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研究生:陳俊男
研究生(外文):Chen, Jiuan-Nan
論文名稱:膀胱癌職業性致癌因子分析研究
論文名稱(外文):Occupational risk factor in bladder cancer
指導教授:陳保中陳保中引用關係鄭遵仁江漢聲江漢聲引用關係---
指導教授(外文):Wang Jung-Der
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:職業醫學與工業衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文出版年:1998
畢業學年度:86
語文別:中文
論文頁數:60
中文關鍵詞:膀胱癌移行上皮癌危險因子烏腳病環境職業暴露
外文關鍵詞:bladder cancertransitional cell carcinomarisk factorblack foot diseaseoccupational and envioccupational exposure
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台灣地區自光復以來經濟、工商業高度發展,民眾生活型態改變,癌症已躍居十大
死因首位,而在過去較不注重菸害,工業衛生及有害物質暴露保護之下,因此抽菸
,職業暴露因素所導致癌症為造成癌症之重要因素之一。膀胱癌雖然不是國內十大
癌症死因之一,但每年仍然約有500多人因此死亡,並且有增加之趨勢(民國八十四
年癌症發生率男性排名第七位,女性排名第十四位)。其危險因子依文獻報告;包括
男性、年齡大於60歲、抽煙、暴露於aromatic amines、cyclophosphamide、
chemical dye stuff、rubber、arsenic 等已被証實極有相關,至於暴露於其它物
質如aluminium、coal tar、diesel及petrol exhaust fumes、cutting oils、
chlorinated aliphatic hydrocarbons、pesticide、加氯飲用水、止痛藥,生活
習慣(包括咖啡,茶及人工添加食物)、以及泌尿系統感染(包括寄生蟲)及遺傳
等亦可能為致癌因子,並且某些特定職業如dye workers、rubber workers、
hairdressers、chemical workers、petroleum workers、trunk drivers、
painters、textile workers、leather workers等亦增加致膀胱癌危險性。過去,
臺灣有關膀胱癌的本土性研究相當缺乏,僅烏腳病盛行地區(北門,學甲,布袋,
義竹等四鄉鎮)有膀胱癌的相關流行病學研究,證實無機砷的暴露與膀胱癌發生有
顯著相關。據國外研究顯示膀胱癌患者可歸因於抽菸因素男性佔39-56%,而女性則
佔29%。至於環境職業暴露則大約為佔20-25%,但因其暴露後潛伏期可長達40年
(15-40年、平均25年),且勞工職業登錄,轉移追蹤不夠完備,死因及癌症登錄
正確率亦不易掌握,加上職業暴露有害物質及濃度不易確認,造成國內尚無有關職
業暴露導致膀胱癌相關流行病學研究及病例報告,亦無膀胱癌致癌因子分析研究。

本研究旨在利用病例對照研究法(case-control study),研究過去幾年來臺灣南北
二大醫學中心罹患膀胱癌病例及對照組(313名病例組及346名對照組)的分析比較,
在調整干擾因素(confounding effect)後,曾居住於烏腳病地區,某些職業暴露,
抽煙,及特殊飲食習慣(如常食用人工甘味劑,醃製,燻烤食品及自認常吃很鹹),
經常接觸印刷油品及泌尿系統感染會增加罹患膀胱癌的危險性,至於喝酒,咖啡,
茶,飲用井水則不具顯著意義,再進conditional logistic regression 分析後,
僅發現曾居住於烏腳病地區,某些職業暴露,抽煙,及特殊飲食習慣(常食用人工
甘味劑) 及泌尿系統感染仍具顯著意義。
關鍵字(中):膀胱癌,移行上皮癌,危險因子,烏腳病,環境職業暴露

Abstract:
The economics and industry of Taiwan highly developed in recent years.
Disease patterns are also different than before, the cancer has been
ranked first in mortality as infectious disease ever. The bladder cancer
was not included in ten causes of cancer mortality , however about 500
persons died of it and incidence of bladder cancer still increases in
recent years. The risk factors of bladder cancer included male,
age over 60 years old, smoking, exposure to aromatic amines,
cyclophosphamide, chemical dye stuff, rubber, and arsenic. Exposure to
other materials such as aluminium, coal tar, diesel and petrol exhaust
fumes, cutting oils, chlorinated aliphatic hydrocarbons, pesticide,
chorinated water, life style(coffee, artificial sweetener),urinary tract
infection and inheritance may also be risk factors. Some occupational
exposure also increase incidence of bladder cancer. Epidemiologic studies
about bladder cancer in Taiwan area are still few and most confined to
BFD (black foot disease) prevalence districts, it showed arsenic exposure
was related to increase cancer risk. According to review literature,
occupational and environmental exposure contribute about 20-25% of
bladder cancer. Because of long exposure latency (15-40 years, average
25 years), and imperfect labor registry and occupational follow up,
incorrect death certificate and cancer registry, poor recognition of
exposure hazards, there still were not any bladder cancer case report
and epidemiologic survey about occupational and environmental exposure.

This study is a hospital-based case-control study, analyzing bladder
cancers (transitional cell carcinoma) diagnosed from 1992 to 1997 and
regularly followed up in 2 years from two medical centers(313 urothelial
patients ). Control cases(346 controls) are randomly selected from
opthalmologic and health exam departmentin same hospital. After adjusting
the confounding factors, we found some risk factors related to incidence
of bladder cancer, including ever living at BFD prevalence districts ,
some occupational exposure, cigarette smoking, frequent intake of
fermented, smoked, salted food, artificial sweetner, exposed to printing
solvent and ever urinary tract infection .None of alcohol drinking, tea,
coffee and consuming well water was significantly associated with risk
of bladder cancer. In the conditional logistic regression analysis, ever
living at BFD prevalence districts ,some occupational exposure, cigarette
smoking, artificial sweetner and ever urinary tract infection were
significant factors associated with urothelial carcinoma.
(Key word: bladder cancer, transitional cell carcinoma, risk factor,
occupational and environmental exposure , black foot disease)

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