- 學位論文
環境和個人因子與幽門螺旋桿菌感染之相關性研究
Relationship of environmental and personal factors with Helicobacter pylori infection
摘要
研究背景與目的：全世界目前感染幽門螺旋桿菌的盛行率大約在50%，而幽門螺旋桿菌的感染途徑與主要的危險因數至今仍不明確。因此本研究目的在探討環境和個人因數與幽門螺旋桿菌感染之相關性。 材料與方法：本研究為一橫斷性研究，包含2組個案族群，一組個案族群為收集台灣北部及南部兩大醫學中心健康門診中心的個案，主要是針對食道癌之健康對照組，從2,000年到2,005年共收集773位個案，年齡從29歲到89歲；另一組個案族群為收集大高雄縣市地區十五個鄉區之石化工廠附近居民，主要是針對發生血癌及腦癌之個案篩選出的健康對照組，從1,998年到2,005年共收集592為個案，年齡從1歲到54歲，其中大於20歲的個案有482位。2組個案族群都接受問卷訪視及血液採集，問卷內容中主要探討的危險因數包括居住環境及抽煙、飲酒、飲食習慣；而血液採集主要在測血中IgG抗體來判斷有無幽門螺旋桿菌感染。 結果：首先在773位健康門診中心的個案族群，個案之年齡及教育程度與是否感染幽門螺旋桿菌並無顯著差異；在危險因數方面，調整年齡、性別、教育程度、飲酒後，抽煙量＞16pake-year的人感染幽門螺旋桿菌的相對危險性為不抽煙的1.47倍(95%CI=1.02-2.12)；飲酒量＜70g/week (OR=1.79,95%CI=1.08-2.95)以及70-140g/week (OR=0.79, 95%CI= 0.39-1.63)者感染幽門螺旋桿菌的相對危險性相較於無飲酒者有下降的趨勢，但未達統計上顯著差異；飲食方面發現在小於20歲食用辛辣食物者，每天吃一次以上比每年吃少於1次者感染幽門螺旋桿菌的危險性高3.19倍(95%CI=1.04-9.75)，而在20-40歲食用硝化食物，每星期1-6次比1年吃少於1次的危險性高1.92倍(95%CI=1.02-3.61)。 在第二部份石化工業區的健康個案族群，分析20歲以上共482位個案，則未發現飲酒、抽煙、飲水、飲食狀態有顯著差異。 結論：本研究的2組個案族群，因年齡層的不同而有不同的結果。在773位健康門診中心個案發現抽煙者有較高感染幽門桿菌的危險性；而飲酒在感染幽門桿菌的影響上呈現U型分佈，說明適量飲酒具有保護作用，可減少幽門螺旋桿菌的感染，然而未逹統計上顯著差異；另外在早期年齡時期常吃辛辣食物及硝化食物者對感染幽門桿菌可能具有危險性。然而，在石化工業區所獲得的健康個案族群中發現主要危險因數對感染幽門螺旋桿菌的危險性和健檢中心個案的結果並不一致且未達統計上的顯著差異，因此尚待進一步研究探討。
關鍵字
幽門桿菌並列摘要
Background and Objective：To date, the prevalence of Helicobacter pylori (HP) infection is 50% in the worldwide. Route of infections and major environment and personal factors are still uncertain. Therefore, the purpose of this study is to investigate the relationship of environment and personal factors with HP infection. Method：This is a cross-sectional study, and two study populations were examined. The first study is the subjects (n = 773) from north and south of medical centers in Taiwan for health check-ups, ages 29-59 years, who participated in the study about environmental factor exposures and risks of esophageal cancer between 2,000and 2,005. The second study is the healthy subjects (n = 592) from Kaohsiung metropolitan, ages 1-54 years, who participated in the study about petrochemical exposures and risks of leukemia and brain neoplasms between 1,998 and 2,005. Trained interviewers conducted personal structured questionnaires to collect epidemiology data, including water consumption, cigarette smoking, alcohol consumption and diet intake, and the status of HP infection in the serum was determined by immunoglobulin-G antibodies form study subjects. Result：For the first study, subjects who smoked >16 pack-year had a 1.47 times (95% CI: 1.02-2.12) more likely to have HP infection than those who VI II did not smoke. Subjects who consumed alcohol <70g-week had a 1.79 times (95% CI: 1.08-2.95) more likely to have HP infection than those who did not consumed alcohol, and subjects who consumed alcohol <70-140g-week had a 0.79 times (95% CI: 0.39-1.63) more likely to reduce HP infection than those who did not consumed alcohol. Subjects who often consumed spice-food ages <20 years and nitro-food between ages 20-40 years had 3.19 times (95% CI: 1.04-9.75) and 1.92 times (95%CI: 1.02-3.61) more likely to have HP infection than those who seldom consumed these food. The second study of subjects ages >20 years analysis, the result indicated no significant relations between cigarette smoking, alcohol consumption and diet intak, and HP infection. Conclusions：We found that subjects with small alcohol consumption had a significantly risk association with HP infection, while there were no significantly findings in protective effect in moderate alcohol consumption. Besides, cigarette smoking, spice and nitro food intakes in early stage of life suggested a risk factor for HP infection. Inconsistent results were found in these two studies, therefore, we need further study to determine these environmental factors and HP infection, as well as those personal factors.