臺灣博碩士論文加值系統

前言：
近年來因全球氣候的變遷，極端溫度事件頻傳，研究已經證實，空氣汙染物與環境溫度的顯著變化與心血管疾病發病率與死亡率增加有所關聯，此外心跳速率變異性（heart rate variability, HRV）的測量已成為評估心血管健康與自主神經系統調節功能常用的生理指標。目前許多政府及研究單位除了傳統溫溼度之外，也使用了綜合溫度熱指數（wet bulb globe temperature, WBGT）作為熱預警指標，因此本研究目的為探討健康族群在控制生活微環境暴露的汙染物後，溫濕度與WBGT對HRV變化之影響，並比較兩種指標評估HRV影響的差異。

材料與方法：
本研究使用各式直讀式儀器對健康成年人、老年人進行微環境空氣汙染物、溫濕度與WBGT暴露監測，並同步監測個案的心電圖資料以計算HRV。本研究選用廣義可加混合模型（generalized additive mixed model, GAMM）進行資料分析，在控制人口學變項及各種汙染物後，計算熱環境指標與HRV時間同步之前5分鐘、1、4、8、12、24小時移動平均，以評估溫濕度與WBGT對健康族群HRV變化之影響及累積效應，並使用Vuong's closeness test比較熱環境指標之間在評估HRV變化的模型配適度。

結果：
研究結果發現年齡、性別、季節及個案活動位置為影響HRV的重要因子，WBGT對心跳速率（heart rate, HR）及HRV的影響皆為非線性關係，且平滑函數圖多在15-20℃之間以及在20-25℃之間出現反曲點，而形成M形曲線，其中以頻率域指標LF的平滑函數圖變化最明顯。以GAMM分析溫度與HR及HRV的線性關係後發現溫度增加對HRV的改變量百分比有顯著下降的累積效應，最長可達24小時，溫度與HR及HRV的非線性關係多在28℃產生反曲點，且多出現在5分鐘及1小時時序中，相對濕度與HR及HRV的非線性關係則多出現於4小時時序。熱環境指標模型配適度比較中，不論時序為何，溫濕度及其交互作用項指標皆比WBGT適合評估頻率域指標HF的變化，此外，溫濕度及其交互作用項也較WBGT適合評估4-hr HR及1-hr LF的變化。而溫度及濕度指標較WBGT適合評估5min HR及1-hr LF的變化。

結論：
WBGT對HRV的即時效應皆呈現顯著非線性關係，溫濕度則對HRV會有線性與非線性影響，且具有累積效應，而整體比較熱環境指標配適度的結果發現溫濕度及其交互作用項於評估某些HRV指標變化時優於WBGT。

Background
In recent years, the changes in the frequency and intensity of extreme weather and climate events have been outgoing frequently. Numerous studies have indicated that exposure to air pollutants and variation in ambient temperature are associated with elevated risks in cardiovascular morbidity and mortality. In addition, the measurement of heart rate variability (HRV) indices has been a common physiological indicator to reflect the function of cardiac autonomic system. At present, many governmental and research units use not only the traditional temperature and relative humidity, but also wet bulb globe temperature (WBGT) as thermal environment indices. The purpose of this study is to explore the effects of temperature, humidity and WBGT on HRV changes in the healthy subjects by adjusting the microenvironment air pollutants exposures, and to compare the differences between these two thermal indices to evaluate the effects of HRV.
Methods
In this study, a variety of direct reading instruments were used for the monitoring of microenvironmental air pollutants, hygrothermal parameters and WBGT in healthy adults and the elderly, and for synchronous monitoring of heart rate(HR) and HRV indices. After adjusting the demographic variables and each kind of pollutant, we calculated the 5-minutes, 1, 4, 8, 12, and 24-hour moving average of thermal environment indices with the HR/HRV time synchronization. Generalized additive mixed model (GAMM) was applied to evaluate the effects of thermal indices on HRV. Vuong’s closeness test was used to compare the model fitness between the thermal environment indices and HRV change.
 
Results
The study found that age, gender, season and case activity were the important factors affecting HRV. The association between WBGT and HR/HRV had nonlinear relationship, and the inflection points appeared in mostly between 15-20℃ and 20-25℃ in the smooth function graph, forming M-shaped curve. The smooth function curve of the low-frequency (LF) and WBGT showed the most obvious variation. The GAMM analysis results of the linear relationship between temperature and HR/HRV founded that increases in temperature were associated with declines in the percentage change of HR/HRV, and the cumulative effect could last up to 24 hours. The inflection points appeared mostly at 28℃ in the non-linear relationship curve between temperature and HR/HRV, as well as in 5-minute and 1-hour time series. The non-linear relationship between relative humidity and HR/HRV appeared frequently in 4-hour time series. In the comparison of model fitness between the thermal environment indices, regardless of the timing, temperature/humidity and their interaction term were more appropriate than WBGT for evaluating the change of high-frequency (HF). Besides, temperature/humidity and their interaction term were also more suitable than WBGT for evaluating the changes of 4-hour HR and 1-hour LF. Moreover, temperature and humidity were appropriate than WBGT for evaluating 5-min HR and 1-hour LF changes.
Conclusion
The real time effects of WBGT on HRV showed the non-linear relations. The temperature and humidity had linear and non-linear influence to HRV along with cumulative effect. After overall evaluating the model fitness of thermal environment indices, it was found that temperature, humidity and their interaction term were better than WBGT for evaluating the changes of some HRV indices.

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 心跳速率變異性 4
第二節 空氣汙染物的特性及其對心跳速率變異性的影響 8
2.1 懸浮微粒（particulate matter, PM） 8
2.2 多環芳香烴（polycyclic aromatic hydrocarbons, PAHs） 12
2.3 黑碳（black carbon, BC） 13
2.4 一氧化碳（carbon monoxide, CO） 15
第三節 熱環境評估指標 17
第四節 熱環境指標對心跳速率變異性的影響 20
第三章 材料與方法 30
第一節 研究設計與研究流程 30
第二節 研究對象與採樣時間 36
第三節 監測之儀器設備 37
3.1 微粒濃度光譜儀 37
3.2 微型擴散式微粒計數器 38
3.3 微粒多環芳香烴成分監測儀 39
3.4 微粒黑碳成分監測儀 40
3.5 室內空氣品質監測儀 41
3.6 綜合溫度熱指數監測儀 43
3.7 HOBO溫度濕度/照度紀錄器. 44
3.8 可攜式心電圖紀錄器 45
第四節 綜合溫度熱指數計算方法 46
第五節 儀器品保品管與同步比對 49
5.1 微粒濃度光譜儀 49
5.2 微型擴散式微粒計數器 50
5.3 微粒多環芳香烴成分監測儀 52
5.4 微粒黑碳成分監測儀 53
5.5 室內空氣品質監測儀 53
5.6 綜合溫度熱指數監測儀 53
5.7 可攜式心電圖紀錄器 54
5.8 儀器同步比對 54
第六節 統計分析 56
6.1 WBGT及溫濕度對HR及HRV之影響 56
6.2 比較不同熱環境指標的模型配適度 62
第四章 結果與討論 64
第一節 研究對象基本特徵 64
第二節 個案微環境汙染物及溫濕度與WBGT暴露情形 72
第三節 個案HRV生理指標監測情形 76
第四節 WBGT及溫濕度對HR及HRV之影響 78
4.1 人口學變項對HR及HRV之影響 93
4.2 空氣汙染物對HR及HRV之影響 98
4.3 WBGT在細粒徑模型中對HRV的影響 109
4.4 WBGT在粗粒徑模型中對HRV的影響 111
4.5 不同時序溫濕度在細粒徑模型中對HR及HRV的影響 113
4.6 不同時序溫濕度在粗粒徑模型中對HR及HRV的影響 120
4.7 不同時序溫濕度模型比較 130
第五節 比較不同熱環境指標的模型配適度 136
第五章 結論與建議 148
參考文獻 152
附錄一 個案同意書 160
附錄二 活動日誌 162
附錄三 儀器同步比對 163
附錄四 空氣汙染物與HRV影響之文獻整理表 170
附錄五 汙染物與HRV之平滑函數圖 180
（一）WBGT細粒徑模型中汙染物與HR及HRV之平滑函數圖 180
（二）WBGT粗粒徑模型中汙染物與HR及HRV之平滑函數圖 182
（三）不同時序溫濕度細粒徑模型中汙染物與HR及HRV之平滑函數圖 184
（四）不同時序溫濕度粗粒徑模型中汙染物與HR及HRV之平滑函數圖 187

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