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研究生:周貽珊
研究生(外文):Chou, Yi-Shan
論文名稱:細懸浮微粒暴露與心血管疾病早期生物效應指標之相關研究
論文名稱(外文):The Relation between Fine Particles Exposure and the Early Biological Effects of Cardiovascular Disease
指導教授:賴錦皇賴錦皇引用關係劉紹興劉紹興引用關係
指導教授(外文):Lai, Ching-HuangLiou, Saou-Hsing
口試委員:賴錦皇劉紹興郭憲文唐進勝黃翰斌
口試委員(外文):Lai, Ching-HuangLiou, Saou-HsingKuo, Hsien-WenTang, Chin-ShengHuang, Han-Bin
口試日期:2014-05-22
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:113
中文關鍵詞:細懸浮微粒縱貫性研究個人採樣心血管疾病早期生物效應指標
外文關鍵詞:PM2.5Longitudinal StudyPersonal Environmental MonitoringEarly Biological Effects of Cardiovascular Disease
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背景:不論長期暴露於高濃度的懸浮微粒或短期暴露於交通空氣汙染,皆有研究發現會增加罹患動脈硬化及致命的心肌梗塞的風險,而心血管疾病早期生物效應指標發展應用在預測心臟病和腦中風發生的預測因素上,有助於及早評估可能的相關心血管疾病之風險及其早期預防。

目標:探討暴露於細懸浮微粒之民眾心血管疾病早期生物效應指標之情形及不同時點的暴露對早期效應指標之變化。

方法:本研究使用縱貫性研究設計,對象為大臺北地區A地工業區(32人)及B地住商混和區(50人)之居民,於研究開始及兩個月後實施追蹤量測,使用個人採樣器採集空氣樣本收集細懸浮微粒作為暴露評估指標,問卷調查個人習慣及健康狀態,採集血液進行生化值檢驗與心率變異分析儀量測受試者之心率變異情形。

結果:橫斷研究部分發現,於全體研究對象分析中,校正各因子後,除VCAM-1會增加,其他早期生物效應指標皆下降,但皆無顯著意義。於A地之分析中,在校正各因子後,每暴露10µg/m3之細懸浮微粒,其族群平均SDNN下降4.89ms,RMSSD下降4.40ms,並皆達顯著意義(95%C.I.: -8.37,-1.41, p<0.01及95%C.I.: -7.87,-0.94, p=0.01)。B地之縱貫研究部分發現,在校正相關因子後,每暴露10µg/m3之細懸浮微粒,隨著追蹤時間,其族群平均WBC下降0.33×103/µL, 並達統計上顯著意義 (95%C.I.:-0.59,-0.07, p=0.01)。

結論:橫斷研究部分,本研究發現健康人暴露細懸浮微粒後,在高濃度暴露地區,其SDNN及RMSSD可能受細懸浮微粒之影響較大。而縱貫研究部分則發現除WBC外,其他心血管疾病早期生物效應指標並不會隨時間及暴露濃度有顯著變化。

Epidemiological studies found that due to particles its aerodynamic particle size affects the deposition site, its different chemical composition will cause different health effects; studies indicate fine particle exposure may increase the risk of cardiovascular disease and death. The purpose of this study was to investigate the general population exposure to fine particles and the relation with early biological effects of cardiovascular disease.

For this longitudinal study, we recruited 82 subjects from 2 different areas (Area A [residential and commercial area] and Area B [industrial area]) in Taipei Metropolitan at baseline. We used personal samplers to collect 24 hours PM2.5 exposure samples. The study population underwent an interview and a health examination on the next day morning, where blood and urine samples were collected. All of subjects were repeated measured after two months for two times of follow-up. Our current aim was to investigate the relation between fine particlces exposure and cardiovascular disease markers and heart rate variability.

After adjusted for confounding factors, except for VCAM-1, all cardiovascular biomarkers (Hs-CRP, Fibrinogen, WBC, Platelet) of early biological effects have negative relation but no statistically significant with PM2.5 exposure levels. In addition, after adjusting for confounding factors, every 10μg/m3 fine particles exposure levels increased, SDNN declined 4.89 ms (95%CI, -8.37~-1.41, p<0.01), while RMSSD decreased 4.40 ms (95% CI, -7.87~-0.94, p=0.01), and there were no significant findings between early biological effects and PM2.5 in this longitudinal analyses.

目錄 I
表目錄 III
圖目錄 V
附錄目錄 VI
摘要 VII
Abstract VIII
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機與重要性 3
第三節 研究目的 4
第二章 文獻探討 5
第一節 細懸浮微粒來源 5
第二節 各國規範與暴露評估 7
第三節 細懸浮微粒進入人體之途徑 9
第四節 細懸浮微粒誘發急性心血管效應之可能機制 11
第五節 動脈粥狀硬化之發展 12
第六節 心血管疾病早期生物效應指標 14
第七節 流行病學研究 19
第三章 研究方法 22
第一節 研究設計與架構 22
第二節 研究對象 25
第三節 研究方法與工具 26
第四節 Quality Assurance/ Quality Control(QA/QC) 29
第五節 資料處理及統計方法 34
第四章 研究結果 35
第一節 研究對象描述性統計與檢定 35
第二節 研究對象細懸浮微粒暴露情形之描述與檢定(橫斷) 39
第三節 心血管疾病早期生物效應指標之描述與檢定(橫斷) 40
第四節 細懸浮微粒暴露與心血管疾病早期生物效應指標之相關矩陣 47
第五節 研究對象細懸浮微粒暴露於追蹤期間內變化之描述 48
第五章 討論 50
第一節 研究對象之選取與研究效度 51
第二節 研究對象細懸浮微粒暴露情形 52
第三節 細懸浮微粒暴露與心率變異相關之探討 53
第四節 細懸浮微粒暴露與凝血相關因子及發炎反應指標之探討 55
第五節 細懸浮微粒暴露與沾黏分子相關之探討 56
第六節 研究限制 57
第六章 結論 58
第一節 研究結論 58
第二節 建議 59
參考文獻 60

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