大氣細懸浮微粒與結核病之關係

Ambient Fine Particulate Matter and Risk of tuberculosis

陳明賢(Ming-Hsien Chen)

指導教授 ： 陳佳堃

共同指導教授 ： 陳秀熙(Hsiu-Hsi Chen)

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2022年)

https://doi.org/10.6342/NTU202203147

摘要

研究背景
在這個工業化的時代，因為大量使用石化燃料，而造成了嚴重的空氣汚染問題。這些空氣汚染物中，以細懸浮微粒（PM2.5）最為知名。細懸浮微粒指懸浮於空氣中，粒徑在2.5微米（μm）以下之粒子。長期暴露於細懸浮微粒，可引發心血管疾病、呼吸道疾病以及增加癌症的風險等。結核病是一個可空氣傳播感染的疾病，至今仍是國際重視的嚴重傳染病，也是全球公衛重大的負擔。大氣的空氣汚染，可能會傷害肺部的免疫機制，而增加了結核病的發生。
研究目的
由於細懸浮大氣細懸浮微粒和結核病都會對人體造成危害，且可能會有關連性，故本研究為探討大氣細懸浮微粒和結核病傳染可能的相關性。
研究方法
以2005-2012年彰化縣整合式健康篩檢參加者，追蹤結核病發生至2016年，得到整篩後結核病的發生率和時間。對照該地區的空氣品質監測站PM2.5年平均值，使用羅吉斯迴歸進行分析。並以貝氏層次變點模型來預測在實驗室診斷代檢網（NRLN）和都治計畫（DOTS）影響下，不同鄉鎮和年齡層至2035年結核病的發生率。
研究結果
高細懸浮微粒暴露組（PM2.5>35μg/m3）得到結核病的勝算比是低細懸浮微粒暴露組的1.69倍（95% CI 1.35 - 2.15）。每增加1μg/m3的年平均細懸浮微粒，結核病的勝算比增加為1.065倍（95% CI 1.035 - 1.097）。年齡每增加1歲，結核病的勝算比增加為1.084倍（95% CI 1.074 - 1.095）。男性結核病的勝算比是女性的3.093倍（95% CI 2.540 - 3.776）。而低教育程度發生結核病的勝算比是高教育程度的1.577倍（95% CI 1.176 – 2.151）。根據貝氏變點模型未來20年的結核病發生率為26.3每十萬人。
結論
大氣空氣汚染中的細懸浮微粒和結核病的發生有相關性。年齡、男性、低教育程度也和結核病有相關。為了達到2035年結核病發生率降到每10萬人口10例之全球目標，需要更多策略來幫忙。

關鍵字

細懸浮微粒 ； 結核病 ； 空氣汚染 ； 實驗室診斷代檢網 ； 都治計畫

並列摘要

Objectives
Air pollution due to petrochemical fuel is a critical problem in industrial era. The most famous pollutant is fine particulate matter (PM2.5). PM2.5 are particles less than 2.5 micrometers. Long term exposure to PM2.5 may induce cardiovascular disease, respiratory disease, and cancers on vulnerable populations. Tuberculosis is an airborne disease. Ambient air pollution may harm immune system and increase incidents of tuberculosis.
Methods
Attendees to Changhua Community integrated screening (ChCis) from 2005 to 2012 had been followed until 2016. Incidence and time of active tuberculosis in this population was recorded. Ambient PM2.5 values collected by Air Quality Monitoring Stations was downloaded from Environmental Protection Administration (EPA) website. Logistic regression model was used for analysis. We develop a Bayesian change-point model to assess the effectiveness of National Reference Laboratory Network (NRLN) and Directly Observed Treatment Short-Course (DOTS) and elucidate the causal inference of both strategies in reducing TB incidence.
Result
Higher PM2.5 exposure group (PM2.5 >35 μg/m3) has higher risk of active tuberculosis than lower PM2.5 exposure group (adjusted OR: 1.69/μg/m3 (95% CI 1.35 - 2.15)). Exposure to fine particulate matter (PM2.5) was associated with increased risk of active tuberculosis (adjusted OR: 1.065/μg/m3 (95% CI 1.035 - 1.097)). Age was associated with increasing risk of active tuberculosis (adjusted OR: 1.084/years old (95% CI 1.074 - 1.095)). Male had higher risk of active tuberculosis then females (adjusted OR: 3.093 (95% CI 2.540 - 3.776)). Less-educated people had more tuberculosis (adjusted OR: 1.577 (95% CI 1.176 – 2.151)). Based on Bayesian change point model to predict the incidence trend in the next two decades, the predicted incidence of TB will be 26.3 per 100,000 person-year.
Conclusions
Ambient PM2.5 may associate with the incident of tuberculosis. To reach the goal of WHO, we need more strategy to control tuberculosis.

並列關鍵字

fine particulate matter ； tuberculosis ； air pollution ； National Reference Laboratory Network ； Directly Observed Treatment Short-Course

參考文獻

1. Hayes RB, Lim C, Zhang Y, et al. PM2.5 air pollution and cause-specific cardiovascular disease mortality. Int J Epidemiol 2020;49:25-35. doi: 10.1093/ije/dyz114.

2. International Agency for Research on Cancer. Air Pollution and Cancer. France: International Agency for Research on Cancer, 2013.

3. Lin HH, Suk CW, Lo HL, Huang RY, Enarson DA, Chiang CY. Indoor air pollution from solid fuel and tuberculosis: a systematic review and meta-analysis. Int J Tuberc Lung Dis 2014;18:613-21. doi: 10.5588/ijtld.13.0765.

4. 衛生福利部疾病管制署. 結核病診治指引第六版: 衛生福利部疾病管制署, 2017.

5. World Health Organization. Global tuberculosis report 2020. Geneva2020.