臺灣博碩士論文加值系統

背景與目的
垃圾焚化爐在燃燒的過程中易排放金屬汙染物，造成附近居民健康的影響。本研究目的在探討某焚化爐附近居民金屬的生物偵測、氧化性壓力與腎損傷之相關性。
材料與方法
本研究為橫斷性研究，並依民眾居住焚化爐距離遠近，將國小學童及其家長分為暴露組與非暴露組。使用問卷收集基本人口學變項，並以ICP-MS分析受測者尿液及指甲九種金屬濃度 (As, Cd, Cr, Cu, Hg, Ni, Pb, Se, Zn)。總共收集學童及家長有效問卷份數共215份，尿液樣本共233件，指甲樣本共129件。以NAG (N-Acetyl-β-D-glucosaminidase)當作評估腎損傷指標，利用ELISA分析氧化壓力指標8-isoprostane之濃度。統計方法使用SAS9.4版進行分析。
結果
暴露組學童在尿液中鎘、鋅與硒金屬濃度顯著高於對照組學童，但在對照組學童之鉻、汞金屬濃度則有顯著性偏高。暴露組家長在尿中鎘、硒及鋅濃度有顯著高於對照組的家長，在尿中鉻及汞則反之。對照組學童與家長在指甲鎘元素濃度則有顯著性偏高。以線性複迴歸分析控制其它變項後，學童尿液金屬濃度與8-isoprostane及NAG的相關性均高於指甲金屬，且均呈現正相關。家長部分尿液及指甲重金屬濃度與其NAG有顯著正相關。此外，利用羅吉斯複迴歸分析得知暴露組學童在NAG及8-isoprostane勝算比分別為4.269 (95% CI:2.144 – 8.922) 及14.154 (95% CI:5.698 – 35.162) 均高於對照組。
結論
研究結果得知住在焚化爐附近學童其生物檢體中金屬濃度偏高，且與氧化壓力指標與腎功能指標均呈現正相關，有可能與其暴露焚化爐排放金屬濃度有關。因此，環保機關應加強管制焚化爐排放金屬汙染量，及早發現汙染物散播途徑，有效降低焚化爐附近居民暴露重金屬汙染之健康危害。

Background and purpose
Metals are frequently emitted from waste incinerator and cause adverse health effects for residents living nearby incinerator. The aim of this study was to investigate the metals in biological specimens associated with oxidative stress and renal damage among residents nearby a waste incinerator.
Material and Methods
Our study design is cross-sectional study. According to the distance from their residence to the waste incinerator, all participants from elementary school students and their parents were divided into exposure group and non-exposure group. Questionnaire and biological specimens were collected from each participants. Inductively coupled plasma mass spectrometry (ICP-MS) was used to analyze levels of nine metals in urine and fingernail, including 9 metals (As, Cd, Cr, Cu, Hg, Ni, Pb, Se and Zn). We collected 215 valid questionnaires, 233 urine samples and 129 nail samples from adults and schoolchildren. Urinary NAG (N-Acetyl-β-D-glucosaminidase) was used as biomarker of renal damage and urinary 8-isoprostane was acted as oxidative stress. Statistical methods were analyzed using SAS version 9.4.
Results
Significant elevated levels of Cd, Se and Zn in urine, NAG and 8-isoprostanewere found among students in exposure groups. However, there are significant elevated levels of Cr and Hg in urine and Cd in nail in control group (p value<0.05) Among their parents, urinary Cr level, and nail Cd and Pb levels in control group had higher than those of exposure group. Using multiple linear regression and adjusted for other potential confounders, urinary metal levels among students significantly and positively correlated with NAG and 8-isoprostane, but not found in nail. Moreover, some urinary and nail metals also had significant correlation with NAG in parent. Multiple logistic regression was used to find ORs with 4.269 for NAG and 14.154 for isoprostane among students in the exposure group compared to in the control group.
Conclusion and Suggestion
Our study indicated that schoolchildren living near a waste incinerator had elevated level of metals in biological specimens, which may cause oxidative stress and renal damage. It possibly correlated with emission of metals from the incinerator. Therefore, environmental protection agency should continuously control their emission of pollutants and elaborate their dispersion pathway to minimize the risk of expose to metals from incinerator.

目錄
中文摘要 I
Abstract III
目錄 V
表目錄 VIII
附表目錄 X
附圖目錄 XII
附件目錄 XIII
第一章、前言 1
第一節、研究背景與動機 1
第二節、研究目的 2
第二章、文獻探討 3
第一節、焚化爐可能排放之金屬元素 3
砷 (Arsenic, As) 3
鎘 (Cadmium, Cd) 3
鉻 (Chromium, Cr) 4
銅 (Copper, Cu) 4
汞 (Mercury, Hg) 4
鎳 (Nickel, Ni) 5
鉛 (Lead, Pb) 5
硒 (Selenium, Se) 6
鋅 (Zinc, Zn) 6
第二節、金屬生物指標之選擇 6
第三節、尿液金屬相關研究 7
第四節、指甲金屬相關研究 9
第五節、腎損傷指標之選擇 10
白蛋白 (Albumin) 11
N-乙醯-β-氨基葡萄糖?? (N-Acetyl-β-D-glucosaminidase, NAG) 12
第六節、氧化壓力指標之選擇 13
第七節、職業性與非職業性金屬暴露與氧化性傷害及腎臟損傷 16
第三章、研究方法與材料 18
第一節、研究架構 18
第二節、研究方法與對象 19
研究對象及地點 19
風向測定 21
第三節、藥品與設備 22
藥品 22
設備 22
第四節、生物檢體採樣方法與分析 23
尿液樣本 23
指甲樣本 25
儀器分析條件 26
分析方法之品保/品管 (Quality assurance/Quality control) 26
第五節NAG分析之測定 27
尿中NAG分析流程 27
分析條件 28
分析方法之再現性 28
第六節、8-isoprostane分析 29
96格孔盤配置 30
檢量線 31
分光光度計設定條件 31
第七節、資料整理與統計分析 32
第四章、研究結果 33
第一節、問卷基本資料 33
第二節、暴露組與對照組生物檢體金屬之濃度與腎臟損傷及氧化壓力指標之單變項分析 34
第三節、影響學童及家長NAG及8-isoprostane濃度之迴歸分析 37
第五章、討論 40
第一節、研究對象及方法之代表性 40
研究對象選取 40
尿液及指甲樣本 40
問卷調查 41
第二節、焚化爐附近空氣金屬濃度與檢體金屬之濃度 43
焚化爐附近空氣金屬濃度 43
檢體金屬濃度之探討 45
比較國內外民眾尿中金屬濃度 48
比較國內外民眾指甲金屬濃度 49
第三節、學童及家長生物檢體中金屬、8-isoprostane及NAG濃度之探討 53
國內外研究8-isoprostane濃度之比較 55
第四節、研究限制與未來研究方向 57
一、研究限制 57
二、未來研究方向 58
第六章、結論 59

表目錄
表一、暴露組與對照組學童基本資料比較 72
表二、暴露組與對照組學童自覺健康與住家型態之比較 73
表三、暴露組與對照組家長基本資料比較 74
表四、暴露組與對照組呼吸道疾病之比較 75
表五、暴露組與對照組學童尿中與指甲重金屬濃度之比較 76
表六、暴露組與對照組家長尿中與指甲重金屬濃度之比較 77
表七、暴露組與對照組學童及家長腎功能指標及氧化性傷害指標之比較 78
表八、學童尿中濃度之相關性 79
表九、學童指甲重金屬濃度之相關性 80
表十、家長尿中重金屬濃度之相關性 81
表十一、家長指甲重金屬濃度之相關性 82
表十二、學童及家長在兩組間尿液與指甲重金屬濃度之相關性 83
表十三、學童及家長腎臟功能指標及氧化壓力與尿液與指甲重金屬間的相關性 84
表十四、尿液樣本中氧化壓力指標與腎臟功能指標間的相關性 85
表十五、影響學童及家長NAG及8-isoprostane濃度之線性複迴歸分析 86
表十六、線性複迴歸模型分析學童重金屬濃度影響腎功能 (NAG) 與氧化壓力指標 (8-isoprostane) 87
表十七、線性複迴歸模型分析家長重金屬濃度影響腎功能 (NAG) 與氧化壓力指標 (8-isoprostane) 88
表十八、羅吉斯複迴歸模型分析學童及家長重金屬濃度影響腎功能 (NAG) 與氧化壓力指標 (8-isoprostane) 89
表十九、羅吉斯複迴歸模型分析學童重金屬濃度影響腎功能 (NAG) 與氧化壓力指標 (8-isoprostane) 90
表二十、羅吉斯複迴模型分析家長重金屬濃度影響腎功能 (NAG) 與氧化壓力指標 (8-isoprostane) 91
表二十一、羅吉斯複迴歸模型分析學童及家長危險因子影響自覺健康狀況 92
表二十二、羅吉斯複迴歸模型分析學童危險因子影響呼吸道症狀 93


附表目錄
附表一、暴露組及對照組研究對象收集樣本數之結果 94
附表二、ICP-MS分析條件 95
附表三、尿液及指甲檢量線與定量極限 96
附表四、重金屬排放管制相關法規 97
附表五、台中市某焚化廠102-106年煙道採樣資料 98
附表六、2016年台中文山及大里測站細懸浮微粒濃度比較 99
附表七、八個採樣點及煙道採樣之十六種金屬平均濃度 100
附表八、此研究與世界其它研究重金屬濃度之比較 101
附表九、暴露組A國小懸浮微粒金屬元素濃度 102
附表十、暴露組A國小歷年呼吸道症狀比例 103
附表十一、對照組C國小歷年呼吸道症狀比例 104
附表十二、以皮爾森 (Pearson) 相關分析尿液樣本間相關，並校正教育程度、年齡、國籍及農場工作年資 105
附表十三、以皮爾森 (Pearson) 相關分析指甲樣本間相關，並校正教育程度、年齡、國籍及農場工作年資 106
附表十四、國內外文獻分析尿中砷濃度 107
附表十五、國內外文獻分析尿中鎘濃度 108
附表十六、國內外文獻分析尿中鉻濃度 109
附表十七、國內外文獻分析尿中銅濃度 110
附表十八、國內外文獻分析尿中汞濃度 111
附表十九、國內外文獻分析尿中鎳濃度 112
附表二十、國內外文獻分析尿中鉛濃度 113
附表二十一、國內外文獻分析尿中硒濃度 114
附表二十二、國內外文獻分析尿中鋅濃度 115
附表二十三、國內外文獻分析指甲砷濃度 116
附表二十四、國內外文獻分析指甲鎘濃度 117
附表二十五、國內外文獻分析指甲鉻濃度 118
附表二十六、國內外文獻分析指甲銅濃度 119
附表二十七、國內外文獻分析指甲汞濃度 120
附表二十八、國內外文獻分析指甲鎳濃度 121
附表二十九、國內外文獻分析指甲鉛濃度 122
附表三十、國內外文獻分析指甲硒濃度 123
附表三十一、國內外文獻分析指甲鋅濃度 124
附表三十二、國內外文獻分析NAG濃度之比較 125
附表三十三、國內外文獻分析8-isoprostane濃度之比較 126

附圖目錄
附圖一、採樣點及焚化爐煙道金屬濃度測量結果 127
附圖二、焚化爐與各國小之地理位置圖 128
附圖三、2016年3、6、8及10月A國小風花圖 129
附圖四、歷年尿液重金屬濃度趨勢分析 130


附件目錄
附件一、台中垃圾處理場附近學童健康問卷調查表 137
附件二、暴露組居民對臺中市文山焚化爐的風險認知問卷調查表 142
附件三、對照組居民對臺中市文山焚化爐的風險認知問卷調查表 148
附件四、自覺呼吸道症狀嚴重程度分級 153

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