彰化縣大城鄉居民慢性腎臟病與六輕工業區距離相關性之研究

Chronic Kidney Disease of Residents in Dacheng Township, Changhua County, and its Relationship with the Distance to the No. 6 Naphtha Cracking Complex

莊明潔(Ming-Jie Jhuang)

指導教授 ： 詹長權

國立臺灣大學/公共衛生學院/職業醫學與工業衛生研究所/碩士(2018年)

https://doi.org/10.6342/NTU201802693

摘要

腎臟相關疾病在世界上需多國家的盛行率都急遽增加，且過去常見的腎臟疾病危險因子可能不足以解釋這樣急遽上升的盛行率，過去研究顯示暴露於環境汙染物會對腎功能造成影響，而燃燒燃料及石化工業的製程會產生各種環境汙染物並對人體健康產生危害。本研究則在北鄰六輕工業區的彰化縣大城鄉執行，利用1,374名於2014-2016年收案時年齡大於35歲且居住在鄰近六輕工業區的彰化縣大城鄉居民。將採集之尿液樣本以感應耦合電漿質譜儀進行重金屬分析，分析鎳、釩、鉻、砷、鎘等五種金屬。統計方法以一般線性回歸模式分析住家與六輕工業區距離與腎絲球過濾率、尿液中重金屬濃度關係，並以羅吉斯回歸模式分析住家與六輕工業區距離與慢性腎臟病之罹病勝算比，探討大城鄉居民的腎功能或尿中重金濃度是否受到來自六輕工業區汙染的影響。
本研究的研究個案包含622名(45%)男性居民及752名(55%)女性居民；居民平均年齡為62.5歲；居民住家與六輕的最短距離平均為8.77公里；平均腎絲球過濾率為70.82 ml/min/1.73m2；罹患有慢性腎臟病者為321名(23%)。在探討居民住家距離六輕距離與腎功能指標時，校正年齡、性別、身體質量數、教育程度、抽菸習慣、住家鄰近大馬路及糖尿病後，發現居民住家每靠近六輕工業區1公里，腎絲球過濾率會顯著的下降1.269 ml/min/1.73m2，慢性腎臟病風險會顯著的增加為1.269倍，慢性腎臟病中、高度風險會分別顯著的增加為1.314、1.244倍。在探討居民住家距離六輕距離與尿液重金屬濃度時，發現居民住家每靠近六輕工業區1公里，尿液中鎳、釩、鉻、砷與鎘濃度在分別上升1.09、1.11、1.14、1.06與1.02 µg/g creatinine。在探討腎功能指標與尿液中重金屬濃度時，校正年齡、性別、身體質量數、教育程度、抽菸習慣、住家鄰近大馬路及糖尿病，發現尿液中鎳濃度和腎絲球過濾率的下降有顯著相關、尿液中鉻濃度和腎絲球過濾率的下降有邊際顯著相關；尿液中鎳濃度和慢性腎臟病罹病風險的上升有邊際顯著相關；尿液中鎳、鉻濃度和中度慢性腎臟病罹病風險的上升有邊際顯著相關。
本研究發現居住在彰化縣大城鄉35歲以上居民的住家越靠近六輕工業區其腎絲球過濾率越低、慢性腎臟病風險越高、慢性腎臟病中、高度風險也越高。且居民的住家越靠近六輕工業區其尿液中重金屬鎳、釩、砷、鉻、鎘的濃度也越高。而在腎功能指標與尿液中重金屬中也看到重金屬鎳與鉻有顯著或邊際顯著的相關。因此彰化縣大城鄉居民腎絲球過濾率的下降、腎臟病風險上升與尿液重金屬濃度的上升可能是受到來自六輕工業區的汙染物暴露影響所致。

關鍵字

石化工業區 ； 尿液 ； 重金屬 ； 腎絲球過濾率 ； 慢性腎臟病

並列摘要

Previously established common risk factors fall short of accounting for the rapid increase in prevalence of chronic kidney disease (CKD) in many countries. The present study recruited 1,374 study subjects residing in Dacheng Township of Changhua County from 2014 to 2016, analyzed their urinary metals levels via inductively coupled plasma mass spectrometry (ICP-MS), and applied linear and logistic regression models to investigate whether the residents’ decreased kidney function and increased urinary metals levels are affected by the pollutants emitted from petrochemical complex. Results indicated that after adjusting for potential confounding variables, residents’ estimated Glomerular filtration rate (eGFR) decreases at a rate of 1.269 ml/min/1.73m2 for every kilometer near the complex, residents’ risk of CKD increases by 1.269, residents’ intermediate-risk of CKD increases by 1.314 and high-risk of CKD increases by 1.244. Similarly, urinary metal levels of nickel, vanadium, chromium, arsenic and cadmium increased by 1.09, 1.11, 1.14, 1.06 and 1.02 µg/g creatinine. Specifically, urinary nickel levels were significantly associated with decreased eGFR, marginally significantly associated with increased risk of CKD and increased intermediate-risk of CKD. Urinary chromium levels were marginally significantly associated with decreased eGFR and increased intermediate-risk of CKD. Based on presented findings, this study concludes that residential distance to petrochemical complex is associated with statistically significant decreases in eGFR and increases in urinary nickel, vanadium, chromium, arsenic and cadmium. Therefore, there was a potential that residents in Dacheng Township with decreased kidney function were affected by pollutants emitted from the petrochemical complex nearby. However, in this study we only used urinary heavy metals as exposure biomarkers, further investigation of the association between other pollutants and kidney functions of residents is required.

並列關鍵字

petrochemical complex ； urine ； heavy metals ； eGFR ； chronic kidney disease

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