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研究生:鍾秉諺
研究生(外文):Chung,Ping-Yen
論文名稱:電鍍廠作業人員金屬暴露與代謝症候群
論文名稱(外文):Exposure to metals and metabolic syndrome in electroplating factory workers
指導教授:賴錦皇賴錦皇引用關係
指導教授(外文):Lai,Ching-Huang
口試委員:劉紹興賴錦皇陳韋良莊凱任莊校奇
口試委員(外文):Liu,shao-xingLai,Ching-HuangChen,Wei-LiangZhuang,Kai-RenZhuang,Xiao-Qi
口試日期:2017-05-15
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:2017
畢業學年度:105
語文別:中文
論文頁數:175
中文關鍵詞:電鍍金屬暴露胰島素阻抗代謝症候群
外文關鍵詞:ElectroplatingMetals exposureInsulin resistanceMetabolic syndrome
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台灣為電鍍業、皮革業等基礎工業發達之地區,在作業過程中會使用到大量金屬,其中以鎳、鉻金屬為主,這兩種金屬已被國際癌症研究中心列為致癌性物質,電鍍時暴露金屬會造成細胞產生氧化性傷害,進而影響胰島ẞ細胞分泌胰島素造成胰島素阻抗,漸漸演變成糖尿病及代謝症候群,高血壓與糖尿病一直是台灣的前十大死因,過去有文獻指出金屬與代謝症候群有相關性,但仍有部分金屬尚未確立,故本研究將探討電鍍廠勞工金屬暴露與胰島素阻抗及代謝症候群的相關性。
本研究採用橫斷性研究設計,選取四家工廠,共選取現場作業會暴露金屬之暴露組172人,辦公室行政人員為對照組84人,總計256人,收取問卷資料及血液尿液檢體,分析研究對象尿中金屬濃度後以SPSS 22版進行分析,評估胰島素阻抗使用HOMA-IR指標,並參考國民健康署公布之代謝症候群定義,探討尿中各金屬濃度與代謝症候群指標之相關性。
研究結果發現暴露組尿中釩(0.11 vs. 0.07 μg/g creatinine,p<0.001)、鐵(8.81 vs. 6.88 μg/g creatinine,p=0.03)、鎳(1.66 vs. 1.4 μg/g creatinine,p=0.02)、鋅(351 vs. 298.2 μg/g creatinine,p=0.002)共四種金屬濃度顯著高於對照組,另外邏輯斯迴歸分析結果發現,尿中鎳金屬每上升log10一個單位,發生胰島素阻抗的風險多了4.52倍(95%CI:1.04-19.63),尿中鎘與鉛同樣也達統計上顯著意義,鎘的OR值為6.03(95%CI:1.63-22.35)、鉛的OR值為31.44(95%CI:6.02-164.32);在代謝症候群邏輯斯迴歸結果為尿中釩(OR=6.23,95%CI:1.22-31.87)、銅(OR=588.9,95%CI:21.5-16092.1)、鋅(OR=10.6,95%CI:1.05-106.6)、硒(OR=0.02,95%CI:0-0.53)共四種金屬達顯著意義,而在多變項迴歸分析中,將金屬濃度與生化指標經對數轉換並校正性別、年齡等干擾因子後發現,尿中鎳、砷、鎘、鉛與HOMA-IR呈現顯著正向關係;尿中鋅、砷、鎘、鉛與空腹血糖呈現顯著正向關係;尿中釩、鉻、鎳、銅、鎘與三酸甘油脂呈現顯著正向關係;尿中銅、鉻、鉛與腰圍呈現顯著正向關係;尿中鉻與血壓也呈現顯著正相關;而與高密度脂蛋白膽固醇呈現顯著負向關係之金屬有釩、鎳、銅、鎘。
總結上述與胰島素阻抗及代謝症候群各指標相關之金屬,根據國民健康署公布代謝症候群之定義,將影響其中三項指標以上之金屬視為可能與代謝症候群有相關性,即鎳、銅、鉻、鎘、鉛,但未來仍需要再進一步使用世代研究法追蹤研究對象尿中之濃度變化,探討金屬與代謝症候群的因果關係,才能更確立此研究結果。

Taiwan has a high number of electroplating factories. Electroplating workers are exposed to a variety of metals as a result of their occupation. Exposure to metals has been shown to elevate oxidative stress in cells and induce insulin resistance. Previous research has also demonstrated an association between insulin resistance and metabolic syndrome. Therefore, we aim to determine whether there is an association between metals exposure and metabolic syndrome in electroplating workers.
We recruited 172 electroplating workers and 84 office workers from 4 factories. We collected background information from the participants using questionnaires, as well as urine and blood samples in the morning. Volunteers were required to fast overnight before samples were collected. We used the homeostatic model assessment of insulin resistance (HOMA-IR) to assess for insulin resistance, and criteria according to Health Promotion Administration of Taiwan to assess for metabolic syndrome.
Our study showed that urinary vanadium (0.11 vs. 0.07 μg/g creatinine, p<0.001), iron (8.81 vs. 6.88 μg/g creatinine, p=0.03), nickel (1.66 vs. 1.4 μg/g creatinine, p=0.02), and zinc (351 vs. 298.2 μg/g creatinine. p=0.002) concentrations in the exposed group are significantly higher than that of the reference group. Multivariate-linear regression showed that urinary nickel, arsenic, cadmium, lead concentrations have significant positive correlations with HOMA-IR, and urinary zinc, arsenic, cadmium, lead concentrations have significant positive correlations with fasting glucose levels. We also found that urinary vanadium, chromium, nickel, copper, and cadmium concentrations have significant positive correlations with triglyceride levels; urinary copper, chromium, and lead concentrations have significant positive correlations with waist circumference; and urinary chromium is significantly positively correlated to blood pressure. However, urinary vanadium, nickel, copper, cadmium concentrations were found to be significantly negatively correlated to high-density lipoprotein levels.
In conclusion, we find that urinary nickel, copper, chromium, cadmium, lead levels are associated with metabolic syndrome, and elevated concentrations of these five metals may induce metabolic syndrome.

第一章、緒論 1
第一節、研究背景 1
第二節、研究動機及重要性 6
第二章、文獻探討 9
第一節、金屬之健康危害 9
第二節、國內外法規標準 14
第三節、氧化性傷害之流行病學 18
第四節、胰島素阻抗 23
第五節、代謝症候群指標 26
第三章、研究目的與假設 28
第一節、研究目的 28
第二節、研究假設 29
第四章、研究材料與方法 30
第一節、研究架構及研究設計 30
第二節、研究對象 33
第三節、研究工具與步驟 36
第四節、品質管制步驟(QA/QC) 43
第五節、資料處理及統計分析 45
第五章、 研究結果 47
第一節、基本資料描述性檢定 47
第二節、胰島素阻抗與代謝症候群指標之描述與檢定 54
第三節、尿中金屬濃度與人口學分層分析HOMA-IR指標 61
第四節、尿中金屬濃度與人口學分層分析代謝症候群 64
第五節、尿中金屬與HOMA-IR及代謝症候群邏輯斯迴歸分析 67
第六節、尿中金屬與HOMA-IR及代謝症候群之多變項迴歸分析 72
第六章、 討論 78
第一節、胰島素阻抗之探討 78
第二節、尿中金屬濃度與代謝症候群之探討 81
第三節、研究優點 87
第四節、研究限制 88
第七章、 結論與建議 89
第一節、結論 89
第二節、建議 90
參考文獻 91


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