大高雄地區婦女之慢性支氣管炎之相關性研究

研究目的：抽菸是目前已知慢性支氣管炎最主要的危險因子，但是台灣婦女的吸煙盛行率僅有3-4﹪，可見在女性中除了抽菸外，環境上應該還有其他導致慢性支氣管炎的危險因子。因此本研究的主要目的是探討導致婦女慢性支氣管炎的危險因子。方法：本計畫研究設計採用社區基礎巢式病例對照研究法。研究的個案組與對照組均來自高屏地區中央健保局民國89年度一月至十二月的健保資料中40歲以上（包括40歲）的女性，且均居住在高雄縣市至少五年以上。病例組為在研究期間被診斷為慢性支氣管炎( ICD-9 code: 491 )至少兩次，且排除其他呼吸道疾病；對照組為在研究期間內，曾經因為交通意外( ICD-9 code: E800~E848 )或急性腸胃炎( ICD-9 code: 008.8;009.1;558.3;558.9 )而就醫，並且排除其他呼吸道疾病的民眾。對個案進行實際問卷訪視和肺功能檢查，問卷蒐集結果以SPSS統計軟體進行分析。結果：研究發現婦女在20-40歲若有抽菸的習慣，其罹患慢性支氣管炎的危險性是沒有抽菸習慣婦女的3.32倍(95% CI=1.15-9.54)。另外再以是否有咳嗽或咳痰症狀來分組，探討其相關環境危險因子，結果發現當比較於非抽菸和二手菸暴露的婦女，具有二手菸暴露和抽菸習慣的婦女，分別具有9.51(95% CI=1.18-76.91)與86.03(95% CI=8.61-865.08)的危險性會有咳嗽或咳痰症狀。本研究另外發現在20-40歲時，病例組在家中裝設有排油煙機的比率(32人, 39.0%)比對照組中在家中裝設有排油煙機的人(85人, 50.9%)還少，沒有裝設排油煙機的人較有裝設排油煙機者，其調整了年齡、BMI、教育程度、20-40歲菸的暴露情形和燒香拜拜後之危險性為2.11倍，且達到統計上的意義(95% CI=1.10-4.06)。另外，本研究也發現抽菸與燒香拜拜習慣是造成婦女FEV1下降的主要原因。結論：婦女在20-40歲若有抽菸的習慣較易罹患慢性支氣管，並且二手菸暴露容易導致婦女產生咳嗽或咳痰症狀；20-40歲時家中沒有裝設排油煙機的婦女較易罹患罹患慢性支氣管，抽菸與燒香拜拜習慣是造成婦女FEV1下降的主要原因。

關鍵字

慢性支氣管炎

並列摘要

Objective: Cigarette smoking is a major risk factor of chronic bronchitis. Although 85-90% of chronic bronchitis was caused by cigarette smoking, only 3-4% women are smokers in Taiwan. In addition to cigarette smoking, other environmental risk factors may play important roles for chronic bronchitis in women. Therefore, the purpose of this study is to investigate the effect of environmental risk factors on chronic bronchitis risk in Taiwanese women. Methods: A community-based nested case-control study was conducted. The potential study subjects were from the data of Bureau National Health Insurance between January and December, 2000. Eligible cases and controls were female who were 40 years old and over and had lived in Kaohsiung metropolitan area for 5 years and over. Potential study cases were those who were diagnosed with chronic bronchitis (ICD-9 code: 491) without other respiratory diseases at least 2 times in the year 2000. Potential controls were those who were healthy and suffered from traffic accident (ICD-9 code: E800~E848) or acute gastroenteritis (ICD-9 code: 008.8; 009.1; 558.3; 558.9) and matched with cases by the same age (case: control=1:2). Information about pulmonary function tests and potential environmental risk factors were collected. Results: Women who smoked at age 20-40 years had a higher risk to contract chronic bronchitis when compared with non-smoking women (OR= 3.32, 95% CI=1.15-9.54). Using the ATS criteria (American Thoracic Society) of chronic bronchitis, we found subjects with ETS (environmental tobacco smoke) exposure and smoking habit had significantly higher risks to develop chronic bronchitis (OR=9.51, 95% CI=1.18-76.91; OR=86.03, 95% CI=8.61-865.08, respectively) than those who didn’t. The frequency of installing fume extraction at home (32, 39.0%) in cases are lower than that in controls (85, 50.9%). Women without installing fume extraction at home were more likely to contract chronic bronchitis than those with installing fume extraction at home (OR= 2.11, 95% CI=1.10-4.06). Our study also found that smoking and burning incense are the main risk factors for the decline of FEV1 index in Taiwanese women. Conclusion: Among non-smoking Taiwanese women, ETS and the installation of fume extraction were major determinants of contracting chronic bronchitis. In addition, smoking and exposure to burning incense can decline FEV1 index.