臺灣博碩士論文加值系統

摘要
本研究旨在探討內生性及外生性的環境因子和女性肺癌發生之相關性。採病例對照研究法，立意取樣方式，研究設計以中部某醫學中心肺癌患者為病例組共110人，包含女性53人及男性57人;非癌症患者為對照組，包含女性47人及男性53人共100人，進行結構式問卷訪談收集資料。所得資料編碼、建檔，以SPSS for windows 10.0及SAS進行統計分析，結果顯示: 女性在控制年齡和教育程度後1.曾暴露於二手菸者，具2.28倍( 95% 信賴區間 1.05-7.60)罹患肺癌之危險性，並進一步發現二手菸的來源為同事者有差異。2.習慣以炒方式烹調者較其他方式煮食者有3.01倍( 95% 信賴區間 1.13-8.02)罹患肺癌的危險性。3.拜香習慣者具2.94倍( 95% 信賴區間 1.00-8.66)罹患肺癌的危險性。4.初經年齡小於15歲者，具2.95倍( 95%信賴區間 1.26-6.88)罹患肺癌的危險性。5.曾子宮頸病變者有9.44倍(95%信賴區間 1.12-79.90)罹患肺癌的危險性。6. 男性罹患肺癌和職業、嚼檳榔及二等親內家人之健康狀況有關;而女性肺癌和環境暴露、荷爾蒙因子及子宮頸病變有密切關聯性。更進一步，探究於暴露環境因子和子宮頸病變、荷爾蒙因子和子宮頸病變及環境因子和荷爾蒙因子之合併效應下，個別地提升了4.69倍(95%信賴區間 1.51-14.53)、6.32倍(95%信賴區間 1.34-29.90)及3.24倍(95%信賴區間 1.07-5.59) 罹患肺癌之危險性。我們的研究裡可發現二手菸、油煙及拜香暴露和女性肺癌的發生具相關係。有趣的是，初經年齡較早及曾子宮頸病變和女性肺癌的發生有關，這似乎也支持過去學者的研究，人類乳突瘤病毒和台灣非抽菸女性肺癌之發生有著密切的關聯性。
關鍵字: 女性、肺癌、環境暴露、子宮頸病變、人類乳頭瘤病毒

Abstract
The purpose of this study is to understand whether endogenous and exogenous environmental factors were associated with female lung cancer incidence. The method is a case-control study by intent sampling. Our study had 110 lung cancer patients including 53 female and 57 male case group and 100 non-cancer control group including 47 female and 53 male non-cancer subjects.The data were collected by processing structive questionaire interview and statistically analyzed by SPSS and SAS. Based on the statistical analysis, the following findings were found: (1) passive smoking exposure having 2.28-fold of risk (the 95% CI, 1.05-7.60), especially passive smoking from colleagues, (2) exposure of stir-frying cooking fumes having 3.01-fold of risk ( 95% CI, 1.13-8.02), (3) incense smoke exposure having 2.94-fold of risk (95% CI, 1.00-8.66), (4) the first menstruate before 15 years old having 2.95 fold (95% CI, 1.26-6.88) of risk, and (5) cervical lesion having 9.44-fold (95% CI, 1.12-79.90) of risk in lung cancer incidence.(6) There is a relationship between occupation, hetel
nut, the healthy condition of 2nd-generation family members and male who had lung cancer.The association of environmental exposure, hormone factor and cervicial lesion with female lung cancer.
Moreover, the three combination including any one exogenous environmental factor and cervical lesion, hormone factor and cervical lesion and any one exogenous environmental factor and hormone factor, the risk of lung cancer was increased to 4.69 fold (95% CI, 1.51-14.53), 6.32 fold (95% CI, 1.34-29.90) and 3.24 fold (95% CI, 1.07-5.59), respectively. Similar findings such as the association of passive smoking, cooking oil fumes and incinse smokes with lung cancer incidence were also observed in our study. Interesting, the association of early menstruate and cervical lesion with female lung cancer incidence found in this study seems to support the previous finding showing that human papillomavirus infection was associated with nonsmoking female lung cancer in Taiwan.
Key words:female, lung cancer, environmental exposure, cervical
lesion ,human papilloma virus

目 錄
目錄…………………………………………………………………….. Ⅲ
圖表目錄……………………………………………………………… Ⅵ
附錄目錄………………………………………………………………..Ⅶ
中文摘要………………………………………………………………. 01
英文摘要………………………………………………………………. 03
第一章 緒論…………………………………………………………. 05
第一節 研究動機及背景………………………………………. 05
第二節 問題陳述………………………………………………. 07
第三節 研究目的………………………………………………. 08
第四節 名詞界定………………………………………………. 08
第五節 研究架構………………………………………………. 10
第二章 文獻查證……………………………………………………..11
第一節 肺癌……………………………………………………. 11
第二節 肺癌與香菸之關係…………………………………… 12
第三節 肺癌與油煙、煮食燃料之關係……………………… 14
第四節 肺癌與荷爾蒙之關係………………………………… 15
第五節 肺癌與人類乳突瘤病毒之關係……………………… 18
第六節 肺癌與其他因子之關係……………………………… 20
第三章 研究方法……………………………………………………. 23
第一節 研究設計及研究對象………………………………… 23
第二節 研究工具……………………………………………… 23
第三節 研究工具之信效度測試……………………………… 24
第四節 研究實施步驟………………………………………… 25
第五節 資料統計與分析方法………………………………… 26
第六節 研究對象保護措施…………………………………… 26
第四章 研究結果…………………………………………………… 28
第一節 研究對象之基本資料分析…………………………… 27
第二節 研究對象之生活習慣分析…………………………… 28
第三節 研究對象之月經史及生育史分析…………………… 30
第四節 研究對象之個人疾病史及家人健康狀況分析……... 31
第五節 環境因子、賀爾蒙因子及子宮頸發炎
對於女性肺癌發生之關係…………………………… 32
第五章 討論…………………………………………………………. 34
第一節 研究對象之基本資料………………………………… 34
第二節 研究對象之生活習慣………………………………… 35
第三節 研究對象之月經史及生育史………………………… 38
第四節 研究對象之個人疾病史及家人健康狀況…………… 39
第五節 環境因子、賀爾蒙因子及子宮頸發炎
對於女性肺癌發生之關係…………………………… 40
第六章 結論與建議………………………………………………… 42
第一節 結論…………………………………………………… 42
第二節 建議…………………………………………………… 44
第三節 護理上的應用………………………………………… 45
第四節 研究限制及未來研究之方向………………………… 46
參 考資料……………………………………………………………… 47
一、中文部分…………………………………………………… 47
二、英文部分…………………………………………………… 49
圖表目錄
圖一 研究架構圖…………………………………………………… 10
圖二 環境因子及子宮頸發炎狀態，對於女性罹患肺癌
的合併效應…………………………………………………… 70
圖三 荷爾蒙因子及子宮頸發炎狀態，對於女性罹患肺癌
的合併效應……………………………………………………. 71
圖四 環境因子及荷爾蒙因子，對於女性罹患肺癌的
合併效應………………………………………………………. 72
表一 研究對象之基本資料…………………………………………. 63
表二 研究對象之生活習慣………………………………………… 64
表三 研究對象之月經史及生產史………………………………… 66
表四 研究對象之個人疾病史及家人健康狀況…………………… 67
表五 研究對象之環境暴露、荷爾蒙及子宮頸發炎……………… 68
表六 環境因子及子宮頸發炎狀態，對於女性罹患肺癌
的合併效應……………………………………………………. 69
表七 荷爾蒙因子及子宮頸發炎狀態，對於女性罹患肺癌
的合併效應……………………………………………………. 69
表八 環境因子及荷爾蒙因子，對於女性罹患肺癌的
合併效應………………………………………………………. 69
附錄目錄
附錄一 國人肺癌調查研究同意書………………………………… 73
附錄二 國人肺癌調查研究問卷…………………………………… 74
附錄三 效度評量專家名單…………………………………………. 84
附錄四 問卷內容效度檢定…………………………………………. 85附錄五 問卷內容效度表…………………………………………… 90
附錄六 收案場所同意書…………………………………………….

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