臺灣博碩士論文加值系統

背景與目的
垃圾焚化爐在燃燒的過程中，會排放許多對環境及人體健康有害物質，包括重金屬及戴奧辛類化合物等，造成附近居民健康影響。本研究的目的在於利用生物檢體金屬濃度評估焚化爐排放對附近居民的影響，探討某焚化爐附近居民的生物檢體金屬濃度及腎小管損傷指標之間的相關性，並計算其吸入戴奧辛致癌風險值。
材料與方法
第一部分：研究對象依照距離遠近，收取暴露組與對照組學童及家長尿液、指甲及問卷，和居住於焚化爐周圍二十年以上之長期居民尿液及問卷，並以ICP-MS分析尿液及指甲十四種金屬濃度：砷、鎘、鉻、銅、汞、鎳、鉛、硒、鋅、鎵、銦、鉀、鍶及釩。以分光光度計(Spectrophotometer)分析尿液中乙醯胺基葡萄糖苷酶(N-acetyl-β-D-glucosaminidase, NAG)濃度，利用ELISA分析β2-微球蛋白(Beta2-Microglobulin, B2M)，當作腎臟功能早期傷害指標。統計方法使用SPSS20版及R進行分析。
第二部分：針對居住焚化爐附近的三個環境監測點的偵測到空氣中多氯二聯苯呋喃（PCDD/Fs）的濃度進行致癌之風險評估，計算不同年齡層、性別其戴奧辛暴露量及其致癌風險值，並用CMB-8.2模式估算環境中戴奧辛貢獻量。
結果
第一部分：暴露組學童尿液經肌酸酐校正後，尿液中砷、鎘、鉻、銅、汞、鎳、鉛、硒、鋅、鎵、銦、鉀、鍶濃度皆顯著高於對照組學童，而暴露組家長尿中鎘及硒顯著低於對照組家長。指甲方面，暴露組學童砷、鎘、鎳、鉛及鋅顯著高於對照組學童，而暴露組家長鉻、鎳及鉛顯著高於對照組家長。根據多變項迴歸分析控制其他變項後，暴露組學童尿中十四種金屬濃度皆顯著高於對照組學童，暴露組家長尿液中鎘及硒皆顯著低於對照組家長。在指甲方面，暴露組學童指甲中鎳及鉛濃度顯著高於對照組學童，指甲釩金屬濃度則顯著低於對照組學童，暴露組家長鉻、銅、鎳及鉛顯著高於對照組家長，砷及釩顯著低於對照組家長。在腎小管損傷指標上，暴露組學童NAG及B2M濃度顯著高於對照組學童。根據多變項迴歸分析控制其他變項後，學童尿液砷、鎘、鉻、汞、鎳及鉛與NAG及B2M濃度呈顯著正相關，家長尿液汞與NAG呈顯著正相關，砷、鎘、鉻、汞、鎳及鉛與B2M濃度呈顯著正相關。針對砷、鎘、鉻、汞、鎳及鉛六種金屬與腎損傷指標NAG及B2M兩者間的關係，結果顯示在各種重金屬濃度對腎小管損傷之程度，大致上呈現學童較家長敏感、NAG較B2M敏感之趨勢，而其中又以鉻金屬對腎損傷之敏感程度越高。
第二部分：在過去三年平均戴奧辛濃度下其致癌風險評估中，孩童暴露戴奧辛致癌風險值6.65E-07至1.19E-06間，成人暴露戴奧辛致癌風險值5.97E-08至1.21E-07間，老人暴露戴奧辛致癌風險值2.02E-08至4.10E-08間。追分派出所之孩童，其致癌風險值不管男童及女童皆大於10-6。從三年平均環境中戴奧辛/呋喃來源CMB模擬結果，來自於垃圾焚化廠大約佔三成。
結論與建議
研究結果得知住在焚化爐附近學童其生物檢體中金屬濃度大多高於對照組，且與腎小管損傷指標均呈現顯著正相關，有可能與其暴露焚化爐排放金屬濃度有關。此外，在致癌風險評估得知在焚化爐附近之兒童暴露戴奧辛致癌風險值超過人體所能接受之致癌風險值(10-6)。因此，環保機關應加強管制焚化爐排放之汙染物，以降低周圍居民之健康危害。

Background and Purpose
Heavy metals and dioxins are released from incinerator, which lead various adverse health implications for resdients living nearby incineration. The purpose of this study is to evaluate the association of metal concentrations in urine and nail with two biomarkers of renal tubule disfunction and assess cancer risks of dioxin for adult and children living nearby a incinerator.
Material and Methods
Part1：Urine, nails and questionnaires were collected from students and their parents in the exposure and control groups based on the distance from their residence to the incinerator. Long-stay residents living in the incinerator for 20 years and over collected urine and questionnaires. Fourteen metals (arsenic, cadmium, chromium, copper, mercury, nickel, lead, selenium, zinc, gallium, indium, potassium, strontium and vanadium) in urine and nail concentrations were analyzed by ICP-MS: The concentrations of N-acetyl-β-D-glucosaminidase (NAG) and β2-microglobulin (B2M) in urine was used as biomarker of renal tubule dysfunction. Statistical methods were analyzed using SPSS versions 20 and R.
Part2：Air concentrations of Dioxin were measured at three sites nearby an incinerator. Cancer risks of exposure to airborne dioxin were assessed for three age groups and gender. CMB-8.2 model was used to simulate the contribution of dioxins in Central Taiwan, which was used to identify contributing sources of dioxin at three sites.
Results
Part1：After adjusting for urinary creatinine, 14 urinary metal levels in the student exposure group were significantly higher than in the control group. However, the urinary Cd and Se levels in the adult exposure group were significantly lower than in the adult control group. Levels of As, Cd, Ni, Pb and Zn in nails for student exposure group were significantly higher than in the student control group. Levels of Cr, Ni and Pb in nails forthe adult exposure group were significantly higher than in the adult control group. Using multiple linear regression after adjusted for other potential confounders, the urinary concentration of fourteen metals for the student exposure group was significantly higher than in the student control group. However, urinary Cd and Se levels for adult exposure group were significantly lower than in the adult control group. The nail concentrations of Ni and Pb for the children exposure group was significantly higher than that of the children control group, but inverse relationship of V in the nail was found. Levels of Cr, Cu, Ni and Pb in nail for the adult exposure group had significantly higher than in the control group, but inverse relationship of As and V was shown.Two biomarkers of renal tubule dysfunction including urinary NAG and B2M levels in the children exposure group was significantly higher than in the control group. There were significant positive correlations between urinary As, Cd, Cr, Hg, Ni and Pb levels with NAG and B2M concentrations for children using multivariate regression analysis after adjusted for covariates. Urinary Hg levels in adults significantly positively correlated with NAG levels. Urinary levels of As, Cd, Cr, Hg, Ni and Pb significantly correlated with B2M concentration. Summary, urinary levels of six metals correlated with NAG and B2M levels, which indicated in children are more sensitive than in adults and NAG levels are more sensitive than B2M.Our results found Cr metal was the great sensitivity to kidney injury than in five metals.
Part2：The cancer risks were 6.65E-07 to 1.19E-06 for children group, 5.97E-08 to 1.21E-07 for adults, 2.02E-08 and 4.10E-08 for older group, respectivley. Cancer risks for boy and girl children were greater than 10-6, which is an allowable limit for cancer risk. Contributions of dioxin of 30% using simulation by the CMB model was mainly responsible for the incinerator.
Conclusions and Suggestions
The results showed that the high uinray and nail metal levels for children living near the incineraton significantly correlated with the biomarkers of renal tubule dysfunction, appearing high levels of metal in urine and nail in residents obatinned from emitssion of the incinerator. In addiction, children living near at three sites the cancer risks were higher than those of the acceptable value (10-6). Therefore, it is vital for Taiwan Environmental Protection Agencies to strengthen the control of pollutants emitted by the incinerator to reduce the adverse health effects for surrounding residents.

目錄

摘要 i
Abstract iii
目錄 vi
表目錄 ix
圖目錄 xi
附表目錄 xii
第一章、前言 1
第一節、研究背景與動機 1
第二節、研究目的 3
第二章、文獻探討 4
第一節、焚化爐可能排放之金屬元素 4
一、砷（Arsenic, As） 4
二、鎘（Cadmium, Cd） 5
三、鉻（Chromium, Cr） 5
四、銅（Copper, Cu） 6
五、汞（Mercury, Hg） 6
六、鎳（Nickel, Ni） 6
七、鉛（Lead, Pb） 7
八、硒（Selenium, Se） 7
九、鋅（Zinc, Zn） 8
十、鎵（Gallium, Ga）、銦（Indium, In） 8
十一、鉀（Potassium, K） 9
十二、鍶（Strontium, Sr）、釩（Vanadium, Vr） 9
第二節、重金屬相關生物性指標 11
尿液重金屬相關研究 11
指甲重金屬相關研究 13
第三節、重金屬對腎臟損傷之影響 15
第四節、焚化爐附近民眾暴露戴奧辛之健康風險 19
第五節、小結 22
第三章、材料與方法 23
第一節、研究架構 23
第二節、研究方法與對象 24
研究對象及地點 24
問卷內容 26
參加情形 26
第三節、藥品與設備 28
藥品 28
設備 28
第四節、生物檢體採樣方法與分析 29
尿液樣本 29
指甲樣本 31
第五節、NAG分析之測定 33
第六節、B2M分析之測定 35
第七節、資料整理與統計 38
第二部分研究架構 39
第八節、戴奧辛致癌風險評估 39
第九節、戴奧辛採樣地點及採樣頻率 40
第十節、戴奧辛致癌風險評估 41
第十一節、化學質量平衡受體模式評估 43
第四章、研究結果 44
第一節、研究族群基本資料 44
第二節、比較生物檢體金屬濃度與腎損傷指標 46
生物檢體金屬濃度 46
NAG及B2M濃度 47
暴露組與對照組金屬濃度及NAG、B2M濃度之比較 48
第三節、影響腎損傷指標之分析 51
第四節、對焚化爐態度與居民趨避行為兩者間的關係 56
第五節、戴奧辛致癌風險 57
第五章、討論 59
第一節、研究對象及方法代表性 59
研究對象選取 59
尿液及指甲樣本 60
問卷調查 60
第二節、焚化爐附近空氣汙染物濃度及其戴奧辛致癌風險 62
第三節、尿液及指甲金屬濃度與腎小管損傷指標間的關係 64
尿液及指甲金屬濃度之探討 64
國外文獻分析尿液重金屬濃度及其影響因素 66
國外文獻分析指甲重金屬濃度及其影響因素 68
生物檢體金屬濃度與腎小管損傷之間的相關性及中介變項分析 70
第四節、腎小管損傷指標異常及尿液重金屬濃度分析 74
第五節、研究限制與未來方向 76
第一部分研究限制 76
第二部分研究限制 76
研究特點 77
第六章、結論與建議 78
第一節、結論 78
第二節、建議 80
第七章、參考文獻 81
附件一、學童問卷 183
附件二、家長問卷 188
附件三、社區居民問卷 194
附件四、自覺呼吸道症狀嚴重程度分級 200
附件五、風向圖 202



表目錄

表 1、暴露組與對照組學童基本資料比較 88
表 2、暴露組與對照組學童自覺健康與住家型態比較 89
表 3、暴露組及對照組國小家長基本資料及經醫師診斷疾病之比較 90
表 4、暴露組與對照組學童呼吸道疾病比較 91
表 5、南屯區調查民眾個人基本資料 92
表 6、南屯區居民身體健康狀況分布 93
表 7、南屯區居民生活習慣之分布 94
表 8、暴露組及對照組學童尿中金屬濃度（μg/L）比較 95
表 9、暴露組及對照組學童尿中金屬濃度（μg/g cre.）比較 96
表 10、暴露組及對照組家長尿中金屬濃度（μg/L）比較 97
表 11、暴露組及對照組家長尿中金屬濃度（μg/g cre.）比較 98
表 12、暴露組及對照組學童指甲金屬濃度（ug/g）比較 99
表 13、暴露組及對照組家長指甲金屬濃度（ug/g）比較 100
表 14、南屯區民眾尿液中金屬濃度(μg/L) 101
表 15、南屯區民眾居住時間與其尿液中金屬濃度(μg/L)之比較 102
表 16、南屯區民眾尿液中金屬濃度(μg/g cre.) 103
表 17、南屯區民眾居住時間與其尿液中金屬濃度(μg/g cre.)之比較 104
表 18、暴露組及對照組學童與家長尿中NAG、B2M濃度之比較 105
表 19、南屯區民眾居住時間與其尿液腎小管損傷指標濃度之比較 106
表 20、學童與家長尿中、指甲重金屬濃度之相關性分析 107
表 21、學童及家長在未經肌酸酐校正尿液與指甲重金屬濃度之相關性 108
表 22、學童及家長經肌酸酐校正尿液與指甲重金屬濃度之相關性 109
表 23、組別對學童尿中重金屬濃度（μg/g cre.）多變項線性迴歸分析 110
表 24、組別對家長尿中重金屬濃度（μg/g cre.）多變項線性迴歸分析 111
表 25、組別對學童指甲重金屬濃度（μg/g）多變項線性迴歸分析 112
表 26、組別對家長指甲重金屬濃度（μg/g）多變項線性迴歸分析 113
表 27、組別對學童尿中NAG及B2M濃度多變項線性迴歸分析 114
表 28、組別對家長尿中NAG及B2M濃度多變項線性迴歸分析 115
表 29、羅吉斯複迴歸模型分析學童NAG及B2M濃度 116
表 30、羅吉斯複迴歸模型分析家長NAG及B2M濃度 117
表 31、學童及家長生物檢體重金屬濃度與NAG濃度間相關性 118
表 32、學童及家長生物檢體重金屬與B2M濃度間相關性 119
表 33、線性複迴歸模型分析學童重金屬濃度影響NAG與B2M(N=129) 120
表 34、線性複迴歸模型分析家長重金屬濃度影響NAG與B2M(N=66) 121
表 35、羅吉斯複迴歸模型分析學童重金屬濃度影響腎功能NAG與B2M 122
表 36、羅吉斯複迴歸模型分析家長重金屬濃度影響腎功能NAG與B2M 123
表 37、學生在個人特質、生活型態與尿液Cr、Cd濃度對尿液NAG之影響 124
表 38、學生在個人特質、生活型態與尿液Cr、Cd濃度對尿液B2M之影響 125
表 39、家長及社區居民對焚化爐負面態度、信任程度及風險感知比較 126
表 40、對焚化爐的負面態度、信任程度及風險感知三者之間的關係 127
表 41、對焚化爐的負面態度、信任程度及風險認知影響趨避行為 128
表 42、在不同地點、不同時段之3年戴奧辛大氣濃度(pg I-TEQ/m3) 129
表 43、孩童經由空氣吸入所得之戴奧辛吸入終身平均每日暴露劑量 130
表 44、成人經由空氣吸入所得之戴奧辛吸入終身平均每日暴露劑量 131
表 45、老人經由空氣吸入所得之戴奧辛吸入終身平均每日暴露劑量 132
表 46、三年平均吸入終身平均每日暴露劑量 132
表 47、不同年齡、性別在不同地區吸入戴奧辛致癌風險 133
表 48、不同年齡、性別在不同地區95%吸入戴奧辛致癌風險 133
表 49、三年平均環境中戴奧辛/呋喃CMB結果(%) 134

圖目錄

圖一、學童及家長尿中金屬濃度與NAG累積異常率之間的關係圖(As) 135
圖二、學童及家長尿中金屬濃度與NAG累積異常率之間的關係圖(Cd) 135
圖三、學童及家長尿中金屬濃度與NAG累積異常率之間的關係圖(Cr) 136
圖四、學童及家長尿中金屬濃度與NAG累積異常率之間的關係圖(Hg) 136
圖五、學童及家長尿中金屬濃度與NAG累積異常率之間的關係圖(Ni) 137
圖六、學童及家長尿中金屬濃度與NAG累積異常率之間的關係圖(Pb) 137
圖七、學童及家長尿中金屬濃度與B2M累積異常率之間的關係圖(As) 138
圖八、學童及家長尿中金屬濃度與B2M累積異常率之間的關係圖(Cd) 138
圖九、學童及家長尿中金屬濃度與B2M累積異常率之間的關係圖(Cr) 139
圖十、學童及家長尿中金屬濃度與B2M累積異常率之間的關係圖(Hg) 139
圖十一、學童及家長尿中金屬濃度與B2M累積異常率之間的關係圖(Ni) 140
圖十二、學童及家長尿中金屬濃度與B2M累積異常率之間的關係圖(Pb) 140
圖十三、學童尿中金屬濃度與NAG及B2M累積異常率關係圖(As) 141
圖十四、學童尿中金屬濃度與NAG及B2M累積異常率關係圖(Cd) 141
圖十五、學童尿中金屬濃度與NAG及B2M累積異常率關係圖(Cr) 142
圖十六、學童尿中金屬濃度與NAG及B2M累積異常率關係圖(Hg) 142
圖十七、學童尿中金屬濃度與NAG及B2M累積異常率關係圖(Ni) 143
圖十八、學童尿中金屬濃度與NAG及B2M累積異常率關係圖(Pb) 143
圖十九、家長尿中金屬濃度與NAG及B2M累積異常率關係圖(As) 144
圖二十、家長尿中金屬濃度與NAG及B2M累積異常率關係圖(Cd) 144
圖二十一、家長尿中金屬濃度與NAG及B2M累積異常率關係圖(Cr) 145
圖二十二、家長尿中金屬濃度與NAG及B2M累積異常率關係圖(Hg) 145
圖二十三、家長尿中金屬濃度與NAG及B2M累積異常率關係圖(Ni) 146
圖二十四、家長尿中金屬濃度與NAG及B2M累積異常率關係圖(Pb) 146

附表目錄

附表一、三校研究對象收集樣本數之結果 148
附表二、社區長期居民收集樣本數之結果 149
附表三、ICP-MS儀器分析條件 150
附表四、尿液與指甲檢量線與偵測極限 151
附表五、焚化爐排放管制相關法規 152
附表六、臺中市空氣品質人工測站監測結果分析統計表 153
附表七、2018年台中文山及太平區測站細懸浮粒濃度比較 154
附表八、107年暴露組及對照組懸浮微粒金屬元素濃度 155
附表九、八個採樣點及焚化爐煙道排放之十六種金屬濃度（Ng/m3） 156
附表十、台灣與世界其他焚化爐周圍金屬研究比較 157
附表十一、國外文獻分析尿中砷濃度與本研究之比較（μg/g cre.） 158
附表十二、國外文獻分析尿中鎘濃度與本研究之比較（μg/g cre.） 159
附表十三、國外文獻分析尿中鉻濃度與本研究之比較（μg/g cre.） 160
附表十四、國外文獻分析尿中銅濃度與本研究之比較（μg/g cre.） 161
附表十五、國外文獻分析尿中汞濃度與本研究之比較（μg/g cre.） 162
附表十六、國外文獻分析尿中鎳濃度與本研究之比較（μg/g cre.） 163
附表十七、國外文獻分析尿中鉛濃度與本研究之比較（μg/g cre.） 164
附表十八、國外文獻分析尿中硒濃度與本研究之比較（μg/g cre.） 165
附表十九、國外文獻分析尿中鋅濃度與本研究之比較（μg/g cre.） 166
附表二十、國外文獻分析尿中鎵濃度與本研究之比較（μg/g cre.） 167
附表二十一、國外文獻分析尿中銦濃度與本研究之比較（μg/g cre.） 168
附表二十二、國外文獻分析尿中鉀濃度與本研究之比較（mg/g cre.） 169
附表二十三、國外文獻分析尿中鍶濃度與本研究之比較（μg/g cre.） 170
附表二十四、國外文獻分析尿中釩濃度與本研究之比較（μg/g cre.） 171
附表二十五、國外文獻分析指甲砷濃度與本研究之比較（μg/g） 172
附表二十六、國外文獻分析指甲鎘濃度與本研究之比較（μg/g） 173
附表二十七、國外文獻分析指甲鉻濃度與本研究之比較（μg/g） 174
附表二十八、國外文獻分析指甲銅濃度與本研究之比較（μg/g） 175
附表二十九、國外文獻分析指甲汞濃度與本研究之比較（μg/g） 176
附表三十、國外文獻分析指甲鎳濃度與本研究之比較（μg/g） 177
附表三十一、國外文獻分析指甲鉛濃度與本研究之比較（μg/g） 178
附表三十二、國外文獻分析指甲硒濃度與本研究之比較（μg/g） 179
附表三十三、國外文獻分析指甲鋅濃度與本研究之比較（μg/g） 180
附表三十四、國外文獻分析指甲鎵濃度與本研究之比較（μg/g） 181
附表三十五、國外文獻分析指甲釩濃度與本研究之比較（μg/g） 182

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