臺灣博碩士論文加值系統

過去研究大多探討生活因子例如嚼食檳榔、吸菸、飲酒而後發生口腔癌之間的關係，鮮少有研究探討空氣污染與口腔癌之間的關係，本研究探討台灣地區的男性，細懸浮微粒(PM2.5)與口腔癌之間的相關性。進一步分析PM2.5的成分與男性口腔癌之間的關係。
癌症資料的收集分別來自國家衛生研究院所釋放出健保資料庫、衛生福利部所釋放出死因統計檔、衛生福利部國民健康署中的癌症線上登記互動查詢系統及內政部統計處所提供台閩地區人口統計資料，年代從2006至2011年。空氣污染指標則是由環保署中的空氣品質監測網所取得70個測站，空氣污染指標包括SO2 (sulfur dioxide)、NO (nitrogen monoxide)、NO2 (nitrogen dioxide)、O3 (ozone)、CO (carbon monoxide)、NOx (nitrogen oxide)、PM2.5 (fine particulate matter)、PM10 (particulate matter)，資料收集從2006至2011年空氣監測資料。PM2.5成分是由環保署中的空氣品質監測網中的超級測站取得5個測站，PM2.5成分包括硝酸鹽(nitrate，NO3-)、銨鹽(ammonium，NH4+)及元素碳(element carbon，EC)，資料收集為2005年的超級測站資料庫。2009年國民健康訪視調查與2009年國人吸菸行為調查。以2006至2011年間的PM2.5探討在男性有無得到口腔癌。本研究將空氣污染物依據四分法來分組，使用卜瓦松迴歸(Poisson regression)暴露到PM2.5而後得到口腔癌之相對危險比(Relative Ratio, RR)，模式調整年齡、其他空氣污染物、嚼食檳榔率及吸菸率干擾因子。
在調整干擾因子後，以PM2.5<26.45 μg/m3當參考組後，PM2.5介於32.51至40.44及≧40.44μg/m3與口腔癌的相對危險比分別為1.26 (95%CI：1.07-1.48)及1.32 (95%CI：1.10-1.57)。再從PM2.5成分中，硝酸鹽(NO3-)每增加1 μg/m3，口腔癌的相對危險比為1.46 (95% CI：1.01-2.09)。元素碳(EC) 每增加1 μg/m3，口腔癌的相對危險比為17.21 (95% CI：3.28-90.31)。
本研究結果顯示在台灣男性，隨著PM2.5濃度變高，而後會增加罹患口腔癌的風險。進一步發現PM2.5成分中的元素碳及硝酸鹽對男性口腔癌是有影響的。

Study objective: The effects of living habits such as betel-quid chewing, smoking and alcohol drinking on subsequent oral cancer development have been reported, but few studies have focused on the association between air pollutants and oral cancer. This study investigated the association between fine particulate matter (PM2.5), nitrate (NO3-), ammonium (NH4+) and element carbon (EC) and oral cancer in Taiwanese men.
Material and methods: Pollution data were retrieved from air quality monitoring stations and supersite database established by the Environmental Protection Administration (EPA), Taiwan. The air quality of eight pollutants including sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), nitrogen monoxide (NO), nitrogen dioxide (NO2), nitrogen oxide (NOx), particulate matter (PM10) and PM2.5 from 2006 to 2011 was monitored and annual average concentrations were calculated. The monitoring stations were from 70 EPA air quality monitoring stations from different municipalities. Annual average concentrations of NO3-, NH4+ and EC components of PM2.5 in 2005 were retrieved from the EPA supersite. Data of patients with oral cancer were extracted from the National Health Insurance Research Database (NHIRD), the Cause of Death Database and the Online Interactive Data Query for Cancer Registration operated by Taiwan government. Data on betel-quid chewing and smoking status were retrieved from the 2009 National Health Interview Survey (2009 NHIS), Taiwan and 2009 Smoking Behavior Survey, Taiwan. Air pollutant concentrations stratified into quartile groups. Poisson regression model was used to assess the risk of oral cancer while adjustments were made for other air pollutants, betel-quid chewing and smoking.
Results: After adjusting for cofounders with PM2.5 <26.45μg/m3 as the reference group, the RRs of oral cancer were 1.26 for concentration between 32.51 and 40.44 μg/m3 and 1.32 for PM2.5≧40.44 μg/m3. For the PM2.5 components, the RRs of oral cancer were 1.46 for nitrate concentration of 1 μg/m3, and 17.21 for carbon concentration of 1 μg/m3.
Conclusion: The study shows that nitrate, element carbon and higher concentration of PM2.5 were associated with increased risk of oral cancer in Taiwanese men.

誌謝 i
中文摘要 ii
Abstract iv
表目錄 vii
圖目錄 viii
第一章、前言 1
第一節、研究背景 1
第二節、研究目的 4
第二章、文獻探討 5
第一節、口腔癌 5
第二節、口腔癌危險因子 6
第三章、材料與方法 8
第一節、研究架構 8
第二節、資料來源與研究對象 9
第三節、口腔癌定義 16
第四節、空氣污染物計算 17
第五節、率的計算 17
第六節、干擾因子 18
第七節、統計分析 18
第四章、結果 20
第五章、討論 23
第一節、台灣與各國比較 23
第二節、PM2.5與口腔癌 24
第三節、PM2.5成分與口腔癌 24
第四節、進入人體作用機制 25
第五節、研究限制 26
第六章、結論 27
第七章、參考資料 28

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