臺灣博碩士論文加值系統

研究背景與動機：近年來，台灣受到工業以及都市化的影響，空氣汙染物排放量改善有限，空氣污染的問題一直存在。空氣污染物濃度的增加，不只對環境有影響，也對人體健康產生不好的影響。過敏性鼻炎及過敏性結膜炎為空汙相關疾病，且確實會互相影響，大多數研究只針對單一部位過敏狀況作探討，鮮少會再進一步比較空氣汙染物與兩疾病關係之異同。因此，本研究目的在於利用全民健康保險研究資料庫，取得台灣過敏性結膜炎以及過敏性鼻炎的臨床確診診斷資料，來探討全台灣首次有過敏性結膜炎或過敏性鼻炎的患者發生狀況，與暴露於空氣污染物濃度之間的關係，並進一步比較空氣汙染物與兩疾病之關係異同。
研究方法：本研究利用2004年至2013年之全民健康保險研究資料庫之一百萬抽樣資料，依據國際疾病分類第九版（ICD-9-CM）診斷，篩選出首次發病的過敏性結膜炎、過敏性鼻炎的患者，並結合行政院環境保護署空氣品質監測數據，作為暴露資料。使用病例交叉設計，並藉由t檢定及條件式邏輯斯迴歸模式，探討空氣污染物濃度對於過敏性結膜炎及過敏性鼻炎之關聯。此外，考量過敏反應對空氣汙染物的延遲效應，納入了當日（Lag0）及延遲1至2日（Lag-1, Lag-2）的空氣污染物濃度，並以性別、年齡及季節分層分析。藉由邏輯斯迴歸模式，探討空氣汙染物與過敏性結膜炎及過敏性鼻炎之關係異同。
研究結果：2004-2013年過敏性結膜炎首發之患者有100,636位，平均年齡為27.6歲，女性有56,587位（56.23%），19-49歲佔了38.43%，好發季節為春季（29.63%）；過敏性鼻炎首發之患者140,365位，平均年齡為31.41歲，女性有74,896位（53.36%），19-49歲佔了44.67%，好發季節為冬季（28.65%）；同時有過敏性結膜炎及過敏性鼻炎首發的患者共有27,964位，平均年齡為21.34歲，女性有15,099位（53.99%）， 19-49歲佔的比例最高。以條件式邏輯斯迴歸分析過敏性結膜炎與空氣汙染物，發現O3、NO2及溫度與過敏性結膜炎有正相關，與相對濕度有負相關；過敏性鼻炎與空氣汙染物CO及NO2有正相關，與相對濕度及溫度有負相關。以邏輯斯迴歸分析兩疾病與空氣汙染物，在校正基本人口學（性別、年齡）、季節、O3以及溫溼度後，相較於過敏結膜炎來說，發現過敏性鼻炎的發生與較低的NO2（Model 4: OR=0.990）有關。
結論：過敏性結膜炎與過敏性鼻炎常被認為具有共病性，二者皆與天氣變化相關，但與溫度之關聯卻是相反；其共同關聯之空污為NO2，推測主要來源為交通排放。比較NO2與二者關聯發現，過敏性鼻炎與低NO2濃度有關，或許可以稍微說明過敏性鼻炎的患者多於過敏結膜炎患者的原因。

Background and Motivation: In the recent years, influences by industrialization and urbanization on air quality have been prevalent in Taiwan. The improvement on air pollutant emissions is limited, and the problem of air pollution has always existed. The increase in air pollutant concentration not only has an impact on the environment, but also has a bad impact on human health. Allergic conjunctivitis (AC) and allergic rhinitis (AR) are air pollution-related diseases that do affect each other. Most studies only focus on a single allergic condition, and rarely compare the similarities and differences between air pollutants and the two diseases further. Thus, the purpose of this study is to use diagnose of AC and AR from Taiwan’s National Health Insurance Research Database, to explore the relationship between the first incidence of first-time AC or AR and the exposure to air pollutants in Taiwan, and to further compare the relationships of the air pollutants with the two diseases.
Methods: This study used one million samples of the Longitudinal National Health Insurance Database from 2004 to 2013. According to the 9th version of the international disease classification (ICD-9-CM), the study selected patients diagnosed with AC or AR, and linked them with the air quality monitoring data by Environmental Protection Administration as exposure data. The case-crossover design was used for this case control study. The study used the conditional logistic regression model to estimate the relationship between air pollutant concentrations, AC and AR. In addition, considering the lag effect of allergic reactions possibly tiggered by air pollutants, the concentrations of air pollutants on the day (Lag0) and 1 and 2 previous days (Lag-1, Lag-2) were included and stratified by sex, age and season. The comparison between the two air pollutant-disease (AC or AR) relationships was conducte by the logistic regression model.
Results: There were 100,636 patients with first occurrence of AC during 2004-2013, with an average age of 27.6 years. The first occurrences of AC were significantly the most for 19-49 years by age (38.43%), for women by sex (56.23%), and in spring by season (29.63%). There were 140,365 patients with first occurrence of AR during 2004-2013, with an average age of 31.41 years. The first occurrences of AR were significantly the most for 19-49 years by age (44.67%), for women by sex (53.36%), and in winter by season (28.65%). Multivariate conditional logistic regression analyses indicated that ozone (O3), nitrogen dioxide (NO2) and temperature were positively associated with AC (P < 0.001), while relative humidity was negatively related to AC (P < 0.001). For analysis of AR, carbon monoxide (CO)　and 　nitrogen dioxide (NO2) were positively associated (P < 0.001), while temperature and relative humidity was negatively related (P < 0.001).We used multivariate logistic regression analysis to compare the two air pollutant-disease relationships, after adjustment for basic demographics (gender, age), season O3, RH and temperature. Compared with AC, AR was found to be associated with the lower NO2 (Model 4: OR=0.990).
Conclusions: AC and AR are often considered to be comorbid, and related to weather changes, albeit with different trends related to temperature. They are both associated with air pollution NO2, presumably the main source to be traffic emissions. Comparing the relations of NO2 with the two diseases, we found that AR is associated with the lower NO2 concentration, which may slightly explain more patients with AR than with AC.

目錄
中文摘要 I
Abstract III
表目錄 VII
圖目錄 IX
第一章　緒論 1
第一節　研究背景及動機 1
第二節　研究目的 3
第二章　文獻探討 4
第一節　過敏性結膜炎、過敏性鼻炎 4
一、 過敏性結膜炎（Allergic Conjunctivitis, AC） 4
二、 過敏性鼻炎（Allergic Rhinitis, AR） 5
第二節　空氣汙染物 7
一、 空氣汙染物定義 7
二、 空氣汙染物種類 7
第三節　空氣汙染物與過敏性結膜炎及過敏性鼻炎之關聯 10
一、 空氣汙染與過敏性結膜炎相關文獻 10
二、 空氣汙染與過敏性鼻炎的相關文獻 11
三、 空氣汙染物濃度與過敏性鼻結膜炎之間的關係 14
第三章　研究方法 21
第一節　研究設計與架構 21
第二節　資料來源 23
一、 研究對象資料來源 23
二、 空氣汙染物資料來源 24
第三節　資料處理 25
一、 研究對象資料處理 25
二、 空氣汙染物資料處理 25
三、 控制變項處理 26
第四節　統計分析 31
第四章　研究結果 32
第一節　研究對象基本特性 32
第二節　空氣品質概況 34
第三節　過敏性結膜炎與空氣汙染物 39
一、 單一汙染物/多重汙染物與過敏性結膜炎 39
二、 分層分析過敏性結膜炎與空氣汙染物 42
第四節　過敏性鼻炎與空氣汙染物 56
一、 單一汙染物/多重汙染物與過敏性鼻炎 56
二、 分層分析過敏性鼻炎與空氣汙染物 62
第五節　空氣汙染物與過敏性結膜炎及過敏性鼻炎 77
第五章　討論 79
第一節　研究對象基本特性 79
第二節　空氣汙染物與過敏性鼻炎之關聯性探討 80
第三節　空氣汙染物與過敏性結膜炎及過敏性鼻炎 81
第四節　研究限制 83
第六章　結論與建議 84
參考文獻 85
附錄 89

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