteristic curve (AUC). Results A total of 231 water samples were collected from 40 swimming facilities. ICCs ranged from 0.191 to 0.780 (all P<0.05), with an ICC of 0.297 for HPC, indicating notable clustering. FC compliance rate was only 21.65%, with 66.67% exceeding the upper limit. GEE analysis showed that a CYA/FC ratio >20 was positively associated with HPC exceedance (OR=2.690, 95%CI: 1.348-10.283) and demonstrated the best screening performance in the high-FC group (>1.0 mg/L) (AUC=0.918, NPV=0.974). Cluster-bootstrap 95%CI for ORP crossed 1.0 at both cutoffs, indicating no statistical significance. Conclusion Swimming pool surveillance data exhibited notable clustering; cluster-level bootstrap may enhance inference robustness under small-cluster conditions. A CYA/FC ratio >20 was associated with HPC exceedance risk and showed promising rule-out screening potential, particularly in the high-FC group. ORP did not demonstrate statistically significant screening utility. These findings warrant validation in studies with larger sample sizes.
游泳池 / 水质监测 / 聚集效应 / 氰尿酸 / 游离性余氯 / 氧化还原电位 / 广义估计方程
Swimming pool / Water quality monitoring / Clustering effect / Cyanuric acid / Free chlorine / Oxidation-reduction potential / Generalized estimating equations
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