臺灣博碩士論文加值系統

台灣青少年兒童異位性皮膚炎的盛行率約為4%，而塵蟎過敏原已知是誘發過敏性疾病發作與惡化的重要因子，其中歐洲室塵蟎(Dermatophagoides pteronissinus) 被認定與影響異位性皮膚炎與氣喘發作最有相關性。而台灣的氣候條件溫濕，是塵蟎過敏原D. pteronissinus喜好的生長環境，因此應了解歐洲室塵蟎過敏原在台灣的濃度分佈情形與以居家特徵及習慣等因子推估其可能之濃度。此外，過去台灣針對塵蟎過敏原所作的研究，其過敏原收集方法皆由研究人員前往其家中採集，較耗人力、物力。本研究亦評估由研究對象的家長採集塵蟎過敏原，與研究人員所採集所得濃度是否有所差異。
本研究參與對象分佈在台灣六個縣市，台北、嘉義、雲林、台南、高雄、台東等，因採樣戶數不足，故分兩批次採樣，共46戶。第一批次，對象由一小型出生世代中選取願意參與者，共38戶，採樣時間為2007年7月至9月。第二批次，對象為有參與另一呼吸道研究的台北縣新莊市國中生與國小生，共8戶，採樣時間為2008年8月。藉由問卷收集居家環境、建築物特徵、居住習慣、寢具使用及清潔頻率等相關資訊，先請家長按照說明書使用吸塵器採集床墊上之灰塵，再由研究人員繼續收集客廳地板、臥室地板、同一床墊及枕頭上之灰塵，以酵素連結免疫吸附法(ELISA)分析塵蟎過敏原(Der p 1)。將每戶四個樣本視為重複測量樣本(N=184)，進行多變項迴歸、混合式線性迴歸及羅吉斯迴歸。
研究結果顯示，Der p 1濃度幾何平均值分佈為客廳地板0.13 μg/g，臥室地板0.31 μg/g，床墊1.70 μg/g，枕頭2.90 μg/g，枕頭與床墊濃度相對於兩地板濃度統計上顯著較高。家長在床墊採集之塵蟎過敏原平均濃度為1.56 μg/g，matched pair t test分析結果與研究人員採集之濃度統計上無顯著差異，且有高度相關（r=0.75）。家中水管曾經滲漏水、目前家中有養狗、家中有表面真菌、距離上次清洗床單枕套或清掃地板時間超過七天者，有較高的塵蟎過敏原Der p 1濃度。平時使用冷氣能減少塵蟎過敏原濃度超過2 μg/g的風險，而家中水管曾滲漏水者其塵蟎Der p 1濃度超過2 μg/g的機會比家中不曾滲漏水者高3.46倍。
本研究提供了台灣家戶中塵蟎過敏原Der p 1濃度的分佈情形，並評估影響濃度之居家環境因子，建議降低塵蟎過敏原Der p 1濃度的可能方法。期望將來經過降低塵蟎過敏原，以減少孩童過敏性疾之發生或發作。

The prevalence of atopic eczema and asthma in adolescents has been reported to be increasing in the past decades in Taiwan. Exposure to house dust mite (Dermatophagoides pteronissinus) is known to play a potent role in the onset and aggravation of allergic diseases, such as atopic dermatitis and asthma. In Taiwan, high temperature and relative humidity provide favorable conditions for dust mite to grow. It is important to evaluate the level of Der p 1 and environmental predictors, especially the residential characteristics. In addition, previous studies on dust mite allergens in Taiwan were mostly sampled by investigators, we tested the feasibility and comparability of sample collection by adult residents in this study.
We studied 46 homes in the 6 cities and counties in Taiwan, included Taipei, Chiayi, Yulin, Tainan, Kaohsung and Taitung. Among these cities, 38 were the participants of the Taiwan Birth Cohort Pilot study, and their residential characteristics were studied during July to September 2007. The other 8 participants were choosed according to a respiratory study during August 2008 in Sinchuan. The information of environmental conditions, structure of house or apartment, pet-owning, habits, and frequency of cleaning were collected by questionnaire. For the comparison of resident- and investigator-collected dust mite samples, the residents sampled the dust from the surface of mattress by vacuum cleaners according to the investigator’s written sampling direction. The investigator also sampled the dust from the floor of the living room and child’s bedroom, mattress, and pillow. The dust mite allergen (Der p 1) was measured using a two-site monoclonal antibody enzyme-linked immunosorbent assay (ELISA).
Among the 46 homes, the geometric means of Der p 1 were 0.13 μg per gram of dust (μg/g) for the floor of living room, 0.31 μg/g for the floor of children room, 1.70 μg/g for the mattress, and 2.90 μg/g for the pillow. By paired t test, the Der p 1 levels sampled by adult residents was not demonstrated statistically different from those sampled by investigators, moreover, the results sampled by residents and investigators were highly correlated (r=0.75). Higher dust mite levels were associated with having water leakage, dog-owning, observed surface molds, and longer duration after the last cleaning. The usage of air conditioner was negatively associated with level of dust mite
This study provides the background levels of dust mite allergen (Der p 1) in Taiwan 6 cities and the residential environmental factors were found to play an important role in mite allergen concentrations. Future study on the effects for reducing mite allergen by environmental modification will be warranted.

致謝 I
目錄 II
表目錄 IV
圖目錄 V
附錄 VI
中文摘要 1
ABSTRACT 3
第一章 前言 5
第一節 研究背景 5
第二節 研究目的 6
第二章 文獻探討 7
第一節 過敏性疾病 7
(一) 過敏性疾病之盛行率 7
(二) 過敏反應與機轉 8
第二節 塵 蟎 9
(一) 塵蟎過敏原 9
(二) 健康影響 10
(三) 相關環境因子 10
(四) 台灣塵蟎過敏原Der p 1分佈情形 11
第三章 研究方法 13
第一節 研究架構 13
第二節 研究對象 13
第三節 研究工具 14
(一) 問卷調查 14
(二) 室內空氣品質測量 15
(三) 室塵蟎過敏原測量 15
第四節 資料處理與統計分析 19
第四章 研究結果 21
第一節 採樣對象 21
第二節 居家環境狀況 21
第三節 臥室與客廳環境情況 21
第四節 塵蟎過敏原分佈情形 22
(一) 灰塵重量 22
(二) 塵蟎過敏原 22
(三) 過敏性疾病與塵蟎過敏原濃度 23
(四) 各採樣點塵蟎過敏原之單變項迴歸模式與多變項迴歸模式分析 24
(五) 塵蟎過敏原之混合式線性模型(Mixed modle)與羅吉斯迴歸分析 25
(六) 塵蟎過敏原由家長採樣與由研究人員採樣之比較 25
第五章 討論 27
第一節 過敏原濃度分佈 27
第二節 過敏原濃度的影響因子 29
(一) 採樣的地點 29
(二) 採樣的批次 29
(三) 屋齡 30
(四) 冷氣使用 30
(五) 家中水管曾經滲漏水與可觀察之表面真菌 30
(六) 距離上次清掃地板或清洗床單枕套的時間 30
(七) 室內溫度、相對溼度 31
第三節 替代的採樣方法可行性 31
第四節 研究限制 33
第五節 結論與建議 33
第六章 參考文獻 35

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