臺灣博碩士論文加值系統

背景
六輕工業區為1999年開始運轉於雲林縣之石化工業區，過去的研究發現六輕工業區附近成人除了尿中重金屬濃度顯著較高，全癌症之罹癌風險比亦顯著偏高。然而，目前對於六輕工業區鄰近孩童的暴露及健康效應之研究較少，因此本研究的目的即為探討鄰近六輕工業區附近孩童的空氣汙染暴露及過敏、呼吸道疾病的情形。
材料與方法
本研究的研究區域將鄰近六輕工業區之雲林縣 9 個鄉鎮，分為高暴露區−距離六輕工業區 10 公里內的鄉鎮包含台西鄉、麥寮鄉及東勢鄉，低暴露區則為10公里 外的鄉鎮−二崙鄉、崙背鄉、虎尾鎮、褒忠鄉、四湖鄉及元長鄉。本研究之研究期間為 1999-2010，將此期間分為六輕工業區營運後 4 年間(1999-2002)、營運後 8 年間(1999-2006)與營運後 12 年間(1999-2010)探討各種健康效應之罹病情形。研究對象為沿海地區空氣污染物及環境健康世代研究計畫 2009-2011 建立之健康世代中收案時滿 11-14 歲的孩童共 587 位。為探討孩童之急性健康效應，本研究將二氧化硫及 重金屬作為工業區暴露的指標，以台西測站為高暴露區暴露情形之代表測站，低暴露區則以崙背測站為代表測站，探討 1995 年起二氧化硫年超過 75ppb的小時數及三年移動平均 99 百分位濃度之急性暴露情形是否在高低暴露區間有顯著差異。
本研究將2009-2011採集參與者之尿液，以感應耦合電漿質譜儀(ICP-MS)進行重 金屬分析，分析尿中釩、銅、砷、鍶、鎘、汞、鉈及鉛的濃度作為近年來短期暴露的指標。為了解這些孩童在六輕工業區營運後氣喘、過敏性鼻炎及支氣管炎的罹病情形，本研究串聯研究個案於衛生福利部所記錄之中西醫門診檔，定義不同期間氣喘(ICD-9:493.x)、過敏性鼻炎(ICD-9:477.x)及支氣管炎(ICD-9:490.x-491.x)之門診次數超過3次者為罹病者，計算1999年起這些疾病之累積盛行率。本研究以 t-test 分析高低暴露區測站間二氧化硫之三年 99 百分位濃度差異；以卡方檢定計算兩測站間每年超過 75ppb 的小時數；以共變異數分析(ANCOVA)將尿中重金屬濃度校正性別、年齡以及收案時詢問之生活習慣如抽菸習慣、喝酒習慣、食用檳榔習慣、燒香拜拜習慣、蚊香使用習慣、食用魚類習慣、飲水習慣、二手煙暴露情形及鄰近大馬路與否進行探討高低暴露區間之濃度差異；以羅吉斯迴歸分析校正性別、年齡及生活習慣探討高低暴露區間氣喘、過敏性鼻炎及支氣管炎之罹病風險比。
結果
本研究發現高暴露區大氣中二氧化硫濃度在 2000 年前無小時濃度高於 75ppb，但 2001 後逐年皆有小時值高於 75ppb，至 2005 年則達到 61 小時/年；相對於言，低暴露區在 1995-1998 年都有小時值高於 75ppb，但在六輕工業區營運後除了2005 年外，無小時值超過 75ppb。分析兩測站三年 99 百分位濃度發現，高暴露區之三年 99 百分位濃度由 2001 年開始顯著高於低暴露區，在 2001-2010 年間，高暴露區之 三年 99 百分位濃度為 49.6-137.3ppb，低暴露區則為 17.6-31.6ppb，高低暴露區間的差異最大為 5 倍以上。
這 587 位孩童在高暴露區共 216 位在 2009-2011 年收案時平均年齡為 13.59 ± 0.69 歲；低暴露區共 371 位收案時平均年齡為 13.68 ± 0.70 歲。在 2009-2011 年，高暴露區孩童之尿中釩、銅和汞濃度在校正過年齡、性別、抽菸習慣、喝酒習慣、吃檳榔習慣、飲水飲食習慣及鄰近大馬路等變項，顯著高於低暴露區孩童。高暴露區孩童之尿中釩平均濃度為 1.01 ± 1.40μg/g creatinine，低暴露區孩童之尿中釩平均濃度為 0.65 ± 0.58μg/g creatinine；高暴露區孩童之尿中銅平均濃度為 13.61 ± 10.36μg/g creatinine，低暴露區孩童之尿中銅平均濃度為 12.26 ± 11.82μg/g creatinine；高暴露 區孩童之尿中汞平均濃度為 2.54 ± 2.20μg/g creatinine，低暴露區孩童之尿中汞平均 濃度為 2.06 ± 2.41μg/g creatinine。
這 587 位孩童在六輕工業區營運後 4 年間平均年齡為 2.65 歲、營運後 8 年平均年齡為 6.65 歲、營運後 12 年平均年齡為 10.65 歲。以卡分檢定分析，孩童之氣喘累積盛行率在六輕工業區營運後 4 年間有區域間的顯著差異，氣喘之累積盛行率在營 運後 4 年間為 18.52%，低暴露區則為 11.04%；孩童之過敏性鼻炎累積盛行率在六 輕營運後 4 年、8 年及 12 年間皆有區域間顯著差異，高暴露區過敏性鼻炎之累積盛 行率在營運後 4 年間為 26.85%，低暴露區為 9.43%；孩童之支氣管炎累積盛行率在 六輕營運後 4 年及 8 年間有區域間顯著差異，高暴露區支氣管炎之累積盛行率在4 年間為 8.33%，低暴露區為 3.50%。以羅吉斯迴歸分析校正年齡、性別、二手菸暴露、鄰近大馬路與否及室內空氣品質變項，高暴露區孩童過敏性鼻炎之罹病風險比 在六輕營運後 4 年間、8 年間及 12 年間皆有區域間顯著差異；高暴露區孩童在六輕營運後 4 年間過敏性鼻炎之罹病風險比為低暴露區孩童之 3.53 倍(95%CI=2.14-5.83)；高暴露區孩童支氣管炎之罹病風險比在六輕營運後 4 年間及 8 年間皆有區域間顯著差異，高暴露區孩童支氣管炎之罹病風險比為低暴露區孩童之 3.05 倍(95%CI=1.37-6.78)；高暴露區孩童氣喘之罹病風險比邊緣顯著高於低暴露區孩童。
結論
本研究發現高暴露區附近空氣中二氧化硫濃度自六輕工業區營運後至 2010 年皆顯著高於低暴露區；高暴露區鄰近孩童尿中釩、銅和汞在營運後 12 年間亦顯著高 於低暴露區；高暴露區之孩童的過敏性鼻炎罹病風險比顯著高於低暴露區的孩童至 營運後 12 年間，高暴露區之孩童支氣管炎之罹病風險比顯著高於低暴露區至營運後8 年間，而高暴露區孩童之氣喘罹病風險比則邊際顯著高於低暴露區的孩童。

Background: The No. 6 Naphtha Cracker Complex is a petrochemical factory which is located in Yunlin county. Previous studies have found that adults living near the complex had higher exposure of heavy metals and cancer incidence rate. Limited studies for children have been done. The purpose of the study is to investigate the air pollution, atopic and respiratory diseases of children living in the vicinity of the No. 6 Naphtha Cracker Complex.
Materials and Method: Our study area included 9 townships in Yunlin county near the No. 6 Naphtha Cracker Complex. We classified Taisi, Mailiao and Dongshih townships which were within 10km radius of the complex as high exposure (HE) area while we classified Erlun, Lunbei, Huwei, Baojhong, Sihhu and Yuanchang townships which were above 10km radius of the complex as low exposure (LE) area. We classified our study period from 1999 to 2010 as 4, 8 and 12 years after operation of the complex. Our study subjects was aged 11-14 years old in 2009-2011.Concentrations of sulfur dioxide (SO2) were measured at Taisi and Lunbei air quality monitoring stations which used to represent air pollution in HE and LE areas. The numbers of hourly SO2 concentration above 75 ppb and three-year moving average 99th percentile of SO2 concentration were used to represent acute exposure from the complex of our study subjects. During 2009-2011 survey, levels of urinary V, Cu, As, Sr, Cd, Hg, Tl and Pb analyzed by inductively coupled plasma mass spectrometer (ICP-MS) were used to reflect current exposure of children from the complex. Our study selected asthma (ICD-9:493.x) , allergic rhinitis (ICD-9:477.x) and bronchitis (ICD-9:490.x-491.x) recorded by National health insurance research databases. Children with up than 3 times of code records within study period were used to calculate accumulated prevalence rates of these diseases in high and low exposure area over 3 periods. T-test and chi-square test were used to determine difference of SO2 pollution and accumulated prevalence rates of diseases between HE and LE areas. ANCOVA test was used to determine difference of heavy metal exposure after we adjusted age, gender, personal behaviors such as smoking, drinking, betel nut eating, incense burning, mosquito incense burning, fish eating, water drinking and passive smoking. Logistic regression was used to estimate odds ratio of asthma, allergic rhinitis and bronchitis after adjusting by age, gender and personal behaviors.
VII

Result: Our study found that SO2 concentrations in HE area were significantly higher than those in LE area from 2001 to 2010.In 2009-2011, our study subjects in HE and LE area aged at 13.59 ± 0.69 and 13.68 ± 0.70 years old respectively. Children in HE area had significantly higher urinary V, Cu and Hg levels than children in LE area after a djusted age, gender and personal behaviors. Their average concentrations in HE and LE area were:1.01 ± 1.40 and 0.65± 0.58μg/g creatinine respectively for V; 13.61 ± 10.36 and 12.26 ± 11.82 μg/g creatinine respectively for Cu; 2.54 ± 2.20 and 2.06 ± 2.41 μg/g creatinine respectively for Hg. Retrospectively, our study subjects average at 2.65, 6.65 and 10.65 years old in 4, 8 and 12 years after operation of the complex respectively. Asthma’s accumulated prevalence rate of children in HE area (18.52%) was significantly higher than children in LE area (11.04%) in 4 years after operation of the complex; Allergic rhinitis’s accumulated prevalence rates of children in HE area (26.85%, 35.65%, 41.67%) were significantly higher than children in LE area (9.43%, 14.56%, 24.26%) in 4, 8 and 12 years respectively after operation of the complex; Bronchitis’s accumulated prevalence rates of children in HE area (8.33%, 8.80%) were significantly higher than children in LE area (3.50%, 4.60%) in 4 and 8 years after operation of the complex. Logistic regression found the odds ratio of children in HE area’s asthma was 1.63 (95%CI:0.96-2.78) times significantly higher than children in LE area in 4 years after operation of the complex.; allergic rhinitis of odds ratio for children in HE area were, 3.53 (95%CI:2.14-5.83), 2.99 (95%CI:1.92-4.66), 2.07 (95%CI:1.38-3.11) times significantly higher than children in LE area respectively in 4, 8 and 12 years after operation of the complex; bronchitis of odds ratio for children in HE area were, 3.05 (95%CI:1.37-6.78) and 2.27 (95%CI:1.10-4.70) times significantly higher than children in LE area in 4 and 8 years after operation of the complex respectively.
Conclusion: Our study found higher SO2 concentrations in the air near the No. 6 Naphtha cracker complex from operation of the complex until now. Higher urinary V, Cu and Hg of children in HE area were also found. Children in HE area had significantly higher odds ratios of allergic rhinitis and bronchitis until respectively 12 and 8 years after operation of the complex. Marginally difference of asthma were found between HE and LE area.

誌謝 I
中文摘要 IV
Abstract VII
目錄 IX
第 1 章 前言 1
1.1 研究背景 1
1.2 研究目的 3
第 2 章 文獻探討 5
2.1 六輕工業區營運期程 5
2.2 國內外石化工業區鄰近地區之環境暴露評估 6
2.3 國內外石化工業區鄰近居民之尿中重金屬研究 10
2.4 重金屬相關之毒理研究 13
2.5 國內外石化工業區鄰近居民之過敏與呼吸道疾病相關研究 18
第 3 章 材料與方法 23
3.1 研究設計及架構 23
3.2 研究區域 25
3.3 六輕工業區附近空氣品質監測站歷年監測資料分析 27
3.3.1 空氣品質監測站介紹 27
3.3.2 空氣品質監測站監測汙染物 29
3.3.3 數據及統計處理 30
3.4 研究對象及收案流程 30
3.5 六輕工業區附近孩童尿中重金屬暴露評估 32
3.5.1 尿中重金屬分析 33
3.5.2 數據及統計處理 38
3.6 六輕工業區附近孩童歷年之過敏與呼吸道疾病評估 39
3.6.1 健保資料庫簡介 40

3.6.2 疾病定義及分類 41
3.6.3 疾病分期與累積盛行率、罹病風險比定義 42
3.6.4 數據及統計處理 42
第 4 章 研究結果 43
4.1 六輕工業區鄰近空氣品質監測站二氧化硫濃度分析 43
4.2. 六輕工業區鄰近孩童基本資料及生活習慣描述 46
4.2.1 孩童之基本資料 46
4.2.2 孩童之生活習慣及室內空氣品質資料 47
4.3 六輕工業區鄰近孩童尿中重金屬暴露評估 50
4.4 六輕工業區鄰近孩童過敏與呼吸道疾病評估 52
4.4.1 各期間之區域累積盛行率比較 52
4.4.2 累積盛行率之迴歸分析 57
第 5 章 討論 61
5.1 六輕工業區鄰近空氣品質監測站二氧化硫濃度討論 61
5.2 六輕工業區鄰近孩童尿中重金屬濃度暴露討論 65
5.3 六輕工業區鄰近孩童過敏、呼吸道疾病討論 67
5.4 研究限制 71
第 6 章 結論與建議 72
參考文獻 74
附錄 尿液中重金屬分析之 ICP-MS 上機作業程序 80

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