環境油煙暴露與婦女子宮頸?N狀上皮內細胞病變之相關性探討

Environmental exposure to cooking oil fumes and cervical squamous cell intraepithelial lesion

李哲瑋(Che-Wei Lee)

指導教授 ： 李建宏

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2007年)

摘要

目的：以社區為基礎的病例對照研究方法探討油煙暴露與婦女罹患低度鱗狀上皮內細胞病變(LSIL)與高度鱗狀上皮內細胞病變(HSIL)之關係。
材料與方法：研究對象是居住在高雄縣，年齡20及20歲以上，過去子宮頸抹片檢查皆正常者，研究期間自92年1月至96年3月。潛在陽性個案其子宮頸抹片檢查首次被診斷為CIN≥1。對照組的選擇則是以1：1至1：4的比率配對，以住在相同地區之高雄縣婦女、年齡相差正負一歲且子宮頸抹片檢查為陰性者予以隨機抽樣。所有個案均需簽署同意參與研究志願書，由受過訓練的公衛護士收集個案的問卷資料以及子宮頸剝落的細胞檢體以偵測有無人類乳突狀病毒感染。
研究結果：烹煮時沒有打開抽油煙機或本身沒有抽油煙機者，罹患高度鱗狀上皮內細胞病變(HSIL)的危險性，有顯著性差異(AOR=3.4, 95%CI=1.2-10.1)。無高危險性人類乳突狀病毒感染而有油煙暴露者，有4.2倍(95%CI=0.8-23.5)的危險性會罹患高度鱗狀上皮內細胞病變(HSIL)。有高危險性人類乳突狀病毒感染而沒有油煙暴露者，有35.5倍(95%CI=13.9-91.0)的危險性會罹患高度鱗狀上皮內細胞病變(HSIL)。有高危險性人類乳突狀病毒感染而同時又有油煙暴露者，有50.3倍(95%CI=8.3-305.9)的危險性會罹患高度鱗狀上皮內細胞病變(HSIL)。
結論：油煙暴露會增加罹患子宮頸鱗狀上皮內細胞病變的危險性。烹煮時打開排油煙機能減少罹患子宮頸上皮內細胞病變的發生。油煙暴露可能會加強原本有HPV感染者其罹患子宮頸上皮內細胞病變的風險性。

關鍵字

子宮頸鱗狀上皮內細胞病變 ； 油煙 ； HPV感染

並列摘要

Objective: We conducted a community-based case-control study to investigate that exposure to cooking oil fumes is associated with low-grade (LSIL) and high-grade (HSIL) cervical squamous intraepithelial lesions.
Materials and Methods: The study population consisted of women above the age of 19 years living in Kaohsiung County, who had received pap smear screening between January, 2003, and March, 2007. The potential cases were women having lesions greater than cervical intraepithelial lesion I (≧CIN1). The potential controls (case: control =1:2~1:4) were age-matched (±1 years) and residence-matched women who had normal pap smears All of the subjects were completely interviewed by public health nurses to obtain information on their active, passive smoking, cooking oil fume exposure history as well as other potential risk factors and asked to provide the cervical smear for HPV infection examination.
Results: Women who cooked in the kitchen without opening the fume extractor had a 3.4 times higher risk [95% confidence interval (CI)=1.2-10.1] of developing cervical intraepithelial lesion. Women who did not have HPV infection but exposed to cooking oil fumes had a 4.2 times higher risk [95% confidence interval (CI)=0.8-23.5] of developing cervical intraepithelial lesion. Women who have HPV infection but did not expose to cooking oil fumes had a 35.5 times higher risk [95% confidence interval (CI)=13.9-91.0] of developing cervical intraepithelial lesion. Women who have HPV infection and exposed to cooking oil fumes had a 50.3 times higher risk [95% confidence interval (CI)=8.3-305.9] of developing cervical intraepithelial lesion.
Conclusion: Exposure to cooking oil fumes may cause cervical intraepithelial lesion, women can be protected from the risk by always cooking in kitchens equipped with fume extractors and by keeping them on while cooking.

並列關鍵字

cervical squamous cell intraepithelial lesion ； cooking oil fumes ； HPV infection

參考文獻

1.Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer 2006;118:3030-44.

2.行政院衛生署

3.Ostor AG. Studies on 200 cases of early squamous cell carcinoma of the cervix. Int J Gynecol Pathol 1993;12:193-207.

4.Bethesda III System 2001

5.Zuna RE, Allen RA, Moore WE, Lu Y, Mattu R, Dunn ST. Distribution of HPV genotypes in 282 women with cervical lesions: evidence for three categories of intraepithelial lesions based on morphology and HPV type. Mod Pathol 2007;20:167-74.