臺灣博碩士論文加值系統

根據很多流行病學的研究中已經確認游離輻射被認為是人類的致癌因子。游離輻射可以分成天然的游離輻射與人為的游離輻射兩大類。醫療之游離輻射暴露是人為的游離輻射來源之一。因為醫療科技的發展，醫療輻射暴露越來越多，胚胎時期暴露在診斷性放射線之下已知會造成兒童時期的癌症發生增加，特別在白血病有較明顯的效應。雖然在懷孕時期的診斷性放射線暴露已經越來越少，但是對於輻射易感性相對高的兒童，越來越大量的使用電腦斷層之診斷性放射線工具，醫療性輻射暴露所可能造成的風險考量卻越來越高，在英國與澳洲的研究皆指出兒童時期電腦斷層之暴露，可能會引起白血病、腦瘤、消化系統癌症、女性生殖道癌症、軟組織癌症、泌尿道癌症、甲狀腺癌之增加。本研究欲探討在台灣，兒童時期診斷性電腦斷層之暴露與兒童時期癌症發生之間的相關性。
本研究使用國家衛生研究院發行之健保資料庫中重大傷病檔與西元2000年百萬歸人檔進行病例對照研究。利用西元1997年至西元2010年間具有重大傷病之個案醫療紀錄，選出西元1997年至西元2000年間出生並診斷為癌症之個案(ICD9 code= 140~ 208) 作為個案組。每個病例組以配對六位相同年齡與性別之無重大傷病紀錄者為對照組，白血病組計算發病前兩年之電腦斷層次數，其他腫瘤計算發病前五年之電腦斷層數作為暴露評估。自健保資料庫中，我們選取了1383位於西元1997年至2010年間被診斷為癌症的病例組，其中男生738位 (53.4% )，女生645位 (46.6%)。其中共有62人(4.5%)暴露電腦斷層共計87次。對照組共8298人，共有135人(1.6%)暴露電腦斷層共計143次，電腦斷層暴露與癌症發生之罹病勝算比為2.60 (95% C.I：1.90~3.96)，其中淋巴性白血病組，電腦斷層暴露之罹病勝算比為2.51 (95% C.I：1.36~4.64)、腦瘤組中電腦斷層暴露之罹病勝算比為2.45(95% C.I：1.17~5.17)、骨髓性白血病組電腦斷層暴露之罹病勝算比為6.12(95% C.I：2.71~13.81)、非何杰金氏淋巴瘤組電腦斷層暴露之罹病勝算比為3.17 (95% C.I：1.24~8.07)。縱膈腔、心臟、胸腺惡性腫瘤組電腦斷層暴露之罹病勝算比為37.31(95% C.I：1.61~866.1)，不過可能是因為個案數較少產生之結果。本研究中可以觀察到兒童時期電腦斷層之暴露，會增加兒童時期癌症的發生，雖然目前國內兒童使用電腦斷層檢查之情況沒有增加，但對於電腦斷層檢查之使用應該還是要依循一定的臨床指引，盡可能盡量降低每次電腦斷層檢查之游離輻射暴露劑量。

We conducted a case-control study using the National Health Insurance Research Database from 1997 to 2010 to assess the risk of developing cancer in children with exposures to computed tomography scans in Taiwan. The Odds ratios of computed tomography scans in total cancer were 2.60 (95% C.I：1.90~3.96)、2.51 (95% C.I：1.36~4.64) in lymphoid leukemia、2.45(95% C.I：1.17~5.17) in brain tumor、6.12 (95% C.I：2.71~13.81 ) in myeloid leukemia and 3.17 (95% C.I：1.24~8.07 ) in non- Hodgkin's lymphoma. From our study, we have shown that childhood exposure to computed tomography scans increased child malignancy. Although the computed tomography scans have not increased in frequency in the past ten years, computed tomography scans should be limited to situations where there is a definite clinical indication, thus decreasing the risks of radiation exposure dose to young aged patients.

第一章 研究背景 1
第二章 文獻探討 3
第一節 游離輻射的健康效應 3
第二節 游離輻射與癌症的風險 5
壹、 車諾堡及三浬島核電廠研究 5
貳、 日本原子彈爆炸生還者研究(Life span study) 6
參、 台灣輻射鋼筋建築之研究 7
肆、 職業暴露族群之研究 8
伍、 醫療輻射暴露之研究 8
第三節 診斷用輻射線暴露現狀 10
第四節 兒童期診斷用輻射線暴露與癌症之關係 11
壹、 胚胎時期診斷性放射線暴露 12
貳、 兒童時期暴露診斷性放射線之健康效應 13
參、 兒童時期電腦斷層暴露與癌症 13
第三章 研究動機與重要性 15
第一節 本研究重要性 15
第二節 研究目的 15
第三節 研究架構 16
第四章 材料與方法 17
第一節 研究設計與架構 17
第二節 研究資料來源與選取條件 18
壹、 全民健康保險研究資料庫 18
貳、 病例組來源 18
參、 對照組來源 19
肆、 資料選取 19
伍、 暴露評估 19
第三節 統計分析 20
第五章 研究結果 22
第一節 病例組基本人口學變項 22
第二節 病例組電腦斷層暴露評估 24
第三節 對照組電腦斷層暴露評估 25
壹、 電腦斷層暴露族群評估 25
貳、 對照組電腦斷層暴露評估 26
第四節 電腦斷層暴露與癌症發生相關性 27
第六章 討論 29
第一節 病例組代表性 29
第二節 兒童時期電腦斷層暴露 30
第三節 兒童時期暴露電腦斷層與癌症之關係 31
第四節 淋巴瘤 33
第五節 縱膈腔、心臟、胸腺腫瘤 34
第六節 與其他文獻比較 35
第七章 結論與建議 36
第一節 結論 36
第二節 限制與建議 36
第八章 參考文獻 39

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陳詠宸：台灣兒童癌症發生綠之流行病學研究，國立國防醫學院公共衛生研究所 碩士論文，2009。
林仁祥：台灣地區醫療診斷用放射檢查情形暨群體劑量推估，慈濟大學公共衛生 研究所碩士論文，2008。
陳清江 黃景鐘 葉錦勳：台灣地區天然背景輻射介紹，物理雙月刊（廿三卷三期）2001年6月。