肺癌患者就診背景分析以中部某醫學中心為例

Analysis the Background of Lung Cancer Patients From A Medical Center in Central of Taiwan

謝淑慧(Shu-Hui Hsieh)

指導教授 ： 周明智 ； 鄭雅文

中山醫學大學/醫學院/醫學研究所/碩士(2008年)

摘要

本研究旨在探討中部某醫學中心肺癌就診患者背景分析。採立意取樣方式。研究設計以中部某醫學中心肺癌患者為研究對象，研究收案納入255名研究個案，分別是男性病例155位及女性病例100位，進行結構式問卷訪談收集資料，所得資料收集、建檔並去除無效問卷，所有資料以SPSS 13.0版統計軟體分析。針對於研究對象的基本人口學特質，如果是連續變項以平均值 ± 標準差 ( mean ± SD ) 呈現，類別變項以百分比 ( % ) 呈現。研究中發現年齡在男性與女性研究對象並無達到統計顯著差異 ( P=0.116；t-test )。相較於男性研究對象的 【 1 】教育程度：女性研究對象在不識字與小學教育程度相較男性研究對象有較高的比率 ( 80.6% vs 64.5%; P=0.007, x2-test )。 【 2 】婚姻狀況：女性研究對象有配偶與男性研究對象婚姻狀況比較，(86% vs. 92%; P=0.052; x2-test )， 【 3 】職業類型：女性研究對象以家庭主婦 ( 29.5% ) 與農漁牧 ( 27.3% )比例較高，男性研究對象從事運輸與製造業 ( 35.8% ) 和農漁牧 ( 34.4% ) 有較高的比例。顯示男性病例與女性病例在環境的暴露因子不同。 【 4 】在肺癌細胞型態上發現女性研究對象以罹患肺腺癌 ( 74.0% ) 居多，男性研究對象則以罹患肺腺癌 (50.3%) 和麟狀細胞癌 (30.3%) 占多數，由此可得知男性與女性在肺癌型態上雖然同樣居於多數，但男性在鱗狀細胞癌的部份仍佔高的比率，可能與暴露不同的危險因子有正相關。 【 5 】抽煙習慣：研究中發現，男性研究對象較女性研究對象具有較高比率之抽菸習慣 ( 81.2% vs. 11.6%；P<0.001 )。 【 6 】生活習慣上：男性在工作場所同事在旁抽菸比率 ( 43.6% vs. 65.7% ; P = 0.002 ) 、喝酒習慣 ( 7.3% vs. 41.9% ; P = 0.001 )、喝茶習慣( 34.4% vs. 63.2%; P = <0.001 )與嚼食檳榔習慣(3.2% vs. 29.9% ; P = <0.001 )，男性皆比女性病例有高。 【 7 】二手煙：女性研究對象較男性在二手煙的環境暴露高 ( 91.3% vs. 71.7%; P = 0.001 )。 【 8 】油煙、拜香及蚊香暴露：女性病例有較高的(炒菜)油煙暴露 ( 33.0% vs. 23.4% ; P=0.224 )，排煙機使用 ( 90.1% vs. 84.6% ; P= 0.239 )。男性則在蚊香 ( 54.3% vs. 50.7 ; P=0.583 ) 及拜香暴露 ( 75.0% vs. 74.2% ; P = 0.884 )則與女性差異不大。在統計研究中男性抽菸為肺癌的主要致病因子，女性則有高的二手菸暴露及廚房油煙暴露，但由男、女職業分佈中，懷疑工作環境的暴露是中部地區肺癌重要致病因子。

關鍵字

肺癌 ； 廚房 ； 油煙 ； 蚊香 ； 拜香

並列摘要

The aim of this study is to analyze the backgrounds of lung cancer patients from a medical center in Taichung. The subjects enrolled in this study were all primary lung cancer patients from this hospital.
Descriptive statistics were used for the method of study. Questionnaires were administered to 155 male and 100 female primary lung cancer patients. The data were collected by processing structured questionnaire interviews and then statistically analyzed by SPSS 13.0. The following findings are based on the statistical analysis.
The method was based on demographic characteristics. The age, sex, marital status, education, occupation, and morphology, cancer staging for continuous variable mean value ± standard deviation (mean ± SD), percentages (%) to show the categorical variables, and the chi-square test (x2-test) for variables.
Age and Marital Status: The mean age for subjects and controls was 68.0 ± 12.9 years (standard deviation [SD]) for the females and 70.3 ± 11.0 years for the males, P=0.116 (t test). There was no statistically significant difference between the two groups. There was no significant difference between female and male subjects with single marital status (including single, separated, divorced, or widowed) (86.0% vs. 92.0%, P=0.052; x2-test).
Education: Illiteracy and elementary education had the largest distribution among the subjects. The statistics show that the females had a higher rate of illiteracy and fewer had elementary education compared to the males (80.6% vs. 64.5%；x2-test).
Occupations: Among the female subjects 29.5% were homemakers and 27.3% were farmers. More of the male subjects worked in transportation or the manufacturing industry (35.8%), and 34.4% were farmers (29.5% vs. 35.8%, P<0.001; x2-test). The results show that males are more exposed to work place environments than females. It is also means that females and males have different risk factors.
Morphology: All subjects had histologically confirmed primary lung cancer. The results show that there were 74 (74.4%) females with adenocarcinoma and 13 (13%) with squamous cell carcinoma, and for the males, 78 (50.3%) had adenocarcinoma and 47 (30.3%) had squamous cell carcinoma. A statistically significant difference was found between the females and males with adenocarcinoma. (74.4% vs. 50.3%, P=0.002; x2-test) has statistical significance different. Adenocacinoma is the most common type of lung cancer seen in the human population and it is also the most frequently occurring cell type in female nonsmokers. Squamous cell carcinoma is commonly seen in male smokers. The data show that with respect to female and male primary lung cancer, males might have more exposure to different environments compared to females.
Smoking status: In our study, the number of male smokers was higher than female smokers (81.2% vs. 11.6%; P<0.001 x2-test), but female subjects were more exposed to passive smoking environments than males, (91.3% vs. 71.7%; P=0.001 x2-test). This result is similar to other epidemiological studies in Taiwan.
Lifestyles: Our study also revealed that male subjects had more passive smoking experiences in their working environments. They also drink more alcohol and tea and chew betel nut more than the females.
Exposure to cooking oil fumes, incense, and mosquito coil: Comparing females and males, the female subjects had more exposure to cooking fumes and extractor fans in kitchens than males 82 ( 90.1% ) vs. 44 ( 84.6% ) However, there was no statistically significant difference for incense and mosquito coil exposure ( P=0.101 ).
Epidemiologic studies have demonstrated that cigarette smoking is the most important risk factor for male primary lung caner patients, but for female non-smokers, exposure to cooking oil fumes and passive smoking may be an important factor in causing lung cancer in Taiwanese women who are non-smokers.

並列關鍵字

Lung Cancer ； Cooking oil fumes ； Mosquito coil ； Incese

參考文獻

廖國盟、陳建仁 肺癌之流行病學特徵與多重危險因子及防治策略．中華衛誌，16 ( 5 )．375-395, 1997

鄭丁原 溫啟邦 蔡孟娟 蔡善璞．國人吸菸行為現況：2001年國民健康調查之分析． Taiwan J Public Health. 2003;22(6):453-464

陸坤泰　張登斌　台灣的肺癌　台灣醫誌91, 1992

柯舜智 莊春發 再探台灣有線電視市場集中度 新聞學研究94期149-192 , http:// jour.nccu.edu.tw/mer/0094/04.html

A K Hackshaw, lecturer, M R Law, reader, N J Wald, professor The accumulated evidence on lung cancer and environmental tobacco smoke BMJ 1997; 315:980-988