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  • 學位論文

台灣烏腳病高盛行地區居民血清中微量營養素與高血壓、糖尿病盛行率之相關性研究

The association between serum micronutrient levels and prevalence of hypertension/diabetes among residents in blackfoot disease hyperendemic area in Taiwan.

指導教授 : 薛玉梅
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摘要


本研究為探討烏腳病盛行地區居民血清中微量營養素與高血壓及糖尿病盛行率之相關性,係以烏腳病高盛行地區的嘉義縣布袋鎮好美、復興、新民三里為研究地區。於民國77至78年間對所有年滿30歲且每週至少居住五天的現住居民,經由受過訓練的訪視員利用標準化結構式問卷進行家庭訪視,問卷內容包括人口學資料、居住史、飲水史、生活習慣等;之後進行健康檢查篩檢高血壓與糖尿病患者,並以真空採血器採得受檢者之血液,分離血清後予以-70℃冷凍貯存,以備血清中生化檢查(脂質、脂蛋白)和微量營養元素濃度分析。合於受訪條件者有1571人,實際到檢人數為941人,進行血清營養素分析者403人。利用高效率液相層析儀(high performance liquid chromatography, HPLC)分析血清中四種微量營養素維生素A(all-trans retinol)、維生素E(α-tocopherol)、蕃茄紅素(lycopene)、β-胡蘿蔔素(β-carotene)之含量。 研究結果發現女性血清中的維生素A與維生素E顯著較男性偏低,而β-胡蘿蔔素卻比男性顯著偏高。糖尿病病患血清中維生素E的含量顯著高於無糖尿病者,其他三種營養素並無顯著不同。維生素E則隨著累積砷暴露增加而增加。 多變項分析結果發現調整年齡、性別及其他危險因子(抽煙、喝酒、高密度脂蛋白/膽固醇)後,隨著肥胖指數、累積砷暴露量的增加,高血壓的危險對比值有顯著的增加;高血壓的相對危險性隨著維生素E濃度的增加以及累積砷暴露減少而顯著降低。調整年齡、性別及其他危險因子(抽煙、喝酒、高密度脂蛋白/膽固醇、肥胖指數)後,女性比男性有顯著偏高的糖尿病危險對比值,隨著年齡增加糖尿病危險對比值顯著增加。隨著累積砷暴露量增加糖尿病危險對比值增加,但未達統計上顯著性。糖尿病的相對危險性隨著維生素A濃度的增加以及累積砷暴露量減少而有降低的趨勢,但是並未達統計上顯著水準。

並列摘要


To examine the association between serum micronutrient level and prevalence of hypertension/diabetes residents living in Homei, Fuhsin and Hsinming villages, the blackfoot disease hyperendemic area, in Pautai Township of Chiayi County in Taiwan. Study subjects were 1571 residents, >30 years old, who lived in the study area ≧5 days a week. During the year of 1988-1989, study subjects were interviewed by trained public health nurses using structured questionnaires. Information obtained included sociodemographic characteristics, residential history, history of drinking high-arsenic artesian well water, and lifestyle. In addition, hypertension and diabetes health examinations were conducted. And blood samples were collected after fasting. Sera from the blood samples were kept at -70℃, till regulatory blood test and micronutrient measurement. 941 study subjects participated the health examination, and 403 study subjects were determined for micronutrient levels. high-pressure liquid chromatography was used to measure serum retinol,α-tocopherol, lycopene and β-carotene levels. Serum retinol and α-tocopherol levels of women were significantly lower than those of men. The levels of β-carotene in women were significantly higher than those in men. Diabetes patients showed significantly higher levels of serum α-tocopherol than those of controls. Other micronutrients exhibited no statistical difference between diabetes patients and controls. Serum α-tocopherol levels were positive associated with cumulative arsenic exposure. For hypertension, after adjustment for age, sex, other risk factors (cigarette smoking, alcohol drinking, high-density lipoprotein/cholesterol ratio), significant association was acquired between body mass index or cumulative arsenic exposure and the odds ratio of hypertension. A significantly lower odds ratio of hypertension was observed with the high levels of serum α-tocopherol and low cumulative arsenic exposure. For diabetes, after adjustment for age, sex, other risk factors (cigarette smoking, alcohol drinking, high-density lipoprotein/cholesterol ratio), there were significant higher the odds ratios of diabetes in women and in older subjects. An increased odds ratio of diabetes, though not statistically significant, was found in the group with high cumulative arsenic exposure. High levels of serum retinol and low cumulative arsenic exposure showed lower the odds ratio of diabetes, though it was not statistically significantly.

參考文獻


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