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研究生:李建宏
研究生(外文):Lee Chien-Hung
論文名稱:室內空氣污染因子與台灣不吸菸婦女肺癌之研究
論文名稱(外文):Indoor Air Pollution Factors and Primary lung cancer of Non-smoking Taiwanese Women
指導教授:葛應欽葛應欽引用關係
指導教授(外文):Ko Ying-Chin
學位類別:博士
校院名稱:高雄醫學大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2000
畢業學年度:88
語文別:中文
論文頁數:114
中文關鍵詞:煮食油煙排油煙機室內空氣污染環境菸害肺癌
外文關鍵詞:cooking oil fumefume extractorindoor air pollutionenvironmental tobacco smokelung cancer
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研究背景:吸菸無法充份解釋台灣女性肺癌特殊的流行病學特徵,亦即婦女顯少吸菸,但罹患肺癌卻相對頻繁。作者們過去的研究曾懷疑,煮食暴露於烹飪油引起的油煙為台灣不吸菸婦女肺癌的一個重要的危險因子,而台灣婦女又住在一個具有高男性吸菸盛行率的環境。因此,煮食油煙與女性肺癌之間的關係,以及環境菸害對肺癌的危險性值得深入的探討。由於過去三種台灣常用的烹飪油在高溫下產生的油煙均具有直接致突變性及基因毒性。因此,台灣婦女可能置身於具有潛在健康危害的烹飪環境,而瞭解目前台灣婦女各種煮食的習慣可以輔助擬定肺癌預防的最佳措施。
研究方法:本系列研究使用三種研究設計分別探討作者們關心的研究題研,研究方法如下所述:(1) 同時使用醫院對照與社區對照的病例對照型研究。病例組為131位經病理診斷確定為初患原發性肺癌的不吸菸婦女。醫院對照組為252位與吸菸無關之疾病的女性住院病患,社區對照組則為262位族群中隨機選取的健康婦女。所有的對照個案均為不吸菸的婦女,且配對病例個案的年齡及訪視時間。(2) 以醫院為基礎的年齡配對病例對照型研究。268位與445位終身不吸菸的病例個案與醫院對照個案分別由訪視員透過結構式問卷,收集婦女各生活期所有被動吸菸可能來源的詳細資料。分析者應用條件式邏輯迥歸及協同指標來評估控制其他可能干擾結果的變數後,被動吸菸在不同生活期之間的獨立及結合效應。(3) 分層比率隨機取樣的橫斷型研究。以居住於高雄市或高雄縣的居民為研究對象的母群體,使用分層比率抽樣法,以家戶為單位,電腦隨機選取1,000戶研究樣本。合計完成975戶樣本的家庭訪視,其中,67.7%的住戶為原始樣本,32.3%的住戶為替代樣本。研究者應用卡方檢定與邏輯迥歸模式分析各種煮食暴露資料,並估計族群可能存在的肺癌發生負載量。
研究結果:本系列研究的研究結果如下所述:(1) 肺癌的危險性隨著婦女每日煮食餐數的增多而增加至大約3倍高的危險性。婦女習慣等待油煙由煮食用油冒出後再煮者具有2.0-2.6倍高的肺癌危險性,這些婦女在廚房沒有裝設排油煙機的環境下具有最高的肺癌危險性(調整對比值為:3.2-12.2)。(2) 婦女少年期(>20吸菸人年數)及成年期(>40吸菸人年數)近距離暴露於最高水準的環境菸害分別比未曾蒙受二手菸暴露的婦女高出1.8倍(95% CI : 1.2-2.9)及2.2倍(95% CI : 1.4-3.7)的肺癌危險性。此二時期的環境菸害暴露解釋了台灣不吸菸婦女群體大約37%的肺癌歸因。作者們發現少年期的環境菸害暴露比成年期的暴露敏感,並且依照加法模式的交互作用評估,如此早期的暴露對隨後成年期的菸害暴露具有效果修飾作用。(3) 不同年齡群的婦女在特定的煮食習慣之間具有顯著的盛行率差異,不同出生世代的婦女所使用的煮食工具亦具有明顯的世代效應。婦女煮食的廚房裝設排油煙機的比例高達95.2%,但裝置的高度距離油面平台高達77.2±12.0公分。此外,婦女改變煮食習慣在油煙未冒出之前即已煮食,預期可以降低28.0-31.9%的肺癌發生。
研究結論:部份的肺癌發生可歸因於等待烹飪油被加熱至高溫後再煮食的習慣,且發生在少年期的環境菸害暴露加強了成年期高劑量菸害暴露決定肺癌形成的效應。家庭廚房的排油煙機應裝設於可以有效抽取暴露的高度。婦女改變煮食的習慣於油煙未冒出之前即開始煮食可以達到最佳的肺癌預防效果。
Backgrounds :Cigarette smoking cannot fully explain the epidemiologic characteristics of lung cancer in Taiwanese women, who smoke rarely but have lung cancer relatively often. In the authors'' previous study, exposure to fumes from cooking oils and tobacco smoke appeared to be important risk factors for lung cancer in nonsmoking Taiwanese women. In this study series, the authors further explore the roles of oil fumes among lung cancer woman patients who cook, and assess the risk of lung cancer due to environmental tobacco smoke. We also conducted a cross-sectional study to survey a several of cooking condition and habits that Taiwanese women frequently used nowadays.
Methods :The authors used three types of study designs to explore the study purposes, these methods were follows: (1) Two sets of controls were concurrently used. Study subjects included 131 nonsmoking incident cases with newly diagnosed and histologically confirmed primary carcinoma of the lung, 252 hospital controls who were hospitalized for causes unrelated to smoking diseases, and 262 community controls; both controls were nonsmoking women matched by age and time of interview. (2) An age-matched hospital case-control study was designed. Information on passive smoking from all possible sources and life periods were obtained from interviews with 268 and 445 lifetime nonsmoking cases and controls. Conditional logistic regression and synergism ''S'' index were applied to the data to assess the independent and joint effects of passive smoking in different life stages while controlling for possible confounding variables. (3) A cross-sectional study was designed. The source population was defined as the great Kaohsiung area and stratified proportional sampling method was used to select samples with household as a sampling unit. In all, 975 women were interviewed, however, only 67.7% households were original samples. Chi-square and logistic regression model was used to assess the collected data.
Results :In these studies, we have the following findings: (1) Subjects who usually waited until fumes were emitted from the cooking oil and then stir fried, fried, and deep fried had significantly higher risk of lung cancer (Adjusted ORs : 2.0-2.6). Among these women, those who did not use a fume extractor had consistently higher risk of lung cancer (adjusted ORs : 3.2-12.2). (2) Risks of contracting lung cancer among women near-distantly exposed to the highest level of environmental tobacco smoke in childhood (>20 smoker-years) and in adult life (>40 smoker-years) were 1.8 (95% CI: 1.2-2.9) and 2.2 (95% CI: 1.4-3.7) fold higher than that among women being never exposed to environmental tobacco smoke, and the two variables accounted for about 37% of tumors in this nonsmoking female population. Children were found to be more susceptible to environmental tobacco smoke than adults and such early exposure was found to modify the effect of subsequent tobacco smoke exposure in adult life based on an additive interaction model. (3) There were significant cohort effects in cooking tool and appliance between age groups. The fume extractor in home kitchen usually was equipped at the height of 77.2±12.0 cm from oil surface. Women starting to cook when fumes unemitted from oils expectedly could reduce 28.0-31.9% of lung cancer incidence.
Conclusions :A proportion of lung cancer may be attributable to the carcinogens derived from the cooking oil fumes emitted at high temperatures through inappropriate cooking habits. Environmental tobacco smoke exposure occurring in childhood potentate the effect of high doses of exposure in adult life in determining the development of lung cancer. To change the habit of starting to cook when fumes emitted from oils have the largest effect of preventing lung cancer incidence.
封面
目錄
中文總摘要
英文總摘要
第一章 緒論
研究背景
研究目的
參考文獻
第二章 文獻回顧
肺癌的臨床特徵
肺癌之症狀與徵候
肺癌之病程進展
肺癌之診斷
肺癌之病理型分類
肺癌之分期
肺癌之治療及存活率
女性肺癌的流行病學特徵
肺癌之組織型分佈
華人婦女肺癌之流行病學特徵
台灣女性肺癌之流行病學特徵
女性肺癌的室內空氣污染因子
致病與危險因子
女性肺癌的室內危險因子
室內氡衰退物
煮食燃料
油煙暴露與女性肺癌
女性肺癌與廚師團體
華人婦女的煮食狀況
油煙暴露與肺癌之流行病學研究
油煙之致突變性
油煙之致突變性
抗氧化劑與排油煙機的高度
環境菸害與女性肺癌
環境菸煙的成份
環境菸害與肺癌之流行病學研究
主動與被動吸菸的暴露測量
環境菸煙的致癌角色
參考文獻
圖表
第三章 中式食物煮位與不吸菸婦女肺癌之研究
摘要
前言
材料與方法
結果
討論
參考文獻
圖表
第四章 終身環境菸煙暴露與台灣不吸菸婦女肺癌之研究
摘要
前言
材料與方法
結果
討論
參考文獻
圖表
第五章 台灣婦女中式煮位現況之流行病學研究
摘要
前言
材料與方法
結果
討論
參考文獻
圖表
第六章 結論與建議
研究結論
建議
參考文獻
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