臺灣博碩士論文加值系統

許多空氣污染物被發現與心肺疾病的發生息息相關，而心率變異度（HRV）與肺功能則被認為可作為預測心、肺疾病的生理反應指標之一，同時噪音亦會造成心率變異度的變化；在過去多以固定式測站監測資料做為數據來源，或僅探討個別污染物與單一生理反應指標，而本研究同時以移動式量測方法與固定測站，並增加過去文獻未曾考量之變數──低頻噪音與高頻噪音，以系統性地研究探討空氣污染物與噪音對心、肺疾病生理反應指標之相關性，同時考慮溫、溼度造成之影響。
本研究使用線性迴歸與線性混合效應模型兩種統計方法，並區分為單一污染物與兩污染物模型，對空氣污染物與生理反應之相關性進行分析；研究資料使用於台南地區，以移動式量測方法與固定測站所收集之空氣污染物暴露資料、氣象資料（溫、濕度）、噪音與生理反應數據，再用空氣污染物（PM2.5、PM1.0、BC、NO2、SO2、O3）與噪音暴露計算出不同時間段5-、15-、30-、60-和90-分鐘移動平均濃度值，以模型評估心率變異度指標（SDNN、RMMSD、pNN50、HF、LF、TP、LF/HF和心率）、肺功能指標（FVC、VC、FEV1、FEV1%）與空氣污染物、噪音之關係。
研究結果顯示空氣污染物在不同時空之影響有所不同，會受到時間變異與空間變異的影響。其次，以模式對空氣污染物與噪音變數對生理反應指標分析後，發現生理反應會受空氣污染物與噪音暴露改變而有所變化，可以觀察到PM2.5、PM1.0、O3濃度與溫度時對HRV之時域分析（SDNN、RMSSD、pNN50）指標有負相關性，且會因時間效應之拉長隨之增加其影響幅度；O3、溫度與HRV之頻域分析（LF、HF、TP）指標同樣有顯著負相關，當O3濃度、溫度越高時，HRV指標隨之會下降；同時PM2.5、PM1.0、溫度、O3對LF/HF、心率呈顯著正相關；噪音在90-分鐘時間段下，會與所有HRV指標呈負相關，並發現高頻噪音與全頻噪音兩者變化相似。再者，PM1.0、BC與肺功能之FEV1%在時間段較長時，呈統計上顯著負相關，但FVC、VC與FEV1則為顯著正相關。此外，分別以移動式量測方法和固定監測站之數據分析後，可見PM2.5與溫度在心率變異度與肺功能之FEV1指標上，其相關性結果呈現一致。
本研究與過去文獻皆說明短期暴露（90-分鐘內）於空氣污染物與噪音可能會影響心臟自主神經功能，尤其會致自律神經失衡與對副交感神經有負影響，主要在PM2.5與SDNN間特別明顯。在BC與FEV1%間可看到在60-分鐘即有顯著負影響，與過去文獻空氣污染物對肺功能指標要在超過8小時之長時間暴露才有顯著負影響不同。此外，亦發現全頻與高頻噪音兩者造成的變化具有較高之相似性，特別是在對HF與心率時尤為明顯；以及空氣污染物會在特定時間點對健康產生最大的不良效應，如PM2.5主要會在90-分鐘下影響最大。本研究優勢在於以移動式量測進行短時間暴露採樣，探討實時暴露之情形，並結合心率變異度與肺功能指標以達到更全面而系統性的了解空氣污染物與噪音暴露對人體健康反應之影響。但本研究主要針對台南市區進行之調查，是否能外推至其他區域則需要更進一步探討。

Air pollutants are found associated with cardiopulmonary diseases. Physiological responses are considered to be associated with air pollutants. This study uses the mobile measurement method, fixed monitoring stations, linear regression model, and linear mixed model (LMM) to systematically investigate the association among air pollutants, noise, and physiological responses, adjusted for temperature and relative humidity. The mobile measurement of air pollutants, noise, and physiological responses data were collected in southern Taiwan. The measurement of air pollutants and noise was based on the moving averages for 5-minute, 15-minute, 30-minute, 60-minute, and 90-minute. This study assesses the associations among a series of physiological responses and several air pollutants separately. The physiological responses include heart rate variability (HRV) and lung function indicators. The results show that the short-term (e.g. ≦ 90-minute) air pollutants and noise can affect cardiac autonomic function, causing the imbalance of autonomic nervous and the negative effects on parasympathetic nerves. In addition, noise and high frequency noise have very similar effects on physiological responses. Various air pollutants have different degrees of adverse effects on physiological responses over different exposure time.

摘要 I
Extended Abstract II
誌謝 V
目錄 VII
表目錄 X
圖目錄 XII
第1章 研究背景 1
1.1 研究動機 1
1.2 具體目標 2
1.3 研究目的 3
第2章 文獻回顧 4
2.1 空氣污染物 4
2.2 細懸浮微粒 5
2.3 噪音 6
2.4 氣態污染物 7
2.5 心率變異度與疾病 8
2.6 肺功能指標與疾病 9
2.7 空氣污染物與心、肺功能指標 11
2.7.1 空氣污染物與心率變異度 11
2.7.2 空氣污染物與肺功能指標 12
2.7.3 噪音與心率變異度 14
第3章 材料與方法 16
3.1 研究架構 16
3.2 研究對象與健康數據收集 18
3.2.1 心率變異度 19
3.2.2 肺功能指標 21
3.3 採樣規劃 21
3.3.1 研究地點 22
3.3.2 研究時間 23
3.3.3 採樣設備 24
3.3.4 採樣數據品質 28
3.3.5 環保署空氣品質測站資料 29
3.4 統計分析 30
3.4.1 研究變數 30
3.4.2 分析方法 32
第4章 結果與討論 35
4.1 移動式量測方法採樣結果 35
4.1.1 受試者 35
4.1.2 健康指標（outcome）之分布情形 38
4.1.3 暴露因子（exposure）之分布情形 41
4.2 暴露因子與健康指標之相關性分析 48
4.2.1 單一污染物 48
4.2.2 兩污染物 81
4.3 固定測站與移動式測量之比較 85
4.3.1 環境保護署空氣污染物數據情形 85
4.3.2 固定測站與移動式測量之相關式建立 88
4.3.3 固定測站與移動式測量之相關性 91
第5章 討論 95
5.1 暴露因子與各標準值、過去文獻之比較 95
5.2 暴露因子與健康指標之相關性 96
5.2.1 與心率變異度指標之相關性 96
5.2.2 與肺功能指標之相關性 98
5.3 暴露因子與疾病 109
5.4 研究優勢與限制 109
第6章 結論與未來展望 111
6.1 結論 111
6.2 未來展望 112
第7章 參考文獻 113
第8章 附錄 119

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