臺灣博碩士論文加值系統

紡織業一直是台灣的重要基礎工業之一，目前共有七千餘家工廠，受雇員工24萬餘人。由棉塵所引起的疾病及相關症狀很多，其中以棉塵症（byssinosis）及長期肺功能下降為棉紡織作業中最常被廣泛研究的疾病及症狀。為了探究慢性長期肺功能變化與棉塵暴露之間的相關性，本研究採用縱斷性追蹤研究（Longitudinal study）的方法來做評估，時間是從民國87年至91年，測驗時間為二次，研究對象共有208人。研究對象除了接受呼吸道問卷調查及肺功能檢查之外，在環境暴露濃度的採樣部分，採用IOM採樣器來評估作業環境中的區域棉塵濃度，以及總粉塵（Total dust）採樣器配合LAL（Limulus amebocyte lysate）的實驗方法來評估作業環境中的區域細菌內毒素濃度，並用GEE（Generalized estimating equation）模式來分析影響肺功能值變化的因素。
經過三年的持續棉塵暴露，胸悶症狀盛行率由11.2%下降至7.2%，呼吸道刺激症狀盛行率由25.8%下降至9.1%，員工的肺功能均有下降的情形，FVC從3.19升下降至3.06升，FEV1從2.78升下降至2.68升，但肺功能異常型態及慢性肺功能有影響的比例有略為減少的情形，有肺功能異常型態的比例由13.2%下降至12.7%，有慢性肺功能影響的比例由15.8%下降至14.3%。區域棉塵採樣幾何平均濃度從0.89 mg/m3降至0.74mg/m3，區域採樣細菌內毒素幾何平均濃度為1018.28EU/m3。利用GEE模式分析，結果顯示性別、年齡、身高、肺功能異常型態及慢性肺功能變化均會影響三年前後FVC及FEV1的下降情形，而棉塵症胸悶症狀、呼吸道刺激症狀及員工的工作暴露區域分組均不影響三年前後FVC及FEV1的下降情形，抽煙習慣對FEV1的下降情形影響較大，對FVC則沒有影響，但是有WHO棉塵症胸悶或呼吸困難症狀的員工罹患肺功能異常或慢性肺功能變化的機率均較沒有症狀的員工來的高，另log累積暴露棉塵濃度及log累積暴露細菌內毒素濃度亦均不影響FVC及FEV1的變化量。這顯示出一可能的「健康工人效應」，因為有一部分有一部份高齡、工作年資長、線上作業、肺功能較差且有棉塵症症狀及肺功能急、慢性變化的員工並沒有在本研究中被追蹤到，而且在這些未追蹤的員工當中，又有大部分的人均已離職。
本研究建議宜持續改善作業環境的集塵設施或採密閉式作業以減少棉塵散佈於作業場所中，將肺功能檢查訂定為勞工定期體檢項目，持續進行棉塵濃度與細菌內毒素濃度之採樣監控作業，以及再追蹤棉紡紗廠研究族群以進行世代研究，確立棉塵及細菌內毒素暴露與棉塵症、肺功能每年平均下降量、呼吸道刺激症狀之因果關係。

The textile industry has been one of the most important basic industries in Taiwan. There are currently more than 7,000 textile factories with more than 240,000 employees in Taiwan. Many diseases and symptoms are known to be related to the cotton dust exposure, with byssinosis and declined pulmonary function being the most widely researched topics in the textile mills. In order to investigate the relationship between chronic changes of the pulmonary function and cotton dust exposure, a longitudinal study of the three-year changes of pulmonary function was designed. From 1998 to 2002, a total of 208 employees were included in this study with duplicated check－up. Both pulmonary function test and questionnaire about the respiratory symptoms were collected. IOM sampler were used to assess the regional cotton dust concentration in the working place and total dust sampler were used and combined with LAL（Limulus amebocyte lysate） method to evaluate the regional endotoxin concentration. GEE（Generalized estimating equation）model was used to analyze the longitudinal changes of pulmonary function and find out factors that may affect the pulmonary function.
The prevalence of chest tightness symptom had declined from 11.2% in 1988 to 7.2% in 2002, and the prevalence of respiratory irritative symptom had declined from 25.8% to 9.1%. The pulmonary function was also in this three－year period with FVC declining from 3.19 in 1998 to 3.06 liters in 2002 and FEV1 declining from 2.78 to 2.68 liters. However, the percentage of abnormal pulmonary functional pattern and chronic impaired pulmonary function were lower in 2002 than in 1998. The percentage of abnormal pulmonary functional pattern had declined form 13.2% in 1998 to 12.7% in 2002 and the percentage of chronic impairment of pulmonary function had declined from 15.8% to 14.3%.
The geometric mean of the regional cotton dust concentration had dropped from 0.89 in 1998 to 0.74 mg/m3 in 2002. The geometric mean of the regional endotoxin concentration was 1018.28 EU/m3. GEE model analysis revealed that the gender, age, body height, the abnormal pulmonary functional pattern and chronic impairment of pulmonary function influenced the longitudinal decline of the FVC and FEV1 over the three－year interval, while the byssinosis－related symptoms of chest tightness and respiratory irritation as well as the different working places did not affect the changes of pulmonary function . The smoking habit had more influence on the decline of FEV1 but not on the FVC. The workers who had WHO byssinosis－related symptoms of chest tightness or short of breathiness were more frequently to develop abnormal pulmonary function or chronic impaired pulmonary function than the workers who were asymptomatic. The log cumulative cotton and endotoxin concentrations did not affect the decline of the changes of pulmonary function. A possible “healthy worker effect” may bias these results since a portion of workers who were older, senior, with higher exposure, with poor pulmonary function as well as byssinosis－related symptoms, were not followed up in the current study.
The results of our study suggest that：（1）The dust collecting equipment should be improved in the work environment or using closure operation procedure to decrease the cotton dust in the working places.（2）The pulmonary function test should be included in the items of annual physical check－up.（3）Periodic monitoring the concentration of the cotton dust and endotoxin in the workplace and following up the respiratory illnesses among employees in the textile mills.（4）Further study is needed to examine the relationship between the cotton dust and endotoxin exposure and the prevalence of byssinosis, yearly decline in the pulmonary function and respiratory irritative symptoms.

目錄
目錄 I
圖表目錄 II
附錄目錄 III
中文摘要 IV
英文摘要 V
第一章 緒論 1
第一節 研究背景及重要性 1
第二節 研究動機 1
第三節 研究目的 2
第二章 文獻探討 3
第一節 棉紡紗業簡介 3
第二節 棉塵症（BYSSINOSIS） 5
第三節 細菌內毒素（ENDOTOXIN） 6
第四節 與肺功能指標有關的因子 9
第三章 研究方法及進行步驟 11
第一節 研究對象之選擇 11
第二節 研究工具 11
第三節 資料收集及研究進行步驟 15
第四節 名詞解釋 25
第五節 資料整理及統計分析 26
第六節 研究流程圖 29
第四章 結果 30
第一節 已追蹤員工與未被追蹤員工之基本資料 30
第二節 棉塵濃度與細菌內毒素濃度採樣結果 35
第三節 GEE模式分析影響三年前後肺功能變化之相關因素 37
第五章 討論 42
第一節 已追蹤員工與未被追蹤員工比較 42
第二節 已追蹤員工之比較 43
第三節 棉塵濃度與細菌內毒素濃度 45
第四節 影響三年前後肺功能變化之因素 47
第五節 研究限制 50
第六章 結論與建議 51
第一節 結論 51
第二節 建議 52
第七章 參考文獻 53
圖表目錄
表1 已追蹤及未追蹤員工基本資料及棉塵症症狀分布情形 57
表2 已追蹤及未追蹤員工肺功能檢查分布情形 58
表3 已追蹤員工基本資料及棉塵症症狀分布情形 59
表3 已追蹤員工基本資料及棉塵症症狀分布情形（續） 60
表4 已追蹤員工肺功能檢查分布情形 61
表5 已追蹤員工前後棉塵症症狀及肺功能檢查分布情形 62
表6 已追蹤員工肺功能FVC（ml）前後變化之單變項分析a 63
表6 已追蹤員工肺功能FVC（ml）前後變化之單變項分析a（續） 64
表7 已追蹤員工肺功能FEV1（ml）前後變化之GEE單變項分析a 65
表7 已追蹤員工肺功能FEV1（ml）前後變化之單變項分析（續）a 66
表8 八十七年區域棉塵濃度採樣結果a 67
表9 九十一年區域棉塵濃度採樣結果a 68
表10 九十一年區域棉塵濃度採樣結果（分廠別）a 69
表11 九十一年棉塵採樣細菌內毒素濃度分析結果a 70
表12 九十一年棉塵採樣細菌內毒素濃度分析結果（分廠別）a 71
表13 九十一年區域棉塵濃度與細菌內毒素濃度之相關性 72
表14 三年前後肺功能變化因素之GEE多變項分析一（全體208名員工） 73
表15 三年前後肺功能變化因素之GEE多變項分析二（全體208名員工） 74
表16 三年前後肺功能變化因素之GEE多變項分析三（全體208名員工） 75
表17 三年前後肺功能變化因素之GEE多變項分析四（全體208名員工） 76
表18 三年前後肺功能變化因素之GEE多變項分析五（全體208名員工） 77
表19 三年前後肺功能變化因素之GEE多變項分析六（全體208名員工） 78
表20 三年前後肺功能變化因素之GEE多變項分析七（全體208名員工） 79
表21 三年前後肺功能變化因素之GEE多變項分析八（全體208名員工） 80
表22 三年前後肺功能變化因素之GEE多變項分析九（全體208名員工） 81
表23 三年前後肺功能變化因素之GEE多變項分析十（全體208名員工） 82
表24 三年前後肺功能變化因素之GEE多變項分析十一（全體208名員工） 83
表25 肺功能異常型態及慢性肺功能影響之logit GEE多變項分析一（全體208名員工） 84
表26 肺功能異常型態及慢性肺功能影響之logit GEE多變項分析二（全體208名員工） 85
表27 三年前後肺功能變化因素之GEE多變項分析一（線上138名員工） 86
表28 三年前後肺功能變化因素之GEE多變項分析二（線上138名員工） 87
表29 三年前後肺功能變化因素之GEE多變項分析三（線上138名員工） 88
圖1 個人累積暴露棉塵濃度與累積細菌內毒素濃度之相關圖 89
圖2 log個人暴露棉塵濃度與log細菌內毒素濃度之相關圖 90
附錄目錄
附錄一 棉塵症狀影響肺功能指標之文獻回顧總表 91
附錄二 細菌內毒素與呼吸道刺激症狀及肺功能變化文獻回顧總表 92
附錄三 棉塵濃度與細菌內毒素濃度相關文獻之回顧總表 93
附錄四 可接受性與可重複性標準 95
附錄五 HI-298肺功能機校正資料 96
附錄六 棉塵採樣秤重紀錄 97
附錄七 細菌內毒素實驗分析結果 98
附錄八 健檢問卷 99

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