臺灣博碩士論文加值系統

摘要
背景:
國內流行病學調查顯示國人氣喘盛行率逐年增加，空氣污染物如二氧化硫（Sulfur dioxide, SO2）、二氧化氮（Nitric dioxide, NO2）、臭氧（Ozone, O3）、一氧化碳（Carbon monoxide, CO）與懸浮微粒（Particulate matter, PM）及環境因子等已被證實與呼吸症狀的惡化具有正相關。具有非侵襲性及安全性特色的吐氣一氧化氮濃度（The fractional concentration of nitric oxide in exhaled breath﹐FeNO）檢測方式最近被許多研究用為評估呼吸道疾病發炎的指標之ㄧ，與空氣污染物的關係也逐漸受到重視。故本研究擬利用吐氣一氧化氮濃度的檢測，探討室外及室內等環境因子與呼吸道功能之間的相關性。

方法:
本研究為一橫斷性研究（cross-sectional study），採樣期間從2005年2月至2006年3月間，共收取27名氣喘患者、28名慢性阻塞性肺疾病患者及29名控制組個案。本研究利用問卷紀錄研究個案之基本資料、疾病史、生活習慣、用藥狀況及室內拜香習慣，以光化學分析儀（CLD 77 AM sp, ECO Physics, Switzerland）偵測吐氣一氧化氮濃度，及肺功能測試 (pulmonary function test﹐PFT)反應病患肺部支氣管變化，另外選取距離個案居住地最近之環保署空氣品質監測站，下載SO2、NO2、O3、CO、PM等空氣污染物之月平均濃度作為個案之暴露濃度，使用皮爾森相關係數進行吐氣一氧化氮濃度、肺功能參數及空氣污染物質之相關分析。
結果:
本研究所調查之氣喘及慢性阻塞性肺疾病患者之吐氣一氧化氮濃度平均值±標準差分別為24.06±20.05 ppb及19.23±21.21 ppb，分別與控制組個案14.73±9.50 ppb相比較，在氣喘組個案呈現顯著差異 (p<0.05)；觀察氣喘個案其肺功能參數平均值±標準差為用力吐氣肺活量 (Force Vital Capacity, FVC) 2.50±1.27 L、第一秒最大吐氣量 (Forced Expiratory Volume in the first second, FEV1) 1.54±0.86 L、FEV1/FVC 61.51±16.43 %、尖峰吐氣流量 (Peak Expiratory Flow, PEF) 3.32±1.81 L/s；而慢性阻塞性肺疾病個案其肺功能參數平均值±標準差為FVC 2.78±0.92 L、FEV1 1.56±0.82 L、FEV1/FVC 53.78±20.80 %、PEF 3.68±2.21 L/s。分析氣喘患者與慢性阻塞性肺疾病患者所暴露之空氣污染物質與吐氣一氧化氮濃度、肺功能之間的相關性，發現慢性阻塞性肺疾病患者吐氣一氧化氮濃度與肺功能參數之FEV1/FVC呈負相關（r= -0.477﹐p<0.01），而吐氣一氧化氮與空氣汙染物之二氧化硫呈現正相關 (r= 0.454﹐p<0.01)，與二氧化氮呈現正相關(r= 0.384﹐p<0.05)，與一氧化碳亦呈現正相關 (r= 0.417﹐p<0.05)，而肺功能參數中之用力吐氣肺活量與空氣污染物之二氧化氮呈現負相關(r=-0.189﹐p<0.05)，顯示慢性阻塞性肺疾病患者肺功能之惡化可能與暴露二氧化硫、二氧化氮與一氧化碳有關，並且影響吐氣一氧化氮濃度。進一步分析慢性阻塞性肺疾病患者暴露室內拜香環境較沒有暴露者其吐氣一氧化氮濃度較低分別為15.05 ppb及26.96 ppb呈現顯著差異 (p<0.05)。

結論︰
氣喘與慢性阻塞性肺疾病屬發炎性呼吸道疾病，通常伴隨有惡化之肺功能，因此利用安全、可重複測量之吐氣一氧化氮濃度的檢測方式作為評估暴露空氣污染物質與呼吸道健康之間的相關性是可行的，並可利用此生物指標作為呼吸道疾病患者呼吸道健康之評估指標。

關鍵詞:吐氣一氧化氮濃度、肺功能、空氣污染物質、氣喘、慢性阻塞性肺疾病

Abstract
Background:
Epidemiological studies have showed that the prevalence rate of asthma increases rapidly in recent year. Many environmental air-pollutants, such as sulfur dioxide (SO2), nitric dioxide (NO2), ozone (O3), carbon monoxide (CO) and particulate matter (PM) have been proved to correlate with the worsening of respiratory symptoms in patients with airway diseases. The fractional concentration of nitric oxide in exhaled breath (FeNO) is a noninvasive and safe method and has been used to evaluate inflammatory status of respiratory diseases recently. Little study has been focus on the influence of environmental air-pollutants to the FeNO in different patients of airway diseases. Therefore, this study was designed to attempt to assess the relationships between different indoor and outdoor air-pollutants and the severity of airway function in patients with asthma and chronic obstructive pulmonary disease (COPD) by using FeNO and pulmonary function test (PFT).

Methods:
This cross-sectional study recruited 27 asthma patients、28 COPD patients and 29 control cases from march 2005 to march 2006. Information including subject’s gender, age, disease-history, living-habits, medications and resident environmental factors were collected by questionnaire. A Chemiluminescence’s analyzer (CLD 77 AM sp, ECO Physics, Switzerland) was utilized to monitor FeNO and PFT was performed subsequently. Monthly mean concentrations of air pollutants from ambient monitoring site operated by Taiwan Environmental Protection Agency (EPA) which locate nearby subject’s residence were also collected for comparison. Pearson correlation coefficient was used to analyze the association between FeNO, parameters of pulmonary function test and air pollutants.

Results:
The concentration of FeNO in control group (14.73±9.50 ppb, mean±SD) was significant lower than asthma group (24.06±20.05 ppb) (p<0.05), but had no significant difference compared with patients with COPD (19.23±21.21 ppb). The pulmonary function test in the asthma group showed most of our patients were in mild severity (Forced Vital Capacity (FVC) 2.50±1.27 L, Forced Expiratory Volume in the first second (FEV1) 1.54±0.86 L/min、FEV1/FVC 61.51±16.43 %、Peak Expiratory Flow (PEF) 3.32±1.81 L/min). The severity of the COPD patients were mild to moderate (FVC 2.78±0.92 L、FEV1 1.56±0.82 L/min、FEV1/FVC 53.78±20.8 %、PEF 3.68±2.21 L/min). The FeNO in COPD correlated negatively with FEV1/FVC (r= –0.477, p<0.01), and correlated positively to the levels of SO2 (r= 0.454, p<0.01), NO2 (r= 0.384, p<0.05) and CO (r= 0.417, p<0.05).
Conclusion:
Our results have shown that FeNO is a feasible method to use to monitor the airway function in patients with different airway diseases. Environmental air-pollutants may influence the FeNO in patients with airway diseases, especially in COPD patients. Hence, the measurement of FeNO is a practicable modality to evaluate the impact of different factors on respiratory function.

Keywords: FeNO、PFT、Air pollutants、Asthma、COPD

目 錄
頁次
第一章 前言……………………………………………………………... 1
第一節 研究背景………………………………………………………... 1
第二節 研究目的………………………………………………………... 2
第二章 文獻回顧………………………………………………………... 3
第一節 氣喘……………………………………………………………... 3
壹 氣喘定義及診斷………………………………………………... 3
貳 氣喘盛行率……………………………………………………... 5
參 氣喘危險因子…………………………………………………... 9
第二節 慢性阻塞性肺疾病……………………………………………... 15
壹 慢性阻塞性肺疾病定義………………………………………... 15
貳 慢性阻塞性肺疾病盛行率……………………………………... 16
參 慢性阻塞性肺疾病的危險因子………………………………... 17
第三節 吐氣一氧化氮…………………………………………………... 20
壹 定義……………………………………………………………... 20
貳 吐氣一氧化氮之測量…………………………………………... 20
參 吐氣一氧化氮與呼吸道疾病…………………………………... 26
肆 空氣污染物對於吐氣一氧化氮濃度的影響…………………... 29
第四節 肺功能監測……………………………………………………... 32
第五節 綜論……………………………………………………………... 34
第三章 材料與方法……………………………………………………... 35
第一節 實驗設計………………………………………………………... 35
第二節 研究對象………………………………………………………... 35
第三節 測量工具及方法………………………………………………... 37
壹 問卷調查………………………………………………………... 37
貳 吐氣一氧化氮測量……………………………………………... 37
參 肺功能測試……………………………………………………... 44
肆 空氣污染物……………………………………………………... 48
第四節 資料處理與統計分析…………………………………………... 48
壹 問卷……………………………………………………………... 48
貳 吐氣一氧化氮濃度……………………………………………... 49
參 肺功能參數與空氣污染物濃度………………………………... 49
第四章 結果……………………………………………………………... 50
第一節 個案之基本特性、吐氣一氧化氮濃度、肺功能參數及空氣污染物之分佈狀況………………………………………………... 50
壹 氣喘……………………………………………………………... 50
貳 慢性阻塞性肺疾病……………………………………………... 64
第二節 吐氣一氧化氮濃度、肺功能參數與空氣污染物質濃度之相關性分析…………………………………………………………... 90
壹 氣喘……………………………………………………………... 90
貳 慢性阻塞性肺疾病……………………………………………... 90
第五章 討論…………………………………………….……………….. 94
第六章 結論與建議……………………………………………………... 100
參考文獻 …………………………………………………………………... 102
附錄一 研究問卷………………………………………………………... 111
附錄二 個案空品測站選取表…………………………………………... 114
附錄三 空品測站地址…………………………………………………... 118

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