應用統合迴歸來評估暴露於室外空氣污染及室內塑化劑對兒童過敏症狀的可歸因危害

The Application of Meta-regression to Evaluate the Attributable Hazards of Exposing to Outdoor Air Pollution and Indoor Di(2-ethylhexyl) Phthalate to Childhood Allergic Symptoms

陳采榆(Cai-Yu Chen)

指導教授 ： 張玉坤

淡江大學/理學院/數學學系碩士班/碩士(2021年)

https://doi.org/10.6846/TKU.2021.00012

摘要

最近衛福部公布癌症蟬聯39年台灣所有死因第一名，其中氣管、支氣管和肺癌則是連續41年台灣十大癌症死因的首位。然而，2020年環保團體「德國看守協會」（Germanwatch）公佈氣候變遷績效指標，臺灣卻名列全球倒數第三名。我們不禁要對臺灣已出生及未來幾年將出生的新生兒擔憂，因為在他/她們成長的過程中時時都要面對兩項重大環境危險的考驗: 一是日漸惡化的室外空氣污染，另一是無法避免的室內塑化劑。此兩者都是已知會誘發兒童過敏症狀的主要危害因子。
為了進一步探究上述兩大環境因子對兒童過敏症狀的危害情形，我們以統合迴歸來比較不同的影響因素對造成兒童過敏症狀的差異。本研究共蒐集21篇室內塑化劑和35篇室外空氣汙染與兒童過敏症狀相關的文獻，整理出的變數有: 發表年分、兒童年齡、母親分娩年齡、男性佔比(%)、出生體重、出生身高、母親過敏(%)、父親過敏(%)、母親抽菸(%)、母親哮喘(%)、環境煙草煙霧佔比(Environmental Tobacco Smoke，ETS in %)、家庭低收入(%)、母親高教育(%)、家中鋪地毯(%)、居家環境水氣凝結(%)、居家環境漏水(%)、居家環境發霉(%)、臍帶血中的IgE濃度、有養寵物(%)、MEHP、DEHP及HL_DEHP濃度、二氧化硫(SO2)、二氧化氮(NO2)、臭氧(O3)、PM2.5、PM10、一氧化碳(CO)、二氧化碳(CO2)。
研究結果顯示: 家庭影響因素有分娩年齡、母親抽菸、IgE、兒童年齡、母親哮喘、家庭低收入、出生體重及家中鋪地毯會顯著影響兒童誘發過敏症狀，但室內塑化劑DEHP和MEHP都與兒童發生過敏症狀的風險之效益值沒有顯著相關，有可能是蒐集的資料不夠多的原因；而探討室外空氣汙染，導致兒童過敏的最好模型為發表年分、有養寵物、PM2.5與居家環境發霉等對哮喘之效益值有顯著的影響，表示兒童發生哮喘與此四種影響因素有顯著的相關。研究顯示，除家庭影響因素之外，室外空氣汙染NO2、CO2與PM10等亦會顯著的影響兒童發生過敏症狀的風險。

關鍵字

空氣汙染 ； 塑化劑 ； 兒童過敏 ； 統合分析

並列摘要

Recently, the Ministry of Health and Welfare announced that cancer was the number one cause of death in Taiwan for 39 consecutive years. Among them, trachea, bronchus, and lung cancer were the first of the top ten causes of death from cancer in Taiwan for 41 consecutive years. However, in 2020, the environmental group "Germanwatch" announced climate change performance indicators (CCPI), and Taiwan ranked third backward in the world. We can't help but worry about the newborns born and those who will be born in Taiwan in the next few years. Because, they have to face two major environmental hazards as they grow up: the first one is the worsening outdoor air pollution; the other one is the unavoidable indoor plasticizer. Both are the main well-known hazards that could induce allergic symptoms in children.
In order to further explore the hazards of the aforementioned two environmental factors to children's allergic symptoms, we use meta regression to compare the differences in the effects of those available influencing factors on children's allergic symptoms. This study searched, in total, 21 articles on indoor plasticizers and 35 articles on outdoor air pollution and both are related to children’s allergic symptoms. The extracted (available) influencing factors are: publication year, child’s age, mother’s age at childbirth, proportion of males (%), birth weight , birth height, mother's allergy (%), father's allergy (%), mother's smoking (%), mother's asthma (%), percentage of environmental tobacco smoke (ETS in %), low family income (%) , Mother's high education (%), home carpet (%), home environment moisture condensation (%), home environment water leakage (%), home environment moldy (%), IgE concentration in umbilical cord blood, pets (%) , concentration of MEHP, DEHP and HL_DEHP, SO2, NO2, O3, PM2.5, PM10, CO, CO2.
The results of the study showed that family influencing factors such as maternal age, mother’s smoking, IgE, child’s age, mother’s asthma, low family income, birth weight, and carpeting at home can significantly affect children’s induction of allergic symptoms. Both indoor plasticizers DEHP and MEHP There is no significant impact on children’s allergies. The best model for children’s allergies to explore outdoor air pollution is the publication years, having pets, PM2.5, and mildew in the home environment, which have a significant impact on the benefit value of asthma. The occurrence of asthma in children is significantly related to these four influencing factors. Studies have shown that, in addition to family influencing factors, outdoor air pollution such as NO2, CO2, and PM10 can also significantly increase the risk of children developing allergic symptoms.

並列關鍵字

Air Pollution ； Di(2-ethylhexyl) Phthalate ； Childhood Allergic ； Meta-analysis

參考文獻

英文參考文獻

1.Yu Ait Bamai , Chihiro Miyashita , Atsuko Araki , Tamie Nakajima , Seiko Sasaki , Reiko Kishi (2018) “Effects of prenatal di(2-ethylhexyl) phthalate exposure on childhood allergies and infectious diseases: The Hokkaido Study on Environment and Children's Health” . 10.1016/j.scitotenv.2017.09.270

2.Hsiu Ying Ku, Pen Hua Su, Hui Ju Wen, Hai Lun Sun, Chien Jen Wang, Hsiao Yen Chen, Jouni J. K. Jaakkola, Shu-Li Wang, TMICS Group “ Prenatal and Postnatal Exposure to Phthalate Esters and Asthma: A 9-Year Follow-Up Study of a Taiwanese Birth Cohort “. 10.1371/journal.pone.0123309

3.Wenming Shi, Zhijing Lin, Chenxi Liao, Jialing Zhang, Wei Liu, Xueying Wang, Jiao Cai,Zhijun Zou, Heng Wang, Dan Norback, Haidong Kan, Chen Huang, Zhuohui Zhao “Urinary phthalate metabolites in relation to childhood asthmatic andallergic symptoms in Shanghai”. 10.1016/j.envint.2018.08.043

4.Chih-Wei Yen , Yue-Cune Chang , Meng-Rung Lee “Do the Usage of Di(2-ethylhexyl) Phthalate-Containing Medical Devices Promote Development of Allergic Symptoms?”.