臺灣博碩士論文加值系統

目的: 彰化地區金屬製造工廠佔了全台灣24％，在土壤中金屬與工業的關係已被證實，但在人體暴露的研究上沒有確切資料顯示，因此，想進ㄧ步了解彰化地區居民重金屬暴露濃度，尤其是在職業暴露與抽菸行為和貧血的影響程度。
方法: 本研究是社區性研究，而實行時間是從2001-2002和2005-2006。地點是在彰化高工業密度區收案人數524人;低工業密度區收案人數520人。研究對象是以居住5年以上35歲到65歲的居民，利用問卷的方式了解個案的基本資料且收集尿液、血液、頭髮檢體做為分析體內重金屬濃度的介質。
結果: 高工業密度區與低工業密度區在年齡、居住年限、喝牛奶習慣、職業、居家50公尺有無電鍍、鋼鐵廠、有無使用地下水有達顯著(p<0.05)。金屬相關的職業(例如某種電鍍業)與鉛、鎳、鎘、砷濃度的增加有互相的關係存在。多變量線性迴歸中證明尿中鉛(β=0.1, p= 0.013)、尿中鎘 (β=0.177 , p<0.001) 、血中鎘(β=0.318 , p<0.001)和每日抽菸量有正相關。分析鉛、鎳、鎘、砷與血紅素因子以及腎功能，發現鎳與鎘和血紅素因子以及腎功能是有相關性。
討論: 我們發現在工業上使用不同種類重金屬如鉛、鎘所造成的體內暴露濃度與抽菸有正相關顯著存在，血中鉛在抽菸與職業有達相加交互作用，此外鎳與鎘和血紅素因子以及腎功能有顯著相關性，是值得我們進一步探討。
結論: 抽菸會造成鉛、鎘濃度增加；暴露於鎳、鎘重金屬與血紅素因子以及腎功能有顯著相關性，因此職場上菸害防治計劃是需要著重去推行的。

Objective: The Changhua area occupied 24％ of metal manufacturing industry in Taiwan. Combinations of industry related metals in soil has been verified, but there are no accurate information shown on human exposure studies. Therefore this study made further understands of the residents’ toxic metal exposure levels, and emphasized the effect of occupational exposure , smoking behavior and anemia.

Method: This is a community-based study carried out during 2001-2002 and 2005-2006. The research areas from the areas of high industry density collected 532 effective samples and the areas of low industry density collected 543 effective samples. Subjects were between 35 to 65 years old who reside in the areas of research longer than 5 years. The basic information of research targets was collected through the designed questionnaires and the samples of urine, blood, and hair were gathered for the analyzing body burden heavy metal concentration medium.

Result: There are significant differences (p<0.05) between high industrial and the lower industrial areas in age,length of residence, habit of milk drinking ,occupation, 50 meter distance of electroplate or steel factory with residence ,use of groundwater,. Metal related occupation (i.e. electroplating ones) tend to correlate with increased concentrations of lead (Pb),nickel(Ni),cadimum(Cd),arsenic(AS). Multivarientlinear regression results positive relation of urinary-Pb (β=0.1, p= 0.013);U-Cd (β=0.177 , p <0.001) and blood-Cd (β=0.318 , p<0.001) to number of cigarette smoked per day. By the analyze of lead, nickel,cadmium and arsenic, the coeelation of nickel and cadmium with erythrocyte parameters and renal function was discovered.

Discussion: We found that in industrial areas, lead and cadmium may cause a positive significant between exposure of metal levels and cigarette smoking. Blood-Pb have a add of interaction with cigarette smoking and occupation.In addition, nickel and cadmium has significant correlation with erythrocyte parameters and renal function; which worth further study.

Conclusion: Smoking may increases lead and cadmium concentration. The significant relevance of exposure to nickel and cadmium with erythrocyte parameters and renal function ,therefore tobacco control in the workplace need to emphasized.

目錄
摘要 I
Abstract III
致謝 V
目錄 VII
表目錄 X
圖目錄 XIV
第一章 前言 1
第一節 研究背景 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 金屬的基本介紹 4
第二節 重金屬的暴露來源 6
2-2-1. 職業暴露 6
2-2-2. 環境暴露 7
2-2-3. 香菸暴露 7
第三節 抽菸、職業與重金屬的相關性 10
第四節 重金屬與貧血的相關性 11
第三章 材料與方法 13
第一節 研究地區 13
第二節 研究對象 15
第三節 個案訪談與健康檢查 16
3-3-1. 個案訪談 16
3-3-2. 健康檢查 17
第四節 體內金屬濃度分析 19
3-4-1. 儀器設備 20
3-4-2. 尿液、血液、頭髮實驗流程 22
3-4-3. 重金屬分析品保、品管 25
第五節 統計分析 26
第四章 研究結果 27
第一節 人口學基本資料分析 27
第二節 體內重金屬濃度與暴露相關因子分析 29
4-2-1. 抽菸習慣和職業與體內重金屬濃度相關性分析 29
4-2-2. 重金屬濃度在不同危險因子分布與其迴歸分析 43
第三節 貧血相關因子與重金屬濃度相關性分析 64
第五章 討論 76
第一節 研究族群基本資料分佈與重金屬濃度探討 76
第二節 重金屬濃度與抽菸和職業的關係 77
第三節 貧血與重金屬濃度相關性 78
第六章 結論與建議 81
第一節 結論 81
第二節 研究限制 81
第三節 建議 82
參考文獻 87
名詞縮寫與全名對照表 87
附錄 88
表目錄
表2-1香菸重金屬含量 8
表2-2國內外族群重金屬暴露研究 9
表3-1尿液、血液、頭髮分析使用之儀器 20
表3-2尿液與血液分析之儀器操作參數 20
表3-3頭髮分析之儀器操作參數 21
表3-4微波消化爐設定 21
表4-1高低工業密度區男女基本資料分佈 27
表4-2高低工業密度區基本資料分佈 28
表4-3高低工業密度區之男性抽菸習慣與體內金屬濃度分析 32
表4-4高工業密度區之男性抽菸習慣與體內重金屬濃度分析 33
表4-5低工業密度區中之男性抽菸習慣與體內重金屬濃度分析 34
表4-6高低工業密度區之男性有無在電鍍、鋼鐵廠工作與體內重金屬濃度分析 35
表4-7高工業密度區之女性有無在電鍍、鋼鐵廠工作與體內重金屬濃度分析 36
表4-8高低工業密度區有無在電鍍、鋼鐵廠工作與體內重金屬濃度分析 37
表4- 9高工業密度區之男性抽菸習慣和職業分組與體內重金屬濃度分析 38
表4- 10低工業密度區之男性抽菸習慣和職業分組與體內重金屬濃度分析 39
表4-11高低工業密度區居民尿中鉛濃度在不同危險因子之分佈及其迴歸分析(1)(n=1044) 50
表4-12高低工業密度區不同危險因子與尿中鉛濃度回歸分析(2) (n=1044) 51
表4-13高低工業密度區居民血中鉛濃度在不同危險因子之分佈及其迴歸分析(1)(n=1044) 52
表4-14高低工業密度區不同危險因子與血中鉛濃度回歸分析(2) (n=1044) 53
表4-15高低工業密度區居民尿中鎳濃度在不同危險因子之分佈及其迴歸分析(n=1044) 54
表4-16高低工業密度區居民血中鎳濃度在不同危險因子之分佈及其迴歸分析(n=1044) 55
表4-17高低工業密度區居民尿中鎘濃度在不同危險因子之分佈及其迴歸分析(1) (n=1044) 56
表4-18高低工業密度區不同危險因子與尿中鎘濃度回歸分析(2) (n=1044) 57
表4-19高低工業密度區居民血中鎘濃度在不同危險因子之分佈及其迴歸分析(1) (n=1044) 58
表4-20高低工業密度區不同危險因子與血中鎘濃度回歸分析(2) (n=1044) 59
表4-21高低工業密度區居民血中鉻濃度在不同危險因子之分佈及其迴歸分析(n=1044) 60
表4-22高低工業密度區居民髮中砷濃度在不同危險因子之分佈及其迴歸分析(1) (n=1044) 61
表4-23高低工業密度區不同危險因子與髮中砷濃度回歸分析(2) (n=1044) 62
表4-24高低工業密度區居民尿中鋅濃度在不同危險因子之分佈及其迴歸分析(n=1044) 63
表4-25男女性血紅素、腎功能以及體內重金屬濃度分析 69
表4-26男性血紅素因子單一線性迴歸(n=487) 70
表4-27男性血紅素因子多項式線性迴歸(n=487) 71
表4-28女性血紅素因子單一線性迴歸(n=557) 72
表4-29女性血紅素因子多項式迴歸分析(n=557) 73
表4-30男性腎功能與重金屬相關性(pearson correlation) 74
表4-31女性腎功能與重金屬相關性(pearson correlation) 75

圖目錄
圖3-1研究地區鄉鎮市圖 14
圖3-2尿中金屬分析流程 22
圖3-3血中金屬分析流程 23
圖3-4髮中金屬分析流程 24
圖4-1高工業密度區男性抽菸習慣與尿中鉛濃度分析 40
圖4-2高工業密度區男性菸暴露量與血中鉛濃度分析 40
圖4-3男性高工業密度區抽菸和職業分組與血中鎳濃度分析 41
圖4-4男性高工業密度區抽菸和職業分組與尿中鎘濃度分析 41
圖4-5男性高工業密度區抽菸和職業分組與血中鎘濃度分析 42

行政院經濟部統計處. 八十九年工廠校正調整報告.
Jarup L. 2003. Hazards of heavy metal contamination. Br Med Bull 68: 167-182.
Seidler A, Geller P, Nienhaus A, Bernhardt T, Ruppe I, Eggert S, et al. 2007. Occupational exposure to low frequency magnetic fields and dementia: a case-control study. Occupational and environmental medicine 64(2): 108-114.
ATSDR. 1993a. Agency for Toxic Subatances and Disease Registry. Toxicological profile for cadmium. Atlanta, Georgia.
Landsberger S, Wu, D. 1995. The impact of heavy metals from environmentalttobacco smoke on indoor air quality as determined by compton suppression neutron activation analysis. The Science of the Total Environment 173/174: 323-337.
陳怡君, 宋鴻樟, 李旻貞. 2000. 中老年男性血鎘及尿鎘與飲食的關係. 中華衛誌 19(3): 203-213.
Kalcher K, Kern,W.,&Pietsch,R. 1993. Cadmium and lead in the smoke of a filter cigarette. The Science of the Total Environment 128: 21-35.
WHO G. 1997. World Health Organization(WHO),Tobacco or Health : A Global Status Report.
Massadeh AM, Alali, F. Q., &Jaradat, Q. M. 2005. Determination of cadmium and lead in different cigarette brands in Jordan. Environmental Monitoring and Assessment 104: 163-170.
孫忠賢, 劉紹興, 楊燦. 1994. 某印刷廠員工鉛暴露及健康危害之調查. 中華職業醫學雜誌 1(2): 8-15.
Gomez-Caminero A, Howe P, Hughes M, Kenyon E, Lewis D.R, Moore M, et al. 2001. Arsenic and Arsenic Compounds. Geneva:World Health Organization.
Mahaffey KR, Annest, J. L., Roberts, J., & Murphy, R.S. 1982. Estimates of blood lead levels: United States Socioeconomic factors. NEngl J Med, K 307: 573-579.
Costa M. 2000. Trace element: aluminum, arsenic,cadmium, and nickel. In environmental Toxicants-Human exposures and their health effect 2nd Ed(811-850).
Waalkes MP, Rehm S. 1994. Cadmium and prostate cancer. J Toxicol Environ Health 43(3): 251-269.
Gochfeld M, Witmer C. 1991. A research agenda for environmental health aspects of chromium. Environmental health perspectives 92: 141-144.
Lees P. 1991. Chromium and disease, review of epidemiological studies with particular reference to etiological information provided by measure of eaposure. Environmental health perspectives 92: 93-104.
劉秋欣, 賴俊雄, 郭憲文, 林財印, 賴志和. 1994. 中部地區鉻電鍍供人鼻中膈病變之研究. 勞工安全衛生研究季刊 2(3): 25-35.
Englyst V, Lundstrom NG, Gerhardsson L, Rylander L, Nordberg G. 2001. Lung cancer risks among lead smelter workers also exposed to arsenic. Sci Total Environ 273(1-3): 77-82.
Fryzek JP, Mumma MT, McLaughlin JK, Henderson BE, Blot WJ. 2001. Cancer mortality in relation to environmental chromium exposure. J Occup Environ Med 43(7): 635-640.
Hazelton WD, Luebeck EG, Heidenreich WF, Moolgavkar SH. 2001. Analysis of a historical cohort of Chinese tin miners with arsenic, radon, cigarette smoke, and pipe smoke exposures using the biologically based two-stage clonal expansion model. Radiat Res 156(1): 78-94.
Tomita T. 1970. Zinc content of pancreatic tumors of islet cell origin. J Natl Cancer Inst 44(2): 329-337.
Cunzhi H JJ, Xianwen Z, Jingang G,Suling H. 2001. Classification and Prognostic value of serum copper/zinc ratio in Hodagkin,s disease. Biol Trace Elem Res 83: 133-138.
Woo W, Xu Z. 2001. Effect of dietary zinc intake on N-methyl-N-nitrosourea-induced mammary tumorigenesis in rats. Biological Trace Element Research 83(2): 169-179.
王有忠. 1989. 食品安全. 華香園出版社: 116 - 130.
Lyon. 1986. Tobacco Smoking, IARC Monograph 38, International Agency of Research on Cancer International Agency of Research on Cancer
Wen CP, Levy DT, Cheng TY, Hsu CC, Tsai SP. 2005. Smoking behaviour in Taiwan, 2001. Tobacco control 14 Suppl 1: i51-55.
K.W SMa. 1998. Immunomodulatory effects of cigarette smoke. J Neuroimmunol.
沈福銘、林澤聖. 2003. 台灣地區市售香菸中重金屬含量調查研究. 醫護科技學刊 5(2): 119-129.
Kuo CY, Wong RH, Lin JY, Lai JC, Lee H. 2006. Accumulation of chromium and nickel metals in lung tumors from lung cancer patients in Taiwan. J Toxicol Environ Health A 69(14): 1337-1344.
Liou SH, Wu TN, Chiang HC, Yang GY, Wu YQ, Lai JS, et al. 1994. Blood lead levels in the general population of Taiwan, Republic of China. International Archives of Occupational & Environmental Health 66(4): 255-260.
Liou SH, Wu TN, Chiang HC, Yang T, Yang GY, Wu YQ, et al. 1996. Three-year survey of blood lead levels in 8828 Taiwanese adults. International Archives of Occupational & Environmental Health 68(2): 80-87.
Ikeda M, Zhang ZW, Shimbo S, Watanabe T, Nakatsuka H, Moon CS, et al. 2000. Urban population exposure to lead and cadmium in east and south-east Asia. Science of the Total Environment 249(1-3): 373-384.
Apostoli P, Maranelli G, Duca PG, Bavazzano P, Bortoli A, Cruciatti A, et al. 1997. Reference values of urinary chromium in Italy. International Archives of Occupational & Environmental Health 70(3): 173-179.
Hinwood AL, Sim MR, Jolley D, de Klerk N, Bastone EB, Gerostamoulos J, et al. 2003. Hair and toenail arsenic concentrations of residents living in areas with high environmental arsenic concentrations. Environmental health perspectives 111(2): 187-193.
Minoia C, Sabbioni E, Apostoli P, Pietra R, Pozzoli L, Gallorini M, et al. 1990. Trace element reference values in tissues from inhabitants of the European community. I. A study of 46 elements in urine, blood and serum of Italian subjects. Sci Total Environ 95: 89-105.
Sisman AR, Bulbul M, Coker C, Onvural B. 2003. Cadmium exposure in tobacco workers: possible renal effects. J Trace Elem Med Biol 17(1): 51-55.
Fichtenberg CM, Glantz SA. 2002. Effect of smoke-free workplaces on smoking behaviour: systematic review. BMJ (Clinical research ed 325(7357): 188.
Cook, LS. 2000. A simple case of anemia: pathophysiology of a common symptom. J Intraven Nurs 23(271-281).
Little, DR. 1999. Ambulatory management of common forms of anemia. Am Fam Physician 59: 1598-1604.
鍾崇燊、柯捷男. 2002. 可怕的鉛污染. 科學發展 357: 52-55.
Koçak M, E. A. 2006. The Effects of Chronic Cadmium Toxicity on the Hemostatic System. Pathophysiology of haemostasis and thrombosis 36(6): 411-416.
Hatlelid KM, Brailsford C, Carter DE. 1996. Reactions of arsine with hemoglobin. J Toxicol Environ Health 47(2): 145-157.
林政綱. 2003. 攝入地下水砷所引發致癌風險之研究. 萬能學報 25: 285-303

World, Health, Oranisation. 1977. Environmental Health Criteria 3, Lead, Geneva.
Horiguchi H. 2007. [Anemia induced by cadmium intoxication]. Nippon Eiseigaku Zasshi - Japanese Journal of Hygiene 62(3): 888-904.