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  • 學位論文

大氣中真菌孢子之分佈及特性描述與探討其對於哮喘發作的效應

Distributions and Characteristics of Ambient Fungal Spores and Their Effects on Asthma Attack

指導教授 : 郭育良
共同指導教授 : 陳志傑(Chih-Chieh Chen)
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摘要


研究背景和目的:世界上許多國家,包括台灣在內,哮喘的盛行率還在不斷增加。真菌過敏對於嚴重的哮喘發生是一個重要的危險因素,同時在哮喘的季節性變化趨勢也占有很重要的角色。相較於真菌界的豐富多樣性,目前對黴菌過敏的了解是非常有限的。真菌提取物標準品的品質不一致,造成目前臨床上在皮膚和特異性免疫球蛋白E測試的障礙,造成了臨床上對於真菌過敏的嚴重低估。真菌孢子的量測是目前最常用於流行病學研究中的方法。本研究擬達成之研究目的為調查大氣中真菌孢子濃度變化及季節分佈之特性,探討其與環境因子及哮喘急診及住院入院率之相關性變化趨勢。 方法:本研究從2013年4月至2013年12月在台北市古亭國小的環保署空氣污染測站旁,進行真菌孢子採樣。利用Burkard七天連續性孢子採樣器,長期監測大氣中真菌孢子濃度,以瞭解其成分和濃度之分佈特性,並評估可能的健康危害。採樣所得的樣本,利用10% Mowiol固定於玻片並使用Glycerin-jelly染色後,以800倍率的光學顯微鏡進行真菌孢子鑑定。鑑定方法採用縱軸鑑定,計算所得的孢子數利用公式換算成每日的平均孢子濃度(孢子數/立方公尺)。其後與中央氣象局台北測站的氣象資料、環保署古亭測站的空污資料及台大醫院的哮喘急診率,進行統計分析。利用描述性統計呈現真菌孢子濃度的分佈、組成及季節變化。利用主成分分析將真菌種類歸類成三個族群,並與氣象因子及空氣污染物進行相關性分析。利用簡單線性迴歸分析,將與真菌濃度有顯著相關的大氣因子及空氣污染物,納入複迴歸分析模式中,以評估真菌孢子濃度與環境因子之間的相關性。利用時間配對病例交叉研究設計,以條件式邏輯斯迴歸模式,探討氣喘急診就診率及大氣中真菌孢子濃度之相關性。 結果:此研究總共完成分析275個真菌孢子樣本。統計結果顯示,出現頻率超過70%的真菌孢子種類為ascospores, basidiospores, Aspergillus/Penicillium, Cladosporium, smuts, Periconia, Fusarium及Arthrinium。而許多真菌孢子大致上呈現季節變化的趨勢。藉由複迴歸分析,發現大部分的真菌孢子濃度變化與溫度呈正相關,與平均風速呈負相關。平均每日因為氣喘而至台大醫院急診的病患為1.8人次。利用條件式邏輯斯迴歸模式並校正相關危險因子,5歲至15歲的孩童其因哮喘發作急診就診率與ascospores有顯著的正相關 (危險比為1.45,95%信賴區間為1.15至4.57,每一四分位差增加1223 孢子數/立方公尺)。 結論:台北地區最占優勢之真菌孢子總類為Ascospores, Basidiospores, Aspergillus/Penicillium和Cladosporium。氣象因子與空氣污染物會影響大氣中真菌孢子的濃度。大氣中,高濃度的真菌孢子環境可能與小孩的氣喘急診率有關。

並列摘要


Background and Objective:The prevalence of asthma is increasing in many countries worldwide, including Taiwan. Fungal sensitization is an important risk factor for severe asthma, and also plays an important role in asthma seasonality. Comparing to the enor-mous diversity of the Fungal Kingdom, current knowledge on fungal allergy is very limited. Inadequate standardization of fungal extract used in skin and specific immuno-globulin E test further hamper the clinical awareness of fungal sensitization and lead to a severe underestimation of the prevalence of mold allergy. Fungal spores are the most common component being evaluated in epidemiological study. The study aimed to in-vestigate distributions and characteristics of ambient fungal spores, the relationships between ambient fungal levels and environmental factors and the correlation of temporal trends between fungal spore concentrations and emergency room visits for asthma. Method:We have completed documenting ambient fungal spores from April to De-cember 2013 on the roof of Gutting Elementary School near an EPA air pollution moni-toring station. By using the Burkard seven-day volumetric spore trap to monitor the lev-els of ambient fungal spores, we investigated characteristics of ambient fungal spores and the health effects to human. Melinex tape was mounted on microscope slide with 10% Mowiol and stained with glycerin jelly. Samples were identified under microscope at a 800x magnification using the longitudinal traverse method to obtain average daily concentrations (spores m-3). Complete daily meteorological data were retrieved from Central Weather Bureau-Taipei station. Daily air pollutants were retrieved from Taiwan Environmental Protection Administration monitoring station-Gutting station. Emergency room visits for asthma were retrieved from National Taiwan University Hospital (NTUH). We used descriptive statistics to present composition, distributions and tem-poral variation of ambient fungi. Fungal categories were grouped into three groups by principal component analysis. After using simple linear regression to get the variables significantly associated with fungal concentrations, put them into multiple regression to examine the relationships between ambient fungal spores and environmental factors. A time-stratified approach for the case-crossover technique and a conditional logistic re-gression were used to evaluate the associations between asthma-related emergency room visits and the levels of airborne fungal spores. Result:A total of 275 samples was examined in this study. The most prevalent fungi were ascospores, basidiospores, Aspergillus/Penicillium, Cladosporium, smuts, Periconia, Fusarium and Arthrinium, which were present in more than 70% of the samples. In general, many fungal spores showed seasonal patterns during the study period. By multiple regression analysis, we found that most of fungal species were significantly positively associated with temperature and negatively associated with wind speed. Daily emergency room visits for asthma attack in National Taiwan University Hospital were 1.8 cases/day. After adjusting some confounders, asthma-related emergency visits in children aged from 5 to 15 years old were positively related to ascospores by conditional logistic regression (OR = 1.45; 95% CI = 1.15 to 4.57, for per IQR increment of 1223 spores/m3). Conclusion:The most prevalent fungal spores in Taipei were ascospores, basidiospores, Aspergillus/Penicillium, Cladosporium. Meteorological factors and air pollutants ap-peared to affect ambient levels of fungal spores. High ambient levels of fungal spores might be related to emergency room visits due to asthma in children.

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