臺灣博碩士論文加值系統

氣喘是全世界常見的慢性病之一，也是公共衛生上重要的議題。據估計，目前全世界約有3億人口罹患氣喘病，到目前為止，已經有不少研究指出空氣污染對孩童肺功能發展與氣喘有所影響。
本研究延伸應用兩個在台灣收集之氣喘調查資料，包括：1) 1995年10月到1996年6月的全國國中學童氣喘篩檢調查資料庫，內容為收集全國國中生（n=1,144,196）之國際標準化氣喘研究問卷資料，以及肺功能量測資料庫，內容為根據上述青少年氣喘篩檢資料庫，隨機取樣約10%樣本(n=85,615)進行肺功能量測。2) 為1996年7月到1997年6月於台北市針對曾在1995年參與學童呼吸健康調查並接受肺功能檢查的國三生，進行追蹤調查，同樣也包括國際標準化氣喘研究問卷以及肺功能資料。
同時亦利用地理資訊系統(Geographic Information Systems, GIS)的空間分析模式推估歷年空氣汙染濃度，得到住家與學校環境的汙染物濃度，再綜合評估空氣污染對學童肺功能與氣喘盛行率的影響。
研究結果發現在學童肺功能部分，粒徑小於等於10微米之微粒(PM10)、二氧化硫(SO2)、二氧化氮(NO2)和臭氧(O3)對FVC與FEV1有所影響，而一氧化碳(CO)的暴露增加則會明顯降低FEV1/FVC，造成肺部的危害。至於在學童氣喘部份，暴露在高濃度NO2的學童，其罹患氣喘的勝算比為3.07 (95% CI: 1.06 - 8.87)，但父母親是否有氣喘仍對學童氣喘狀態佔較大的貢獻能力。
雖然父母親的氣喘狀態以及室內污染源對於學童的肺功能以及氣喘有明顯的作用，但空氣污染物仍有其一定的影響力存在，而空氣污染物之間的交互作用對孩童的影響仍需進一步的探討與研究。

Asthma is one of most concerned chronic diseases and important in public health. It is estimated that around 3 billion of population suffer from the disease worldwide. A number of studies have reported the air pollution may affect children’s lung function development and asthmatic condition.
This study used data established from two mass asthma screening surveys conducted in Taiwan. The first one was a nationwide for asthma among all junior high school students and 20% students received further lung function tests in October 1995 - June 1996. The other one was a mass screening survey from July 1996 - June 1997 in Taipei area among ninth-grade students who had participated in both asthma screening and pulmonary function measurement in the previous year.
In this study, Geographic Information Systems (GIS) was used to estimate the association between air pollution exposure and lung function and asthma. The spatial analysis procedure was used Inverse Distance Weighting (IDW) estimate method in 500m × 500m grid squares.
The results showed PM10, SO2, NO2 and O3 were related to adolescent lung function in both FVC and FEV1, and the CO exposure increased significantly the lowered FEV1 to FVC ratio, causing lung hazards. Children with high NO2 concentrations exposure have the increased asthma prevalence with an odds ratio of 3.07 (95% CI: 1.06-8.87). However, parental asthma still association their children with asthma.
This study found parental asthmatic condition and indoor pollution are highly association with asthma and lung function in children. Outdoor air pollutants are also risk factors deserve further exploration.

誌謝 i
摘要 ii
Abstract iv
目次 vi
表目錄 vii
圖目錄 viii
附錄目錄 ix
第一章 緒論 1
第一節 研究背景與研究動機 1
第二節 研究目的與重要性 2
第三節 研究問題與假設 3
第四節 名詞界定 4
第二章 文獻探討 6
第一節 環境汙染對肺功能之影響 6
第二節 環境汙染對氣喘之影響 7
第三節 地理資訊系統於醫藥衛生之應用 8
第四節 研究架構 10
第三章 研究方法 12
第一節 研究設計 12
第二節 研究對象 12
第三節 研究工具的擬定 13
3-1 肺功能量測與氣喘問卷資料 13
3-2 學童住家及就讀學校定位資料 14
3-3 空氣污染物濃度推估資料 14
第四節 資料統計與分析 16
第四章 研究結果 18
第一部份：1995-1996年台灣地區國中學童肺功能研究 18
第二部份：1996-1997年台北市國中學童氣喘研究 30
第五章 討論 44
第六章 結論與建議 48
第一節 結論 48
第二節 研究限制 48
第三節 應用與建議 49
參考文獻 51
附錄 55

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