臺灣博碩士論文加值系統

此研究的目的在計算死因勝算比，以釐清曾居住在地下水源已被含氯碳氫化合物污染地區之居民其癌症死亡率是否有增加的現象。在此收集西元1966年至1997年間桃園市與八德市兩個村里的死亡證明資料，以不同器官系統的癌症作為懷疑死因，心臟血管及腦血管疾病作為對照死因，並依照地下水文資料定義居住在RCA工廠地下水下游居民為暴露組，地下水上游區為非暴露組，計算性別、年齡、及潛伏期分層後之各種癌症的死因勝算比。
結果顯示在西元1966-1975年各種癌症的死因勝算比均無明顯增加，而在1976-1997年間50-69歲男性其胃癌、肝癌的危險性有顯著增加，其死因勝算比及95%信賴區間分別為4.28 (1.29, 16.40) 及2.89 (1.06, 8.19)。以對數複迴歸分析（Multiple Logistic Regression）模式，在調整年齡、死亡年代之作用後，估計暴露的相對危險性，男性之胃癌及肝癌的死因勝算比分別為2.02 (0.90, 4.52)及2.27 (1.09, 4.75)。根據氣相層析儀的分析資料，RCA工廠下游地區民宅水井中的污染物中，其可測得的最高濃度，四氯乙烯、三氯乙烯等十種含氯碳氫化合物超過飲用水水質標準（如四氯乙烯：<0.5-4800μg/L，三氯乙烯：<0.5-930μg/L，1,1-二氯乙烯：<0.5-1417.5μg/L），而分析考慮排除RCA員工、居住史至少大於五年以上，並且以暴露區再細分組之分析嘗試否證，在調整年齡、潛伏期，與死亡年代之作用後，死因勝算比研究顯示在男性的肝癌危險性有一致性增高的顯著趨勢，顯示含氯碳氫化合物的地下水污染與肝癌之間有因果關係存在的可能性。
基於死因勝算比研究的發現，必須針對其研究之限制，再進一步釐清暴露含氯碳氫化合物污染之地下水與各種癌症之因果關係。由於死因勝算比研究是無分母的病例對照研究，且在暴露評估方面以定性的兩分法區分，故進一步的研究需針對所有居住在地下水源遭污染的地區居民，使用地下水的暴露量作定量的估計，以計算總暴露人年，並且在控制個人其他變因下，求證劑量反應關係是否存在，以尋求因果推論上更明確的證據。

The objectives of this project are to conduct a MOR (mortality odds ratio) study and determine if there is increased cancer frequency among residents who have lived in a community where the groundwater was contaminated with wastes of chlorinated organic solvents disposed by an electronic manufacturing factory. Death certificate data of two villages at Taoyuan were collected for the period 1966-1997. Cancers at different organ systems were considered as the diseases of interest, while cardiovascular-cerebrovascular (CV-CB) diseases as the reference disease. After studying the groundwater hydrogeology, residents were classified as exposed and non-exposed groups according to villages where they once lived were either downstream or upstream of the contaminated factory. MORs were calculated for various kinds of cancers after stratified by sex, age, and latency period. Multiple logistic regression adjusting for age and period were performed to evaluate the exposure effect.
The results showed that there was no increase of MOR for all sites of cancers during the period 1966-1975. The MORs for stomach and liver cancers during 1976-1997 for men aged 50-69 were significantly increased with ORs (95% confidence interval) of 4.28 (1.29, 16.40) and 2.89 (1.06, 8.19). After adjustment for age and period, MORs for stomach and liver cancer in men were 2.02 (0.90, 4.52) and 2.27 (1.09, 4.75). Gas chromatography showed the contaminated compounds and their individual concentrations in wells of downstream village were tetrachloroethylene (<0.5~4800μg/L), trichloroethylene (<0.5~930μg/L), vinyl chloride (<0.5~25μg/L), 1,1-dichloroethylene (<0.5~1418μg/L), and 1,1,1-trichloroethane (<0.5~1121μg/L). Since there was a temporal trend i.e., the factory established in early 1970''s, and age, sex were under control in the analysis, we tentatively concluded that the causal association can not be ruled out.

目　　錄
圖表目錄
中文摘要1
英文摘要2
第一章　導論 3
第一節　研究背景 3
第二節　研究目的5
第三節　研究流程 5
第二章　文獻回顧 6
第一節　含氯碳氫化合物之地下水污染6
第二節　含氯碳氫化合物之毒理資料與健康危害10
第三章　死因勝算比研究12
第一節　材料與方法 12
第二節　研究結果 17
第三節　討論 23
參考文獻28
附錄1：含氯碳氫化合物之健康危害（Health Hazards）
附錄2：含氯碳氫化合物之主要用途

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