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研究生:闕大順
研究生(外文):Ta Shun Chueh
論文名稱:年輕族群白血病與石化相關暴露之流行病學研究-以高密度石化工業區為例之病例對照研究
論文名稱(外文):Petrochemical Exposure and Leukemia Among Young People-A Case-Control Study in a High Density of the petrochemical Industrial Complexes area
指導教授:潘碧珍吳明蒼吳明蒼引用關係
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2001
畢業學年度:89
語文別:中文
論文頁數:91
中文關鍵詞:白血病年輕族群石油化學職業暴露
外文關鍵詞:LeukemiaYoung GroupPetrochemicalOccupational exposure
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中文摘要
高雄地區具大社、仁武、林園、左楠四大石化工業區,且緊臨著高人口密度的都市化社區。石化工業可能逸散洩露其之污染物,如苯、環氧乙烷等都是淋巴造血系統可能致癌物。因此本研究擬以較具易感性的年輕族群來探討石化工業暴露與白血病的關聯性。
本研究利用病例對照研究法,收集自民國86年1月至民國90年1月,居住於高雄縣市26個鄉鎮區域內30歲以下的新發生白血病個案,以1:3隨機抽取同年齡性別之健康居民為對照,探討不同時期(懷孕前、懷孕期間、出生至診斷前)居住地距離石化工業區的遠近及父母親職業暴露對年輕族群白血病的影響。
本研究共收集到88名新白血病個案及181名對照,以居住在工業區周界三公里外為對照,結果發現懷孕時期居住在一公里內罹患急性淋巴性白血病的危險性是3.73倍(95% CI= 1.04 - 13.33 )達統計顯著;父母親的職業暴露中,母親曾經暴露於美容美髮劑(OR=6.42 , 95%CI=1.60 — 25.68),父親曾經暴露於錫焊燻煙(OR=4.43 , 95%CI=1.02 — 19.11)、在母親懷孕期間暴露廢氣(OR=4.43 , 95%CI=1.02 — 19.11)等對於子代罹患白血病呈高相關且達統計顯著性。特別是調整了年齡、性別及相關的干擾因子後,在懷孕時期居住距離石化工業區周界一公里內罹患急性淋巴性白血病的危險性為4.82倍(95%CI=1.06-21.92),達統計顯著性。
本研究首度以三大教學醫院(高醫、高長庚、高榮總)的主動通報與健康保險局住院資料來收集新發生病例,結果顯示無論在完整性或時效性上皆優於國家癌症登記資料,值得推廣應用﹔本研究選擇以工業區與鄰近人口密度高的社區作為研究對象,提高暴露率(約18%),可明顯減少統計所需樣本數,雖可能有過度配對所造成危險性低估的疑慮,但我們仍發現懷孕期間的石化居住暴露與年輕白血病有顯著相關,因此建議懷孕時期的居住暴露應受到重視;在雙親的職業暴露方面,亦發現父親在母親懷孕時的油漆暴露與年輕白血病有顯著相關,故呼籲父親自工作場所回家前應更換工作服,以避免家人暴露的危險性。未來本研究仍針對暴露做進一步的評估,並繼續收集研究樣本數以獲得更多的資訊及更深入的分析。
Abstract
In Taiwan, four large petroleum/petrochemical complexes are located in the Kaohsiung metropolitan area. These petroleum/petrochemical complexes are adjacent to communities with high-density populations. Experimental animals and epidemiologic studies suggested that exposure to polycyclic aromatic hydrocarbons (PAH) and volatile organic compounds (VOC), emitted from petrochemical industries, increase leukemia risks. Since young people may be more vulnerable to exposure to organic chemicals, in this study, we investigated the effect of petrochemical exposure on leukemia who were less than 30 years old in Kaohsiung metropolitan.
Newly-diagnosed leukemia, who are lesser than 30 years of age and currently live in the Kaohsiung metropolitan area (26 administrative areas) at the time of diagnosis, were recruited between January, 1, 1997, and January, 1, 2001.Controls were randomly selected from the same study area as cases, on the basis of personal identification number from house—hold registration offices in the Kaohsiung city and county, with matching (case:control = 1:3) on age (± 1 yrs) and gender.
After adjusting for age and gender in logistic regression, we found that subjects who had lived within 1 km away from petrochemical industries during the period of their maternal conception, had a 3.73-fold risk (95%CI=1.04 - 13.33) to develop acute lymphoblastic leukemia (ALL) than those who had not (n=179). After further adjusting for age, gender, and other confounders, the findings even strengthened (OR=4.82; 95%CI=1.06-21.92). Although no personal exposure data were available in this study, our finding suggests that exposure to petrochemicals may be associated with the development of leukemia in the young people.
目錄
中文摘要……………………………………………………………….…….I
英文摘要…………………………………………………………….……….II
第一章 序論
第1節:前言……………………………………………………….…….2
第2節:研究目的………………………………………………….…….4
第二章 文獻探討
第1節:石油及石化工業的定義……………………………….……….6
第2節: 高雄縣市主要的石化工業分布…………………….………...8
第3節: 石化工業主要的空氣污染以及來源…………….…………...9
第4節:白血病的定義…………………………………….……………11
第5節:白血病在台灣的發生狀況……………………….……………16
第6節:白血病的流行病學
第6-1節:居住環境之石化暴露與年輕族群白血病……….………….17
第6-2節:父母親的職業史與子代白血病的發生………….………….20
第6-3節:可能的干擾因子與白血病其他的危險因子…….………….25
第三章 材料與方法
第1節:研究期間與研究區域…………………………….……………27
第2節:病例組與對照組的定義………………………….……………27
第3節:污染區、居住時期定義、職業暴露時期、暴露物質定義….29
第4節:樣本數估計…………………………………………….………31
第5節: 問卷訪視……………………………………………….……..32
第6節:統計分析……………………………………………….………34
第四章 結果……………………………………………………….………36
第五章 討論……………………………………………………….………48
參考文獻…………………………………………………………….………54
圖及表目錄………………………………………………………….………61
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