六輕石化工業區周界成人居民腎功能與慢性腎臟病之探討

Renal Function and Chronic Kidney Disease of Adults Living Near the No.6 Naphtha Cracking Complex

柯登元(Deng-Yuan Ke)

指導教授 ： 詹長權

國立臺灣大學/公共衛生學院/職業醫學與工業衛生研究所/碩士(2016年)

https://doi.org/10.6342/NTU201700017

摘要

背景: 過去研究指出工作者的重金屬職業性暴露與腎功能下降有關，但對於一般族群之重金屬暴露是否影響腎功能的研究仍有限。本研究目的為探討工業污染排放對於鄰近居民的腎絲球過濾率與慢性腎臟病之影響。
方法: 本研究的對象為2009到2012年收案時35歲以上且長期居住在雲林縣六輕石化工業區周界的十個鄉鎮，包含麥寮、台西、東勢、崙背、褒忠、四湖、二崙、元長、莿桐鄉與虎尾鎮，共2,069位成人。三個石化工業汙染的暴露指標為: (一)住家與六輕石化工業區的距離: 以ArcGIS 10.1計算出居民住家到六輕石化工業區邊界的最短直線距離; (二)尿中生物標記濃度: 居民的尿中砷、鎘、汞、鉈與1-羥基芘濃度; (三)住家位於高、低暴露區: 距六輕石化工業區10公里內的麥寮與台西鄉定義為高暴露區，10公里外的其他八個鄉鎮定義為低暴露區。三個可能的暴露效應為: (一)腎絲球過濾率: 居民的年齡、性別與血清肌酐酸代入Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI-Taiwan) 公式計算腎絲球過濾率; (二)慢性腎臟病: 以腎絲球過濾率小於60 ml/min/1.73m2定義為慢性腎臟病; (三)慢性腎臟病中重度風險: 以腎絲球過濾率小於60 ml/min/1.73m2或腎絲球過濾率大於60 ml/min/1.73m2且尿蛋白試紙檢測結果為1+(含)以上定義為慢性腎臟病中重度風險。統計分析方法為使用一般線性迴歸與羅吉斯迴歸模式評估石化工業汙染暴露指標是否跟健康效應有關，並校正人口學特徵、個人風險因子與交通汙染。使用共變數分析檢定比較高、低暴露區居民尿中砷、鎘、汞、鉈、1-羥基芘濃度與腎絲球過濾率是否有差異，並校正人口學特徵、個人風險因子、飲食與交通汙染。使用卡方檢定比較高、低暴露區居民的慢性腎臟病盛行率是否存在差異。
結果: 本研究對象為居住在六輕石化工業區周界35歲以上的2,069位成人，其平均年齡為57.45歲、男性比例為40%、平均住家與六輕石化工業區之距離為14.21 km、平均尿中砷、鎘、汞、鉈、1-羥基芘濃度分別為81.12、0.88、2.25、0.20 µg/g creatinine、0.12 µmol/mol creatinine、平均腎絲球過濾率為65.88 ml/min/1.73 m2與慢性腎臟病盛行率為33%。本研究發現居民住家每接近六輕石化工業區1公里，腎絲球過濾率下降0.29 ml/min/1.73m2 (95% CI: -0.36, -0.22)、罹患慢性腎臟病風險增加為1.05倍 (1.03, 1.06)、慢性腎臟病中重度風險增加為1.03倍 (1.02, 1.05)。尿中砷濃度每增加1倍，腎絲球過濾率下降0.68 mL/min/1.73m2 (-1.12, -0.23)、罹患慢性腎臟病風險增加為1.14倍 (1.04, 1.26)。尿中1-羥基芘濃度每增加1倍，腎絲球過濾率下降0.49 mL/min/1.73m2 (-0.78, -0.20)。居住在高暴露區的居民有669位，其平均年齡為57.72歲、男性比例為39%、平均住家與六輕石化工業區之距離為6.10 km，居住在低暴露區的居民有1,400位，其平均年齡為57.32歲、男性比例為40%、平均住家與六輕石化工業區之距離為18.09 km。居住在高暴露區的居民之平均尿中砷、鎘、汞、鉈、1-羥基芘濃度分別為94.60、0.89、2.34、0.22 µg/g creatinine、0.13 µmol/mol creatinine、平均腎絲球過濾率為63.74 ml/min/1.73 m2、慢性腎臟病盛行率為38%。居住在低暴露區的居民之平均尿中砷、鎘、汞、鉈、1-羥基芘濃度分別為74.68、0.87、2.20、0.19 µg/g creatinine與0.11 µmol/mol creatinine、平均腎絲球過濾率為66.90 ml/min/1.73 m2、慢性腎臟病盛行率為30%。居住在高暴露區的居民相對於低暴露區，尿中砷、鎘、汞、鉈、1-羥基芘濃度與慢性腎臟病盛行率顯著較高且腎絲球過濾率顯著較低。居住在高暴露區的居民相對於低暴露區，腎絲球過濾率下降3.18 ml/min/1.73m2 (-4.28, -2.08)、罹患慢性腎臟病風險增加為1.68倍 (1.32, 2.01) 與慢性腎臟病中重度風險增加為1.45倍 (1.15, 1.82)。
結論: 本研究發現居住在六輕石化工業區附近35歲以上成人的住家越接近六輕石化工業區，其腎絲球過濾率越低、罹患慢性腎臟病風險與慢性腎臟病中重度風險越高。居民尿中砷濃度越高，其腎絲球過濾率越低、罹患慢性腎臟病風險越高。

關鍵字

石化工業區 ； 腎絲球過濾率 ； 慢性腎臟病 ； 重金屬 ； 1-羥基芘

並列摘要

Background: Previous studies reported exposure to heavy metals was associated with alteration of kidney function among workers by little is known among general population. This study tried to see whether such exposure is associated with alterations in estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD) among residents liv-ing near a petrochemical complex.
Methods: Our study subjects were 2,069 long-term residents aged 35 years old in 2009-2012 in ten townships, including Mailiao, Taisi, Dongshih, Lunbei, Baojhong, Sihhu, Erlun, Yuanchang, Cihtong and Huwei, near the No.6 Naphtha Cracking Complex in Yunlin County, Taiwan. Three variables were used to estimate study subject’s exposure to pollution from the petrochemical complex: (1) the distance from their home addresses to the complex; (2) their urinary arsenic, cadmium, mercury, thallium and 1-hydroxypyrene (1-OHP) levels; (3) their homes in either the high exposure (HE) area, i.e Mailiao and Taisi townships within 10km radius away from the complex, or the low exposure (LE) area of the other 8 townships located beyond the 10km radius away from the complex. Three indicators were as potential outcomes of exposure: (1) eGFR calcu-lated by serum creatinine, age, and gender through the equation of Chronic Kidney Dis-ease Epidemiology Collaboration (CKD-EPI-Taiwan); (2) CKD defined as eGFR lower than 60 ml/min/1.73m2; (3) High-intermediate risk of CKD defined as eGFR lower than 60 ml/min/1.73m2 or eGFR higher than 60 ml/min/1.73m2 and dipstick of urine protein larger than 1+. We applied generalized linear models (GLM) and logistic regression mod-els to estimate the associations between petrochemical exposures and health outcomes, adjusting for demographic characteristics, personal risk factors and traffic pollution. Anal-ysis of covariance (ANCOVA) test was used to determine difference of urinary arsenic, cadmium, mercury, thallium, 1-OHP and eGFR between HE and LE area by adjusting demographic characteristics, personal risk factors, food consumption and traffic pollution. Chi-square test were conducted to determine difference in CKD prevalence between HE and LE areas.
Results: Our study subjects included 40% males, an average age of 57.45 years old, and a mean distance of 14.21 km from their homes to the complex. Their urinary arsenic, cadmium, mercury, thallium and 1-OHP levels averaged at 81.12, 0.88, 2.25, 0.20 µg/g creatinine and 0.12 µmol/mol creatinine, respectively. Their overall mean eGFR was 65.88 ml/min/1.73m2 with 33% of them lower than 60 ml/min/1.73m2. For every 1 km closer to the complex from study subjects’ homes, we found their eGFR decreased 0.29 mL/min/1.73m2 (95% CI: -0.36, -0.22), and the odds ratios were 1.05 (1.03, 1.06) for CKD and 1.03 (1.02, 1.05) for high-intermediate risk of CKD. For 1-fold increase in uri-nary arsenic concentration, we found eGFR decreased by 0.68 mL/min/1.73m2 lower (-1.12, -0.23) and the odds ratio of CKD was 1.14 (1.04, 1.26). The eGFR was 0.49 mL/min/1.73m2 lower (-0.78, -0.20) per 1-fold increase in urinary 1-OHP concentration. The mean distance to the complex was 6.10 km for the 669 subjects in HE area and 18.09 km for the 1,400 subjects in LE area, respectively. Age and gender were comparable for both areas. Urinary concentrations of arsenic, cadmium, mercury, thallium and 1-OHP of subjects in the HE area (94.60, 0.89, 2.34, 0.22 µg/g creatinine and 0.13 µmol/mol creati-nine) were significantly higher than those in the LE area (74.68, 0.87, 2.20, 0.19 µg/g creatinine and 0.11 µmol/mol creatinine). The mean eGFR of subjects in the HE area (63.74 ml/min/1.73m2) was significantly lower than those in the LE area (66.90 ml/min/1.73m2). The CKD prevalence in the HE area (38%) was also significantly higher than that in the LE area (30%). Compared to the LE area, subjects living in the HE area were associated with 3.18 ml/min/1.73m2 (-4.28, -2.08) decrease in eGFR, an odds ratio of 1.68 (1.32, 2.01) for CKD and an odds ratio of 1.45 (1.15, 1.82) for high-intermediate risk of CKD.
Conclusion: We concluded that adults above 35 years old who lived closer to the No.6 Naphtha Cracking Complex, were associated with decreased renal function and increased risks of CKD and the high-intermediate risk of CKD. Arsenic was the pollutant contrib-uting to such associations.

並列關鍵字

Petrochemical complex ； Estimated glomerular filtration rate (eGFR) ； Chronic kidney disease (CKD) ； Heavy metals ； 1-Hydroxypyrene (1-OHP)

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