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研究生:黃育菁
研究生(外文):Yu-Jing Huang
論文名稱:台灣地區新生兒臍帶血免疫球蛋白E之背景值及影響因子之調查研究
論文名稱(外文):The background levels and determinants for cord blood IgE of the newborns in Taiwan
指導教授:蘇慧貞蘇慧貞引用關係王志堯
指導教授(外文):Huey-Jen SuJiu-Yao Wang
學位類別:碩士
校院名稱:國立成功大學
系所名稱:環境醫學研究所
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:2002
畢業學年度:90
語文別:中文
論文頁數:62
中文關鍵詞:環境危險因子臍帶血IgE新生兒懷孕時期過敏
外文關鍵詞:cord blood IgEnewbornspregnancyallergyenvironmental factors
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  過敏是一種常見的疾病,近年來全世界過敏性疾病的盛行率有不斷地明顯攀升的事實,尤其是在先進的工業化或已開發國家中,而在台灣也可觀察到相同的趨勢。過敏的危險因子眾多,其中環境危險因子已被證實在生命的任何時期皆可能發生作用,且對誘發或加重過敏性疾病的嚴重度有相當大的影響。嬰幼兒時期是發生致敏反應 (sensitization)的關鍵時期,然而,更有研究指出,在生命發展的更早期、即母親懷孕時期,胎兒在子宮內便可能已發生致敏反應,而發展成易過敏性體質。由此可知,懷孕時期對往後過敏性疾病的發展扮演了關鍵的角色。
  若能愈早得知發展為過敏性疾病之危險性,便能及早採取適合之預防措施。因此近幾十年來,許多研究開始討論,如何能於母親懷孕時期,即能預測並預防其新生兒未來發展為過敏性體質的可能性,並發現家族病史及新生兒臍帶血IgE濃度,或許可作為預測過敏性體質危險性之早期指標。本研究之目的在於獲得台灣地區一般族群臍帶血 IgE濃度之背景值,並評估影響臍帶血 IgE 濃度之危險因子,以及與嬰幼兒早期過敏性疾患發展之相關性。
  本研究至孕婦生產前共收集三次母血血樣(分別為MB1、MB2及MB3)及臍帶血(CB),其中自訴有過敏病史之孕婦占25.61%。自訴有過敏性疾病史之孕婦,其三次血樣之total IgE濃度皆較自訴無過敏疾病史之一組為高,且其差異具有統計上的顯著意義(P<0.05)。然而,進一步比較懷孕過程中三次血樣total IgE濃度變動之情形,不論在有無自訴過敏性疾病的兩組中,皆無統計上之顯著差異存在。在本研究中,有46(19%)的新生兒其臍帶血IgE濃度高於偵測極限(≧0.35 kU/L),而在母親具過敏病史之新生兒中,測出的比率也較無過敏病史的一組為高(分別為14.36%及31.75%, P<0.05)。當校正包括懷孕時期母親之飲食方式、家中是否飼養寵物,以及二手煙的暴露等可能影響臍帶血IgE濃度之因子後,只有母親之過敏性疾病史此因子仍有顯著意義(OR=3.3, 95%CI=1.2-8.9)。而臍帶血IgE濃度較高之新生兒(>0.35 kU/L),其在出生後半年內發生感冒的比例也較另一組明顯為高(50% vs. 24.8%, p<0.05)。然而,和其他早期的過敏性疾患的發生則無明顯的關係存在。
  未來擬繼續追蹤並延長記錄新生兒過敏性疾患之發生情形,以進一步評估臍帶血 IgE於預測過敏性疾病發展之適用性。若能及早界定過敏性疾病發生之高危險族群,並確立疾病發展過程中相對重要之危險因子,可有助於往後在制定預防政策及衛教宣導之參考方針,對於過敏性疾病的預防將有莫大之助益。
  An increasing prevalence of allergic disease, particularly in childhood, has been observed in most parts of the world, including Taiwan, over the recent decades. Among all the factors associated with the development of allergic disease, environmental exposures play a considerable role in promoting and aggravating the development of allergic diseases. Several studies have indicated that a fetus can be sensitized during gestation and later be affected at one’s early infancy. During this period, any exposure from the outside environment could have triggered the primary sensitization, and led an individual to become atopic. This is to say, pregnancy may be a critical time in determining subsequent disease development.
  To identify predisposition risk and take proper measures for primary prevention as early as possible, research interests have been growing and focusing on the possibility of predicting and preventing atopic diseases during pregnancy over recent decades. Many studies have indicated that atopic family history and cord blood IgE may be a predictor of the development of allergic disease in newborns. The aim of this study was to obtain the background levels and determinants for cord blood IgE of the newborns in Taiwan. Also, the relationship between the cord blood IgE levels and the development of allergic symptoms during early infancy were also discussed.
  Maternal serum was obtained from each subject for three times, and cord blood was collected from newborns of these study women. Each sample was assayed for total or specific IgE by using a quantitative fluoroimmuno- assay (CAP-RAST-FEIA; Pharmacia). About 63 (26%) of the pregnant women reported having allergic diseases. No significant difference between the newborns' gender, birth order, weight and maternal age, gestational age, educational levels, type of delivery among the pregnant women with self-reported allergic disease or not. Only the levels of total IgE from maternal serum of the atopic mothers (65.5, 63.5 and 66.4 kU/l at 3 different sampling time) were significantly higher than those of not having allergic diseases (28.6, 28.5, and 27.8 kU/l) (P<0.001). However, the variation among levels of maternal serum IgE was not statistically significant in either group of pregnant women.
  Of the 244 samples, cord blood IgE levels ranged from <0.35 to 2.26 kU/l, with a geometric mean of 0.23 kU/l. About 19% (46 of 244) of cord blood samples were detectable (≧0.35 kU/L), and the probability that had detectable levels was significant higher in the group of atopic mothers than in non-atopic mothers (14.36% vs. 31.75%, respectively; P<0.05). After making an adjustment of other confounding factors, only maternal atopic history was still a significant risk factor for cord blood IgE levels (OR=3.3, 95%CI=1.2-8.9). No association was found between cord blood IgE levels and the exposure of environmental risk factors assessed by questionnaire. The probability of having cold in newborns with detectable cord blood IgE levels was significantly higher than these without (50% vs. 24.8%, p<0.05).
  Future efforts are essential to complete more subjects and to determine the association between cord blood IgE levels and the development of allergic symptoms in their early infancy. When the determinants related to development of allergic disease were assessed, the proper precautions can be instituted as at their earliest possibility.
中文摘要
英文摘要
誌謝
目錄
表目錄
圖目錄
附錄

第一章 緒論……………………………………………………… 1
1-1 研究緣起………………………………………… 1
1-2 研究目的………………………………………… 2


第二章 文獻回顧 …………………………………… 3
 2-1 過敏性疾病之盛行率………………………… 3
 2-2 過敏(Allergy)及異位性體質(Atopy)之定義…………………4
2-3 異位性體質與輔助型T細胞(T helper cells)之作用………………4
2-4 過敏反應之主要機轉………………………… 5
2-5 過敏性疾病之危險因子……………………… 6
2-5-1 遺傳/免疫因子(Genetic/ Immunologic factors)………………… 6
2-5-1-1 家族病史及基因遺傳…………….…………………... 6
2-5-1-2 臍帶血IgE抗體濃度…………….…………………… 7
2-5-2 特異之環境危險因子……………………………………... 8
2-5-2-1 生命早期過敏原之暴露………….…………………... 8
2-5-2-2 母親懷孕時期之飲習慣………….…………………... 10
2-5-3 其他非特異之環境危險因子……………………………... 10
2-6 預測過敏性疾病之指標……………….…………………….…. 11
第三章 研究方法.……………………………………………..…………. 13
3-1 研究對象之選取……….……………………………………….. 13
3-2 研究工具…………………...………….………………………... 14
3-2-1 問卷調查…………………………………………………... 14
3-2-2 母血及臍帶血IgE抗體濃度之測量….…………………... 14
3-3資料處理與統計分析…………………………………………… 15

第四章 研究結果.……………………………………………..…………. 16
4-1 描述性統計…………….……………………………………….. 16
4-2 推論性統計………………...………….………………………... 16
4-2-1 孕婦方面…………………………………………………... 16
4-2-2 新生兒方面………………………...….…………………... 17

第五章 討論.…………………………………………………..…………. 21
5-1 研究群族之代表性…….……………………………………….. 21
5-2 孕婦total IgE濃度之比較及懷孕時期之變異情形…………... 21
5-3 新生兒性別、家族病史對臍帶血 IgE濃度之影響…………... 23
5-4 .臍帶血IgE平均值及分布情形………………………….……... 23
5-5母親total IgE及臍帶血IgE濃度之相關性…………..………... 24
5-6 臍帶血IgE濃度之影響因子…………………………………… 25
5-7 臍帶血IgE濃度與過敏性症狀發展之相關性………………… 26

第六章 結論.…………………………………………………..…………. 28

參考文獻.…………………………………………………..……………... 29
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