臺灣博碩士論文加值系統

中藥腎病變是一種快速進行間質纖維性腎炎，主要是因為誤用含有廣防己的減肥藥丸所引起，它在1993年由Vanherweghem JL首次研究發表，由於中藥腎病變近年已在國際間引起重要的討論及迴響，另一方面，國內政府主管機關及學術單位，亦開始注意到此類疾病的發展。近幾年來又有越來越多的報告指出，中藥腎病變後不少患者演變成泌尿上皮腎臟癌、輸尿管癌、膀胱癌。中藥在國內有廣大的使用者，甚至長期不當的使用者，而末期腎臟疾病又是目前國內耗費健保資源最大的單一疾病，加上先前的研究及分析顯示中藥製造從業人員有較高末期腎臟疾病及腎臟癌的標準死亡比及標準罹病比，因此進行此項研究。
本研究旨在利用病例對照研究法(Matched Case-Control Study) ，使用「中藥製造從業人員資料檔」、「重大傷病資料檔」、「癌症登記檔」及「死因資料檔」等資料，並以問卷方式收集過去台灣地區中藥製造從業人員罹患末期腎臟疾病(尿毒症)及泌尿上皮腎臟癌、輸尿管癌、膀胱癌病患為病例組，而其未罹患這些疾病者為對照組。問卷內容將包括基本人口學資料，其二等血親內家族成員家族腎臟疾病史，中藥暴露史、工作環境職業因素，生活及飲食習慣因素，其他致病及致癌因素等。
我們研究的族群為自1985年1月1日起至1998年12月31日止由勞保局資料中參加台灣地區中藥製造從業人員工會會員，共有男性3085人及女性3453人，將其與健保局之重大傷病資料及衛生署之癌症登記檔連結後共找出26位泌尿上皮腎臟癌、輸尿管癌及膀胱癌病例及57位尿毒症病例，經調整干擾因子，進行配對找尋對照組後進行問卷調查分析，共收集填答內容足供分析之有效問卷共199份，包含59名病例(腎臟上皮癌、輸尿管癌及膀胱癌患者共19名，尿毒症患者40名)及對照組140名(腎臟上皮癌、輸尿管癌及膀胱癌對照組共31名，尿毒症對照組109名)。資料蒐集建檔完成後，除對病例組作一般描述分析外，將計算勝算比以比較病例組與對照組間有無中藥製造環境職業暴露之差異，並進一步作對數迴歸分析，對可能致病之危險因子，作進一步分析探討。其結果顯示實際從事中藥工作、暴露量越高者或處理防己類藥材會明顯的增加罹患慢性腎臟疾病(包括尿毒症及泌尿上皮腎臟癌、輸尿管癌、膀胱癌)、及尿毒症的危險性，即使控制干擾因子後，仍可明顯看出其致病危險性之趨勢，且呈現劑量效應關係。同樣地上述危險因子導致中藥製造從業人員罹患泌尿上皮腎臟癌、輸尿管癌及膀胱癌有危險性較高之趨勢，但並未達顯著統計意義。雖然除了經常服用止痛劑，罹患尿毒症病例組比對照組相對危險性高，時常吃蔬菜水果與罹患尿毒症相對具有保護效果，且達統計學上的顯著性。有尿毒症家族使之個案罹患慢性腎臟疾病(包括尿毒症及泌尿上皮腎臟癌、輸尿管癌、膀胱癌)、及尿毒症的危險性有明顯統計意義的增加。
最後，除討論其罹病危險因子外，將可提供中藥製造從業人員如何預防其危險因子，提出改善工作環境的策略，並做為政府主管機關施政之參考，並建議設立疾病監測系統，以早期發現疾病，維護中藥製造從業人員身體的健康，並降低健保資源的支出。

Chinese herb nephropathy is a rapidly progressive fibrosing interstitial nephritis that develops in some patients who take weight-reducing pills containing misused Chinese herb (Arislochia fungchi) which were first reported by Vanherweghem JL in 1993. Chinese herb nephropathy have been found in many countries since the outbreak in Belgium in 1992, where cases of urothelial carcinoma have also been detected later because of the carcinogen Aristolochic acid.
Because traditional Chinese herbal medicine is very popular in Taiwan and we had reported Chinese herbalist have high risk of mortality and morbidity of chronic renal failure and urothelial carcinoma 2 years ago. For further investigation of the possible risk factors, we obtained the insurance information for the occupational union of Chinese herbalist from the Bureau of Labor Insurance from 1 January 1985 to 31 December 1998 which population consisted of 3085 males and 3453 females. We linked Chinese herbalist to the catastrophic illness/injury certificates from the Bureau of National Health Insurance from 1 March 1995 to 31 March 1999 and cancer registry information from Department of Health. There are 26 cases of urothelial carcinoma and 57 cases of chronic renal failure (uremia) were found in the Chinese herbalist. So we design a matched case-control study and analyze the risk factors of urothelial carcinoma and chronic renal failure (uremia). Control cases are randomly selected from Chinese herbalist free from urothelial carcinoma and chronic renal failure (uremia). After adjusting confounding factors (sex, age, and living area), finally we collect 19 cases of urothelial carcinoma and 31 control cases, 40 uremia cases and 109 control cases, respectively. We find some risk factors related to uremia, including frequent intake of analgesic agents and protected factor related to uremia, including frequent intake of fruits or vegetables. There are also increased risk tendency factors related to urothelial carcinoma including any condition of contact, produce herbs containing Stephania tetrandra or Arislochia fungchi. Produce herbs ,or herbs containing Stephania tetrandra or Arislochia fungchi has risks to get uremia and is related to exposure duration,and accumulation dose.
Because high risk to getting uremia and urethial carcinoma, we suggest to provide education to diffremtiate herbs, improve working environment and provide surveillance system to early detect these catastrophic disease.

摘要…………………………………………………………………………1
ABSTRACT……………………………………………………………………3
目錄…………………………………………………………………………5
表列…………………………………………………………………………6
壹、前言……………………………………………………………………7
貳、材料與方法……………………………………………………………10
參、結果……………………………………………………………………13
肆、討論……………………………………………………………………36
伍、結論……………………………………………………………………45
陸、參考文獻………………………………………………………………46
柒、附錄表…………………………………………………………………49
附錄一 台灣地區腎臟疾病家族研究問卷………………………………50
附錄二 中藥製造從業人員罹患腎臟疾病死因研究資料表……………56
附錄三 中藥製造從業人員罹患重大腎臟疾病研究資料表……………69

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