- 學位論文
探討鉛作業場所員工長期暴露於鉛環境中與體內抑制素及生殖內分泌激素濃度之相關性
The Association of Long-term Lead Exposure and the Concentrations of Serum Inhibin with Reproductive Endocrines among Lead Workers
摘要
研究背景與目的：由於鉛已被許多研究證實可能對人類的生殖能力造成負面的影響，可能干擾人體中的生殖內分泌激素而造成生殖能力降低，所以我們利用民國80年度至民國90年度某鉛作業場所全體員工血中鉛濃度，來比較當前血鉛值及累積性鉛濃度指標與血清中抑制素濃度及生殖內分泌激素之間的相關性，藉由不同的鉛指標來探討鉛可能對生殖內分泌系統所造成的急性或慢性的影響。 材料與方法：以台灣某鉛蓄電池工廠員工為研究對象，利用其民國80年至90年之體檢資料及問卷資料，其中男性體檢資料包括血中鉛、FSH（Follicle stimulating hormone）、inhibin B、LH（Luteinizing hormone）、TTE（Testosterone），而女性的體檢資料包括血中鉛、FSH、LH、inhibin A、E2（Estradiol）及PGN（Progesterone），而問卷內容包含年齡、性別、身高、體重、抽菸及喝酒的情形，其中累積性鉛濃度指標則以ICL（Index of cumulative blood lead）及TWICL（Time weighted index of cumulative blood lead）來代表體內累積性鉛濃度，是以80年到90年每年的鉛作業體檢的血鉛濃度計算而來。以SPSS統計軟體來作基本資料的描述性統計、Pearson相關及複線性迴歸，來探討累積性鉛濃度及其他可能的相關因子是否與血清中抑制素濃度變化有相關。 結果：在男性中，累積性鉛濃度指標ICL和TWICL與血清中inhibin B之Pearson相關係數分別為0.220 (p = 0.003)和0.231(p = 0.002)，在複迴歸分析中，在控制年齡、BMI、FSH及TTE的影響後，ICL和TWICL每增加1單位，則血清中inhibin B則分別增加0.047(p = 0.017)和1.333(p = 0.007) pg/ml。在女性中，從皮爾森相關分析及迴歸分析中均未發現鉛和inhibin A有統計學顯著相關，在其它生殖內分泌激素中，可以發現在濾泡期，PGN和TWICL及當前血鉛值呈現負相關（P<0.05），經由複迴歸調整後，TWICL和當前血鉛值每增加一單位，PGN則分別減少0.007(P=0.049)和0.006(P=0.02) ng/ml。 結論：長期暴露在鉛作業場所的男性員工，會因其體內累積性鉛濃度的增加而造成血清中inhibin B濃度的上升，間接影響到精子的生成而影響其生育能力。在女性中，長期暴露在鉛環境中，可能會干擾婦女生殖內分泌激素，因而對婦女的生育能力造成負面的影響。
並列摘要
Objective: Lead is known that may have negative effect of human reproductive ability and may disturb our reproductive endocrine. We used the current lead level and cumulative lead index calculating the concentrations of blood lead from 1991 to 2001 in a group of lead workers and to investigate the association between different lead indexes and the concentration of serum inhibins or reproductive endocrine. Materials and Methods: The lead workers who worked in the lead-acid battery manufactory in Taiwan participated in this research. We utilized the health examination data which included blood lead concentration、FSH（Follicle stimulating hormone）、inhibin B、LH（Luteinizing hormone）、TTE（Testosterone）in male and FSH、LH、inhibin A、E2（Estradiol）and PGN（Progesterone）in female and questionnaire that included age、gender、height、weight、smoking and alcohol status. The cumulative lead index included ICL (Index of cumulative blood lead) and TWICL（Time weighted index of cumulative blood lead）which were calculated using the blood lead concentrations from 1991 to 2001. Data analysis was performed by SPSS software to conducted descriptive analyses、Pearson correlations and linear regressions. Results: In male workers, the Pearson correlation coefficients of ICL and TWICL versus inhibin B was 0.220 (p = 0.003) and 0.231 (p = 0.008) respectively; in multiple linear regression model, after controlling age、FSH、and TTE, when the ICL and TWICL index increasing 1 unit, the inhibin B will increase 0.047 pg/ml (P=0.024) and 1.333 pg/ml (P=0.017). In female workers, there is no statistic significant in Pearson correlation and regression analysis between lead indexes and inhibin A concentration. But in the follicular phase, we found that PGN was negative correlated with TWICL and current lead level (P<0.05), and in multiple linear regression, when the TWICL and current lead level increasing 1 unit, the PGN will decrease 0.007(P=0.049)and 0.006(P=0.02)ng/ml. Conclusions: The increasing of cumulative lead index will increase the concentration of serum inhibin B in long-term exposure male lead workers and that might indirectly affect the spermatogenesis. In female, long-term lead exposure might disturb the reproductive endocrine and then probably cause negative effect of fertility.