- 學位論文
農業社區腎臟病之職業、環境及個人危害因子系統性回顧與統合分析
Systematic Review and Meta-Analysis of Occupational, Environmental and Personal Risk Factors for Kidney Diseases in Agricultural Communities
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摘要
目的：近年來流行於農業社區的不明原因慢性腎臟病，引起社會大眾開始重視。本篇論文旨在估計職業、環境及個人因子對農業社區腎臟危害影響。 方法：首先，進行系統性回顧，搜尋Web of Science, PubMed, Embase 2010年至2023年以來的流行病學文獻，我利用 (Agriculture和 kidney 和 heat stress) 等相關關鍵字進行系統性文獻蒐集，進一步篩選文章並排除會議摘要、新興生物標記、評論、非人類及回顧性文章，以統合分析之統計方式估計腎臟病之危險因子的暴露勝算比。 結果：本研究一共蒐集8,160篇文獻，共27篇列入最後統計。被納入的文獻，其地理位置位於熱帶地區，包括中美洲 (墨西哥、尼加拉瓜、薩爾瓦多、瓜地馬拉及祕魯)，非洲 (喀麥隆)，南亞 (斯里蘭卡及印度) 及東亞地區 (臺灣)，其地理分布與熱帶地區相關。農民 (Effect size = 1.78, 95% CI, 1.48-2.14)、農藥暴露 (Effect size = 1.40, 95% CI, 1.00-1.95)為腎臟病重要職業因子。 結論： 對於農業社區腎臟病的盛行率，農民與農藥為職業暴露重要的腎臟病危害；環境因子例如飲用井水沒有顯著相關；個人因子包括性別、腎臟病家族史、飲酒及菸草使用。
並列摘要
Introduction: Recently in agricultural communities, there was a trend of chronic kidney disease of undetermined etiology (CKDu). This master thesis aims to assess the magnitude of the influence of occupational, environmental, and personal factors on renal disease. Method: First, We performed a systematic review and searched online databases, including the Web of Science, PubMed, and Embase, for articles published between January 2010 and January 2023 by using keywords such as agriculture, kidney disease, heat stress, or similar words. Furthermore, we screened the studies by excluding conference abstracts, novel biomarkers studies, commentaries, non-human studies, and review articles. Finally, we performed a meta-analysis statistical approach to assess risk factors for kidney disease and estimate the attributable risk for each risk factor. Result: We screened 8,160 articles in total, and 27 articles were included finally. The geographic distribution of included studies was among the tropical zone, including Latin America (Mexico, Nicaragua, El Salvador, Guatemala, and Peru), Africa (Cameroon), South Asia (Sri Lanka and India), and East Asia (Taiwan). The significant occupational factors of kidney disease revealed agricultural workers (Effect size = 1.80, 95% CI, 1.50-2.17) and agrochemicals (Effect size = 1.40, 95% CI, 1.00-1.95). Conclusion: Agricultural workers and agrochemicals are occupational hazards of kidney disease. An environmental hazard such as drinking well water is not a significant environmental risk for kidney disease. Personal hazards, including gender, family history of kidney disease, alcohol drinking, and tobacco use, significantly affect kidney disease prevalence.
參考文獻
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