臺灣博碩士論文加值系統

民國82年某電信公司某機房電池室不到40人之員工中發現3名鼻咽癌的個案聚集現象，由於當年鼻咽癌的粗發生率為每十萬人4.57人，此電池室員工的鼻咽癌個案被懷疑為職業性癌症。電池室內之主要設備為鉛蓄電池，而這些電池可能會釋出硫酸。又根據國際癌症研究機構的報告，長期暴露於無機強酸霧滴之作業環境下，會導致肺癌及上呼吸道癌症，如喉癌等，所以我們想探討與台灣一般民眾比較起來，機房員工是否得癌症，由其是鼻咽癌，的危險性較高。我們計算標準化發生率比、標準化死亡率比及標準化死亡比率比，來評估機房員工癌症發生及死亡情況。在校正五年潛伏期之後，我們求得總癌症的標準化發生率比為0.80 (p=0.05)；氣管、支氣管及肺癌的標準化發生率比為0.83 (p=0.80)；喉癌的標準化發生率比為0.93 (p>0.99)；鼻咽癌的標準化發生率比為1.10 (p=0.87)。總死因之標準化死亡率比為0.43 (p<0.001)，總癌症之標準化死亡率比為0.64 (p<0.001)。總癌症之標準化死亡比率比為1.41 (p=0.03)；氣管、支氣管及肺癌的標準化死亡比率比為1.30 (p=0.59)；鼻咽癌的標準化死亡比率比為1.97 (p=0.23)。由總死因之標準化死亡率比來看，可以發現在機房員工中存在有健康工人效應，因此減低了鼻咽癌的發生率。當計算標準化死亡比率比校正健康工人效應後，我們發現總癌症的標準化死亡比率比大於1，且達到統計上顯著意義。鼻咽癌的標準化死亡比率比亦大於1，只是未達到統計上顯著意義。從此研究中，可以看出機房員工可能有較的高危險性發展出癌症。本研究的主要限制為並未考慮其他危險因子，須要進一步研究來証實此結論。

In 1993, a cluster of three cases of nasopharyngeal cancer (NPC) were observed among less than 40 battery room workers in a branch station of a telecommunication company. As NPC is a rare disease with an incidence of 4.57 per 100,000 persons in 1993 in Taiwan, the cases observed among the battery room workers were suspected to be occupational cancers. The major equipment in the battery room was the lead battery. Because the lead batteries may give off sulfuric acid contained in the batteries and, according to reports of International Agency for Research on Cancer, long term exposures to strong inorganic acid mists may lead to lung cancer and the upper respiratory tract cancers, such as laryngeal cancer, we would like to evaluate whether the employees of the telecommunication company have higher risks of developing NPC and other cancers in comparison with the general population in Taiwan. We calculated standardized incidence ratio (SIR), standardized mortality ratio (SMR), and standardized proportionate mortality ratio (SPMR) to evaluate the occurrence of cancers and deaths in our study. After adjusting a five-year latency period, we found the SIR was 0.80 (p=0.05) for all cancers; 0.83 (p=0.80) for bronchus, trachea, and lung cancers; 0.93 (p>0.99) for laryngeal cancer; and 1.10 (p=0.87) for NPC. The SMR was 0.43 (p<0.001) for all causes and 0.64 (p<0.001) for all cancers. The SPMR was 1.41 (p=0.03) for all cancers; 1.30 (p=0.59) for bronchus, trachea, and lung cancers; and 1.97 (p=0.23) for NPC. From the SMRs for all causes, we knew that there was a healthy worker effect, which led to a lower incidence of NPC among the workers. After adjusting the healthy worker effect using SPMR, we found a significantly high SPMR for all cancers. We concluded that the occurrence of cancers may increased among the workers of the telecommunication company. However, other risk factors of cancer were not assessed in this study, and therefore further studies are necessary to confirm our finding.

目錄
摘要……………………………………………………………………I
Abstract.…………………………………..………………………II
目錄……………………………………………………………..……..IV
表目錄…………………………………………………………..……..VI
圖目錄………………………………………………………….……..VII
第一章 緒論.…………………………………………………..……..1
1-1前言………………………………………………….……..…..1
1-2研究目的……………………………………………..………..2
第二章 文獻探討 ………………………………………….……….3
2-1無機強酸之定義及其在作業環境中所存在的形式.…...3
2-2作業環境無機強酸暴露之流行病學研究…………....….5
2-3鼻咽癌之流行病學及危險因子..…………………….…..19
第三章 研究材料與方法………………………………………....30
3-1研究材料…………………………………………....…..…..30
3-2研究方法………………………………………………….….33
第四章 研究結果……………………………………..…….……..37
4-1癌症標準化發生率比之結果……….……………..……..37
4-2癌症及全死因之標準化死亡率比之結果….…………..43
4-3癌症標準化死亡比率比之結果…………….……….…..44
第五章 討論…………………………………………………….…..46
5-1研究世代之基本特性…………………………..……..…..46
5-2標準化發生率比結果之討論.………………..…………..46
5-3標準化死亡率比結果之討論.……………………..……..47
5-4標準化死亡比率比結果之討論…………………………..48
5-5研究材料可能發生的錯誤……………………….………..50
5-6可能的干擾因子.…………………………….……….……..51
5-7研究限制…..………………………………………..………..52
第六章 結論與建議…………………………………………….…..54
6-1結論…………………………………………………….……..54
6-2建議…………………………………………………….……..54
表目錄
表2-2a 世代研究（一）………………………………………....74
表2-2b 世代研究（二）………………………………………....75
表2-2c 病例對照研究………………………………….…….…...76
表2-3-1 世界衛生組織依據分化程度的不同所做的
鼻咽癌分類………………………………………….……..58
表2-3-2-2探討食用鹹魚與鼻咽癌相關性的病例對照研究…....61
表2-3-2-3探討抽煙與鼻咽癌相關性的個案對照研究.………....62
表2-3-2-4探討職業暴露於木材、甲醛及氯酚與鼻
咽癌相關性之研究…………………..……………….....63
表3-1-1 歷年機房總人數-依性別分………………….…..…..…64
表4-1-1 電信公司機房員工發生鼻咽癌之員工…………….…65
表4-1-2 電信公司機房員工各癌症（ICD=140-199）
之標準化發生率比（一）.…………………………....66
表4-1-3 電信公司機房員工各癌症（ICD=140-199）
之標準化發生率比（二）………………………..…...67
表4-1-4 電信公司機房員工各癌症（ICD=140-199）
之標準化發生率比（三）….……………………….…70
表4-2 電信公司機房員工總死因及癌症之標準化
死亡率比…………………………………………………..…71
表4-3 電信公司機房員工總死因及癌症之標準化
死亡比率比……………………………………………..…..72
表4-5 民國74年至85年間，身份證字號登記錯誤
總數及比率—依死因分類.…………………..…………….73
圖目錄
圖1-1-1 釋氣式電池.…………………………………………………56
圖1-1-2 閥調式電池………………………………………..………..57
圖2-3-1-2 世界各地鼻咽癌的發生率……………………………….59
圖

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