臺灣博碩士論文加值系統

研究目的：本研究想了解台灣地區不同肺癌組織病理型態發生率的地理變異為何，並進一步研究空氣污染與肺癌組織病理型態之間的生態相關。
研究方法：癌症資料的收集來自行政院衛生署國民健康局-台灣癌症登記中心，及內政部所提供的台閩地區人口統計資料，年代從1995年至1998年。空氣污染指標則是由行政院環保署-空氣品質監測網所取得共70個測站，空氣污染指標包括SO2 (ppb)、NO2 (ppb)、O3 (ppb)、CO (ppm)、NO (ppb)及NOX (ppb)，我們資料收集從1994年至1998年空氣監測資料。計算出鄉鎮別男女性全肺癌、肺腺癌及肺鱗狀細胞癌的直接年齡標準化發生率並繪製地圖。利用斯皮爾斯曼(Spearman)相關係數分析肺癌組織病理型態標準化發生率與空氣污染指標之相關性。利用普瓦松(Poisson)複迴歸分析肺癌組織病理型態發生率與空氣污染指標之相對危險性。
結果：肺腺癌男女性幾乎都集中在台北縣市。肺腺癌標準化發生率與空氣污染指標中的NOx及NO有顯著相關，男性肺腺癌標準化發生率與NOx 的相關係數r = 0.424 (p < 0.0001)，與NO的相關係數r = 0.434 (p < 0.0001)；在女性方面則依序為r = 0.277 ( p = 0.021)及r = 0.369 (p = 0.002)。進一步調整NO2、SO2、CO及O3後將NO濃度分層(NO≦5.590、5.590< NO≦8.554、8.554< NO≦13.53和13.536< NO)並以NO≦5.590為基準值。男性肺腺癌標準化發生率在5.59 < NO < 8.554 ppb的層級時為基準值時的1.324倍 (95% CI: 1.105-1.587)，8.554 < NO <13.536 ppb層級是1.332倍 (95% CI: 1.106- 1.606)，13.536 < NO層級是1.655倍 (95% CI: 1.361-2.014)，劑量效應關係也呈顯著(p < 0.0001)，女性肺腺癌標準化發生率也有相似的結果。鱗狀細胞癌發生率之地理分布特別在西南沿海烏腳病地區及東北宜蘭地區有顯著偏高且集中。
結論：肺腺癌發生率之地理分布男女性幾乎都集中在台北縣市，且年齡層愈高趨勢愈明顯。男女性肺腺癌與空氣汙染有關，特別是NO，肺腺癌與NO呈劑量效應關係，肺鱗狀細胞癌則與空氣汙染無關。鱗狀細胞癌發生率之地理分布特別集中在西南沿海烏腳病地區及東北高砷地區。

Objective: The ecological study was to investigate the relationship between lung cancer incidence by histologic types and air pollution indexes in Taiwan. Methods: Air pollution index data was from 70 air quality monitoring stations in different municipalities. We calculated the average air quality values (SO2, CO, O3, NOx, NO, and NO2) from the Taiwan environmental protection association (EPA) between 1994 and 1998. Patients with lung cancer were identified through the National Cancer Registration Program operated by the Taiwanese government. Two major pathological types were adenocarcinoma (AC) and squamous cell cancer (SCC). The Spearman’s correlation coefficients were to calculate the relationship between the air quality index and age-standardized incidence rate (ASR) of AC and SCC in both genders. We conducted 4 levels of analyses based on different NO concentrations (i.e., ≤ 5.590 ppb, 5.590-8.554 ppb, 8.554-13.536 ppb, > 13.536 ppb) when adjusting for NO2, CO, SO2, and O3, used Poisson Regression to estimate the relative risk of lung cancer. Results: The traffic-related NOx and NO showed significantly positive correlations with males (0.424 v.s. 0.434) and female (0.277 v.s. 0.369) AC type incidence rates. Using NO concentration ≤5.59 ppb as the baseline, the risk for AC among males at 5.59 < NO ≤ 8.554 ppb was 1.324 times of that at the baseline level (95% CI: 1.105-1.587), 1.332 times at 8.554 < NO ≤13.536 level (95% CI: 1.106- 1.606), 1.655 times when13.536 < NO (95% CI: 1.361-2.014). The test for trend was statistically significant at p < 0.0001. Similar results were observed among females with increasing NO concentration, the risk for AC went up 1.308, 1.273, and 1.535 times of the baseline level. The test for trend was highly significant at p < 0.0001. On the contrary, the results did’nt find any relationship between NO and SCC in both males and females. Conclusions: The results showed that a dose-response relationship between NO and lung AC incidence in both genders.

第一章、 前言
一、研究動機----------------------------------------------------------1
二、研究目的----------------------------------------------------------3
第二章、材料與方法----------------------------------------------------4
第三章、結果
一、男女性肺癌組織病理型態年齡標準化發生率分布圖----------------------8
二、縣市別機車密度與縣市別男女性全肺癌、肺腺癌及肺鱗狀細胞癌作之斯
皮爾曼(Spearman)相關係數分析----------------------------------------11
三、鄉鎮市空氣測站平均值與男女性全肺癌、肺腺癌及肺鱗狀細胞癌發生率
平均值之斯皮爾曼(Spearman)相關係數分析------------------------------11
四、男女性肺癌病理型態發生率與空氣污染之普瓦松(Poisson)複迴歸分析-----12
第四章、討論
一、肺癌組織病理型態與空氣污染之生態相關----------------------------14
二、研究限制--------------------------------------------------------17
第五章、結論--------------------------------------------------------18
參考文獻------------------------------------------------------------18
圖表目錄
台灣地區肺癌分佈地圖------------------------------------------------27
台灣地區肺癌組織病理型態分佈地圖------------------------------------29
台灣地區年齡分層肺癌分佈地圖----------------------------------------33
台灣地區年齡分層肺癌組織病理型態分佈地圖----------------------------39
1995-1998年肺腺癌與肺鱗狀細胞癌不同年齡層之個數與發生率比值---------51
斯皮爾曼(Spearman)相關係數分析---------------------------------------52
普瓦松(Poisson)複迴歸分析---------------------------------------------55

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