鄰近六輕工業區成人血清中重金屬濃度與高血脂症、慢性腎臟病相關性之研究

Association between Heavy Metal Levels in Serum, Hyperlipidemia and Chronic Kidney Disease in Adults Living Near the No. 6 Naphtha Cracking Complex

孫稚翔(Chih-Hsiang Shun)

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(2017年)

https://doi.org/10.6342/NTU201701039

摘要

六輕工業區是一位於雲林之石化工業區，過去相關研究指出，鄰近居民尿液中重金屬濃度較高，且疾病發生率也高於其他縣市，故本研究希望利用不同的生物指標血清探討居民暴露情形，且藉由居住於不同遠近地區居民的樣本分析，觀察檢體中重金屬濃度是否和住家距離六輕工業區的遠近有關，此外，利用居民血清中重金屬濃度探討其和高血脂症、慢性腎臟病的相關性。
本研究對象為1,000名於2009-2011, 2014年收案時35歲以上之成人且長期居住於六輕工業區鄰近鄉鎮，包括麥寮鄉、臺西鄉、大城鄉、東勢鄉、四湖鄉、崙背鄉、褒忠鄉、虎尾鎮、二崙鄉、莿桐鄉及元長鄉，共十一個鄉鎮。將採集之血清樣本以感應耦合電漿質譜儀進行重金屬分析，分析和血脂、腎功能相關之鉻、砷、鎘、鉈、汞等五種金屬。以一般線性回歸模式分析血清中重金屬濃度、住家與六輕工業區距離、血脂濃度、腎絲球過濾率之關係，並以羅吉斯回歸模式分析血清中重金屬濃度與高血脂症、慢性腎臟病之罹病勝算比。
本研究之1,000名研究對象，男性佔39%，平均年齡為58.96 ± 12.66歲，在2009-2011, 2014年血清中鉻、砷、鎘、鉈、汞濃度分別為3.24 ± 3.41、3.49 ± 4.66、0.31 ± 0.80、0.06 ± 0.07、1.22 ± 1.06，單位為µg/L。校正性別、年齡、抽菸、喝酒、嚼食檳榔、食用海鮮習慣、飲用水來源後，住家與六輕工業區距離和居民血清中鉻、鉈、汞濃度的上升有顯著相關，每靠近六輕工業區1公里，鉻濃度上升0.0144，鉈濃度上升0.0373，汞濃度上升0.0181，單位為log-transform (µg/L)。研究族群之平均總膽固醇、低密度脂蛋白膽固醇、高密度脂蛋白膽固醇和三酸甘油酯濃度分別為205.39、123.39、 56.40、122.74 mg/dL，高血脂症盛行率為57%。校正性別、年齡、身體質量指數、抽菸、飲酒習慣後，血清中鉻、砷、汞濃度的上升和總膽固醇濃度的上升有顯著相關，當血清中鉻濃度每增加1倍，總膽固醇濃度的上升2.855 mg/dL，血清中砷濃度每增加1倍，總膽固醇濃度上升3.720 mg/dL，血清中汞濃度每增加1倍，總膽固醇濃度上升5.081 mg/dL，血清中汞濃度的上升和低密度脂蛋白膽固醇濃度的上升有顯著相關，當血清中汞濃度每增加1倍，低密度脂蛋白膽固醇濃度上升3.627 mg/dL。血清中砷和汞濃度的上升和高血脂症的罹病風險增加有顯著相關，當血清中砷濃度每增加1倍，高血脂症之罹病勝算比為1.308，血清中汞濃度每增加1倍，高血脂症之罹病勝算比為1.230。研究族群之平均腎絲球過濾率為64.63 ml/min/1.73m2，慢性腎臟病盛行率為35%，在校正年齡、性別、身體質量指數、抽菸、膽固醇、糖尿病等危險因子後，血清中鉻、砷、鉈濃度、住家與六輕工業區距離和腎絲球過濾率的下降有顯著相關，血清中鉻濃度每增加1倍，腎絲球過濾率下降2.172 ml/min/1.73m2，砷濃度每增加1倍，腎絲球過濾率下降0.742 ml/min/1.73m2，鉈濃度每增加1倍，腎絲球過濾率下降1.165 ml/min/1.73m2、住家每靠近六輕工業區1公里，腎絲球過濾率下降0.306 ml/min/1.73m2。血清中鉻濃度、住家與六輕工業區距離和慢性腎臟病罹病風險的上升有顯著相關，血清中鉻濃度每增加1倍，慢性腎臟病之罹病勝算比為1.402。血清中鉻濃度每增加1倍，慢性腎臟病中度風險罹病勝算比為1.372，血清中砷濃度每增加1倍，慢性腎臟病高度風險之罹病勝算比為1.372。
本研究發現居住在六輕工業區附近35歲以上成人的住家越靠近六輕工業區，血清中鉻、鉈、汞濃度越高、腎絲球過濾率過低、罹患慢性腎臟病風險越高。居民血清中鉻、砷、汞濃度越高，血脂濃度越高；血清中砷、汞濃度越高，罹患高血脂症之風險越高。居民血清中鉻、砷、鉈濃度越高，其腎絲球過濾率越低；血清中鉻濃度越高，罹患慢性腎臟病風險越高；血清中砷濃度越高，發生慢性腎臟病高度風險越高。

關鍵字

石化工業區 ； 血清 ； 重金屬 ； 血脂 ； 高血脂症 ； 腎絲球過濾率 ； 慢性腎臟病

並列摘要

No. 6 Naphtha Cracking Complex is a petrochemical complex located in Yunlin County. Previous studies indicated residents living near the No. 6 Naphtha Cracking Complex had higher urinary metal levels and the higher incidence rate of diseases. This study investigate the association between serum metal levels, risk of having hyperlipidemia, and chronic kidney disease in adults living near the No. 6 Naphtha Cracking Complex.
Our study population was 1,000 residents with the age above 35 years old living in eleven townships near the No. 6 Naphtha Cracking Complex, including Mailiao, Taisi, Dacheng, Dongshih, Lunbei, Baojhong, Sihhu, Erlun, Yuanchang, Cihtong and Huwei. Serum metal levels were analyzed by ICP-MS. Generalized linear model was used to investigate the association between the distance from subjects’ homes to the petrochemical complex, blood lipids, renal function and serum metal levels. Logistic regression model was used to investigate the association of serum metal levels with hyperlipidemia and chronic kidney disease.
Our subjects included 39% males, a mean age of 58.96 years old, and a mean distance of 12.96 km from their homes to the petrochemical complex. Their mean serum chromium, arsenic, cadmium, thallium and mercury levels were 3.24, 3.49, 0.31, 0.06 and 1.22 µg/L respectively. As study subjects’ homes located 1 km closer to the petrochemical complex, the serum levels of chromium, thallium, and mercury increased by 0.0144, 0.0173 and 0.0181 log-transform (µg/L) respectively. Their mean total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride were 205.39, 123.39, 56.40 and 122.74 mg/dL respectively. The hyperlipidemia prevalence rate was 57%. After adjusting for age, gender, body mass index, smoking and drinking, for 1-fold increase in serum chromium, arsenic and mercury levels, their total cholesterol increased by 2.855, 3.720 and 5.081 mg/dL respectively, and for 1-fold increase in serum mercury level, their LDL-cholesterol increased by 3.627 mg/dL. For 1-fold increase in serum arsenic and mercury levels, the odds ratio of hyperlipidemia was 1.308 and 1.230. Their mean estimated glomerular filtration rate (eGFR) was 64.63 ml/min/1.73m2 and 35% of them with an eGFR less than 60 ml/min/1.73m2 defined as chronic kidney disease (CKD). After adjusting for age, gender, body mass index, smoking habit, total cholesterol, diabetes and hypertension, as study subjects’ homes located 1 km closer to the petrochemical complex, their eGFR decreased by 0.306 mL/min/1.73m2, and the odds ratio of CKD was 1.065. For 1-fold increase in serum chromium, arsenic and thallium levels, their eGFR decreased by 2.172, 0.742 and 1.165 mL/min/1.73m2 respectively and for 1-fold increase in chromium level, the odds ratio of CKD was 1.402. For 1-fold increase in serum chromium level, the odds ratio of intermediate-risk CKD was 1.372 and for 1-fold increase in serum arsenic level, the odds ratio of high-risk CKD was 1.372.
Adults living closer to the No.6 Naphtha Cracking Complex were associated with increased serum levels of chromium, thallium, mercury, decreased renal function and increased risk of CKD. Increased serum levels of chromium, arsenic, mercury were associated with elevated blood lipids. Increased serum levels of arsenic and mercury were associated with increased risk of hyperlipidemia. Increased serum levels of chromium, arsenic and thallium were associated with decreased renal function, and increased serum level of chromium, arsenic were associated with increased risk of CKD and high-risk CKD respectively.

並列關鍵字

petrochemical complex ； serum ； heavy metals ； blood lipids ； hyperlipidemia ； estimated glomerular filtration rate ； chronic kidney disease

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