兒童塑化劑暴露對其肺功能影響

Early Children’s Exposure to Phthalates and Pulmonary Function

林亮瑜(Liang-Yu Lin)

指導教授 ： 陳保中

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(2017年)

https://doi.org/10.6342/NTU201700039

摘要

塑化劑(phthalates)的暴露與氣喘等過敏性疾病的發生有關。氣喘的診斷是以肺功能進行評估，但目前關於塑化劑暴露對肺功能的影響卻少有研究著墨。我們的研究藉由世代追蹤的方式，旨在探討兒童不同塑化劑暴露年齡與其肺功能之關聯性。台灣出生世代追蹤調查研究(TBPS)建立於2004年4月至2005年1月間。我們追蹤了TBPS研究中兩歲、五歲以及九歲的兒童尿液檢體，並使用高效液相層析串連式質譜儀分析兒童尿中塑化劑代謝物濃度。九歲的受試兒童另接受肺功能、血中IgE濃度檢測，其父母亦接受問卷調查。我們使用複迴歸分析校正干擾因子，以之探討不同年齡尿中塑化劑代謝物對九歲肺功能的影響。我們的結果顯示：在九歲患有過敏性疾病的兒童，其九歲時尿中鄰苯二甲酸二乙酯單體(monoethyl phthalate, MEP)濃度越高，與其肺功能指數FEV1（β =-25.22; 95% CI: -47.53 to -2.91)以及FVC(β =-32.3; 95% CI: -63.51 to -1.09)的降低具有關聯性。血中IgE較高(>100 kU/L)的九歲兒童，其尿中MEP濃度與肺功能呈現負相關(FEV1：β =-30.4; 95% CI: -56.8 ~ -4.0；FVC：β =-47.6; 95% CI: -84.2 ~ -11.0；PEF：β =-102.4; 95% CI: -180.2 ~ -24.7)。另一方面，兩歲、五歲以及九歲的其他塑化劑暴露對九歲的兒童肺功能幾乎沒有影響。我們的研究發現，當下的MEP等塑化劑暴露對於兒童的肺功能有較大的影響。未來仍須更多的研究以釐清兩者之因果關係。

關鍵字

環境賀爾蒙 ； 塑化劑 ； 兒童 ； 肺功能

並列摘要

Phthalates exposure is related to the development of allergic diseases such as asthma. Studies about its effect on lung function is limited, which is a parameter of asthma. Our study aims to find an association between different phthalates exposure ages and children’s lung function by conducting a cohort study. The Taiwan Birth Panel Study (TBPS) was established from April 2004 to January 2005. Urine samples were collected from children in the TBPS cohort aged 2, 5, and 9. Urinary phthalates metabolites concentrations were measured by ultrahigh-performance liquid chromatography coupled with tandem mass spectrometry. Children were assessed with questionnaires, lung function tests and serum IgE levels at the age of 9. Multiple linear regressions adjusting for confounding factors were applied to explore the associations between phthalates exposure at different ages and lung function. Our results demonstrate that among children aged 9 with allergic diseases, high urinary phthalate metabolite mono-ethyl phthalate (MEP) concentrations was associated with decreasing FEV1 (β =-25.22; 95% CI: -47.53 to -2.91) and FVC (β =-32.3; 95% CI: -63.51 to -1.09). For children with high serum IgE levels (>100 kU/L), urinary MEP concentrations was negatively associated with FEV1 (β =-30.4; 95% CI: -56.8 to -4.0), FVC (β =-47.6; 95% CI: -84.2 to -11.0) and PEF (β =-102.4; 95% CI: -180.2 to -24.7). On the other hand, phthalates exposure at the age of 2, 5 and 9 had little effect on lung function. Our study suggests that concurrent phthalates exposure including MEP, has a greater influence on children’s lung function. Further investigation is required to confirm this causal effect.

並列關鍵字

Endocrine disruptor chemicals ； children ； lung function ； phthalates

參考文獻

2. Bertelsen RJ, Carlsen KC, Calafat AM, Hoppin JA, Haland G, Mowinckel P, et al. 2013. Urinary biomarkers for phthalates associated with asthma in norwegian children. Environmental health perspectives 121:251-256.

3. Bornehag CG, Sundell J, Weschler CJ, Sigsgaard T, Lundgren B, Hasselgren M, et al. 2004. The association between asthma and allergic symptoms in children and phthalates in house dust: A nested case-control study. Environmental health perspectives 112:1393-1397.

4. Bornehag CG, Sundell J, Weschler CJ, Sigsgaard T, Lundgren B, Hasselgren M, et al. 2004. The association between asthma and allergic symptoms in children and phthalates in house dust: A nested case-control study. Environmental health perspectives 112:1393-1397.

5. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. 2008. Allergic rhinitis and its impact on asthma (aria) 2008 update (in collaboration with the world health organization, ga(2)len and allergen). Allergy 63:8-+.

6. Braun JM, Sathyanarayana S, Hauser R. 2013. Phthalate exposure and children's health. Current opinion in pediatrics 25:247-254.