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研究生:翁怡莘
研究生(外文):Yi-SinWong
論文名稱:職業暴露於低劑量游離輻射員工與血液學變化之關係
論文名稱(外文):The relationship between workers with occupational exposure to low-dose ionizing radiation and changes in the hematological profiles
指導教授:郭浩然郭浩然引用關係
指導教授(外文):How-Ran Guo
學位類別:碩士
校院名稱:國立成功大學
系所名稱:環境醫學研究所
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:2016
畢業學年度:104
語文別:英文
論文頁數:42
中文關鍵詞:職業輻射甲狀腺荷爾蒙血液學
外文關鍵詞:occupationradiationthyroid hormonehematological profile
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目的: 評估工作中長期暴露於低劑量游離輻射可能造成血液學以及甲狀腺荷爾蒙的變化,並了解其變化是否會隨著暴露時間增加而有劑量效應關係。
方法: 在研究1我們收集2005年至2014年於嘉義基督教醫院工作且工作超過10年之員工,將工作中會暴露輻射之相關工作者為實驗組以及非游離輻射暴露相關員工為控制組,收集兩組的健康檢查報告,排除病史中有癌症、自體免疫疾病、以及有肝硬化或是腎臟疾病的員工。並選擇健康檢查報告中之白血球、紅血球、血小板以及血紅素,以重複測量變異數分析的方法比較兩組間血液學變化之差異。研究2我們收集2002至2013年於嘉義基督教醫院游離輻射區工作之員工,且工作超過2年之員工健康檢查報告;研究3則收集2007至2011年於蘭嶼核廢料儲存場且工作2年以上之員工健康檢查報告,研究2及研究3皆排除病史中有癌症、自體免疫疾病、以及系統性疾病之個案,並使用廣義估計方程式去分析甲狀腺荷爾蒙是否會隨著暴露游離輻射之工作年數增加而有變化。
結果: 研究1比較69位實驗組與74位控制組,發現兩組間白血球、紅血球、血小板以及血紅素之變化並無顯著差異。而研究2則發現在326名醫院輻射相關工作之員工在T3以及T4有顯著工作年份而下降,TSH則無顯著差異。此外研究3則發現蘭嶼核廢料儲存場員工之T4有隨著時間顯著下降,但在T3以及TSH則無顯著變化。
結論: 職業暴露於低劑量游離輻射可能會導致甲狀腺荷爾蒙變化,即便在暴露量低於背景輻射值之醫院員工,仍有發現隨著暴露年份增加與T3以及T4下降有顯著的劑量效應關係。甲狀腺荷爾蒙變化對於輻射暴露造成之影響較血液學變化敏感,可以在疾病發現前作為早期良好的生物偵測指標,但也代表即便是工作中低劑量游離輻射暴露且在良好的輻射防護下仍有可能造成健康影響。

Objectives: To evaluate possible changes in the hematological profiles and serum-thyroid hormones of workers with long-term exposure to low-dose ionizing radiation, and determine whether there is a dose-response effect according to exposure duration.
Methods: In study 1, we collected health examination reports from employees who worked near radiation source for more than 10 years in Chiayi Christian Hospital during 2005 to 2014 as case group. In addition, we also selected workers but who were not working on radiation-related jobs in the same hospital as control group. We excluded those with a history of cancer, autoimmune disease, anemia, liver cirrhosis or renal disease. White blood cell count, red blood cell count, platelet count and hemoglobin were selected from reports of health examination in both group, and we used repeated measure ANOVA to compare the difference of hematological changes between case and control group. In study 2, we collected reports of health examination from employees who worked on radiation-related jobs at Chia-Yi Cristian Hospital for more than 2 years during 2002 to 2013. Similarly, we collected health examination reports from workers in Lan-Yu nuclear waste deposal for more than 2 years during 2007 to 2011 in study 3. We excluded those with a history of cancer, autoimmune disease, and systemic diseases, such as liver cirrhosis or end-stage renal disease in study 2 and study 3. Then we analyzed thyroid hormones in the health-examination reports to determine whether the changes in serum-thyroid hormones were related to exposure duration, and the generalized estimating equation for repeated measures with thyroid hormones was used to examine the association between working years and ionizing radiation exposure both in study 2 and study 3.
Results: In study 1, there were no significant differences in the changes of white blood cell count(WBC), red blood cell count(RBC), platelet and hemoglobin(Hb) between case group (n=69) and control group (n=74). In study 2, 326 hospital workers with low-dose radiation exposure were included, and significant declines of Triiodothyronine(T3) (odds ratio, 0.96; 95% confidence interval, 0.96–0.97) and Thyroxine(T4) (odds ratio, 0.89; 95% confidence interval, 0.87–0.91) after occupational exposure to low-dose ionizing radiation were found. Additionally, a significant linear dose-response relationship was observed between exposure duration and the decline in the serum concentrations of T3 and T4. However, there is no significant dose-response relationship between exposure duration and the decline in the serum concentrations of TSH except technician group (odds ratio, 0.96; 95% confidence interval, 0.92–1.0). Moreover, there is significant decline in serum concentration of T4 in workers in Lan-Yu nuclear waste deposal, but there are no significant findings in changes of T3 and TSH in the study 3.
Conclusion: Long-term working n radiation-related job might induce decline of thyroid hormones. Despite the healthcare workers having an extremely low radiation-exposure dose, there was still a dose-response relationship between occupational exposure to ionizing radiation and the decline in the serum concentrations of T3 and T4. This indicates that the serum concentration of thyroid hormones was more sensitive than hematological profiles, and it could be used as early-detection biomarkers for radiation exposure before thyroid disease arises. Accordingly, these results suggest we should reconsider the health impacts of occupational exposure to radiation and provide more protection in the workplace.

Table of Contents

中文摘要 I
Abstract II
誌謝 (Acknowledgement) IV
Table of Contents V
List of Tables VII
List of Figures VIII
1. Introduction 1
1.1 Radiation and hematopoietic system 1
1.2 Physiology of Thyroid 1
1.3 Radiation-related hypothyroidis 1
2. Study 1: Difference of hematological changes
between health care workers whose work were near
radiation and control group 2
2.1 Methods 2
2.1.1 Patient characteristics 2
2.1.2 Statistical Analysis 3
2.2 Results 3
3. Study 2: The relationship between health care
workers with occupational exposure to low-dose
ionizing radiation and changes in thyroid
hormones 4
3.1 Methods 4
3.1.1 Patient characteristics 4
3.1.2 Statistical analysis 5
3.2 Results 5
4. Study 3: The relationship between workers of
nuclear waste deposal with occupational exposure
to low-dose ionizing radiation and changes in
thyroid hormones 6
4.1 Methods 6
4.1.1 Patient characteristics 6
4.1.2 Statistical analysis 7
4.2 Results 7
5. Discussion 8
5.1. Occupational exposure to radiation and
hematological change 8
5.2. Thyroid diseases in radiation exposure related
workers 9
5.3. Whether thyroid hormones change with aging 10
5.4. The relationship between radiation exposure and
hypothyroidism 11
6. Limitations 13
7. Conclusion 13
8. Reference 14


List of Tables

Table 1. Characteristics of workers with radiation-related job and workers whose work not near radiation source exposure to radiation-related job in study 1 17
Table 2. Mean value of hematological profiles in case group and control group in study 1 18
Table 3. Characteristics of workers with radiation-related job in Chia-yi Cristian Hospital in the study 2 19
Table 4. Final multivariate generalized estimating equation (GEE) analysis for change of T3 in the 326 radiation-exposure related workers in Chia-yi Cristian Hospital (Study 2) 20
Table 5. Final multivariate generalized estimating equation (GEE) analysis for change of T4 in the 326 radiation-exposure related workers in Chia-yi Cristian Hospital (Study 2) 21
Table 6. Final multivariate generalized estimating equation (GEE) analysis for change of TSH in the 326 radiation-exposure related workers in Chia-yi Cristian Hospital (Study 2) 22
Table 7. Characters of workers from nuclear waste deposal at Lanyu in the study 3 23
Table 8. Final multivariate generalized estimating equation(GEE) analysis for change of T3 in workers of nuclear waste deposal at Lanyu (Study 3) 24
Table 9. Final multivariate generalized estimating equation(GEE) analysis for change of T4 in workers of nuclear waste deposal at Lanyu (Study 3) 25
Table 10. Final multivariate generalized estimating equation(GEE) analysis for change of TSH in workers of nuclear waste deposal at Lanyu (Study 3) 26


List of Figures

Figure 1. Flowchart of study 1 27
Figure 2. Difference of hematological changes between case group and control group in study 1 28
Figure 3. Flowchart of study 2 29
Figure 4. Trend line showing the changes in mean T3 levels for overall and both gender groups in Chia-yi Cristian hospital (Study 2) 30
Figure 5. Trend line showing the changes in mean T3 levels for each type of workers in 31
Figure 6. Trend line showing the changes in mean T4 levels for overall and both gender groups in Chia-yi Cristian hospital (Study 2) 32
Figure 7. Trend line showing the changes in mean T4 levels for each type of workers in 33
Figure 8. Trend line showing the changes in mean TSH levels in overall and both gender groups in Chia-yi Cristian hospital (Study 2) 34
Figure 9. Trend line showing the changes in mean TSH levels for each type of workers in Chia-yi Cristian hospital (Study 2) 35
Figure 10. Flowchart of study 3 36
Figure 11. Trend line showing the changes in mean T3 levels for overall and each age groups in Lan-Yu nuclear waste deposal (Study 3) 37
Figure 12. Trend line showing the changes in mean T3 levels for the 2 different exposure duration groups in Lan-Yu nuclear waste deposal (Study 3) 38
Figure 13. Trend line showing the changes in mean T4 levels for overall and each age groups in Lan-Yu nuclear waste deposal (Study 3) 39
Figure 14. Trend line showing the changes in mean T4 levels for the 2 different exposure duration groups in Lan-Yu nuclear waste deposal (Study 3) 40
Figure 15. Trend line showing the changes in mean TSH levels for overall and each age groups in Lan-Yu nuclear waste deposal (Study 3) 41
Figure 16. Trend line showing the changes in mean TSH levels for the 2 different exposure duration groups in Lan-Yu nuclear waste deposal (Study 3) 42









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