空氣懸浮顆粒與呼吸道疾病及癌症之關聯性台灣本土大數據資料庫之臨床研究

Association Between Particulate Matters and Respiratory Tract Diseases and Cancers in Taiwan - A Papulation-Based Big Data Analytics

黃旭志(Hsu-Chih Huang)

指導教授 ： 陳志毅

中山醫學大學/醫學院/醫學研究所/博士(2022年)

https://doi.org/10.6834/csmu202200257

摘要

空氣污染物中的懸浮顆粒（particulate matter；PM）被認為與呼吸道疾病及癌症有密切關聯，本研究主要藉由數個台灣本土大數據資料庫來研究懸浮顆粒與呼吸道疾病及癌症之關聯，將分為兩部分來探討，第一部分是細懸浮顆粒（particulate matter < 2.5 μm；PM2.5）與慢性阻塞性肺疾之關聯，第二部分則是粗懸浮顆粒（particulate matter 10-2.5 μm; PM10-2.5）與鼻咽癌之關聯。
慢性阻塞性肺疾是全球的主要死因之一，通常與吸菸有密切關係，對於非吸菸引起的慢性阻塞性肺疾，在台灣並沒有太多相關研究，於是我們首先探討細懸浮顆粒PM2.5與台灣非吸菸慢性阻塞性肺疾之關聯。研究方法上我們運用了台灣本土三個大數據資料庫，首先是台灣人體生物資料庫（Taiwan Biobank），於2008到2015之間登錄了3941位非吸菸之成年人，連結至全民健康保險資料庫（National health insurance Research Database; NHIRD）的慢性阻塞性肺疾資料，以及環保署的空氣品質監測資料（Air Quality Monitoring Database; AQMD），統整起來作一個邏輯性回歸分析。研究結果顯示經多變項校正後，對比於低濃度（小於29.38 μg/m3），高濃度（大於38.98 μg/m3）之細懸浮顆粒PM2.5暴露的民眾在統計上有顯著較高比例之慢性阻塞性肺疾（OR：1.29； CI 1.01–1.65），而其他較高濃度（32.07–38.98及29.38–32.07 μg/m3）之暴露，雖亦有正相關但未達統計上之顯著意義（OR：1.12，CI 0.88–1.44及OR：1.09，CI 0.84–1.41），然而在整體的趨勢分析上已呈現出顯著的相關性（Ptrend = 0.043）；另外在其他空氣汙染物的分析上，如二氧化硫（SO2）、臭氧（O3）、一氧化碳（CO）、氮氧化物（NOx）等，則均未顯示出顯著之相關性。根據這樣的數據分析結果，我們發現非吸菸之台灣成人，高濃度（大於38.98 μg/m3）的細懸浮顆粒PM2.5暴露將增加慢性阻塞性肺疾之發生，對於慢性阻塞性肺疾之防治，除了菸害防制之外，改善空氣品質也是一個重要的課題。
本研究的第二部分則繼續探討鼻咽癌與粗懸浮顆粒PM10-2.5之關聯。與下呼吸道不同，鼻咽主要所捕獲的是較粗之空氣懸浮顆粒，空氣中的致癌物質可能在此產生發炎反應與氧化壓力而造成癌化現象，鼻咽癌盛行於東南亞地區與男性族群，在台灣的男性癌症排行中，盛行率為第十位而死亡率為第九位，主要的危險因子包括年紀、吸菸、飲酒與Epstein-Barr病毒感染等有關，本研究主要在探討粗懸浮顆粒PM10-2.5與鼻咽癌之關聯，同樣運用了三個台灣本土的大數據資料庫，根據成人預防醫學資料庫（Adult Preventive Medical Services Database; APMSD）與台灣癌症登錄資料庫（Taiwan Cancer Registry; TCR），我們收集了521098位四十歲以上之男性資料，包含了355位鼻咽癌病人與520743非鼻咽癌民眾，再引用環保署的空氣品質監測資料（Air Quality Monitoring Database; AQMD）作系統性之大數據分析，經過多變項校正後，包括年紀、身體質量指數、吸菸、飲酒、檳榔、運動、高血壓、糖尿病、高血脂等，結果顯示粗懸浮顆粒PM10-2.5與鼻咽癌有顯著相關性，對比於低濃度（小於20.44 μg/m3）的粗懸浮顆粒PM10-2.5暴露，不同等級之較高濃度（20.44－24.08、24.08－29.27、大於29.27 μg/m3）的粗懸浮顆粒PM10-2.5暴露均呈現出顯著較高之鼻咽癌風險性（OR; CI: 1.47; 1.03–2.11, 1.34; 0.94–1.91, 1.68; 1.16–2.44）。進一步經校正上述變項與細懸浮顆粒PM2.5暴露後發現，不同等級之較高濃度（20.44至24.08, 24.08至29.27, 大於29.27 μg/m3）的粗空氣懸浮顆粒PM10-2.5暴露與鼻咽癌之發生風險依然有統計上顯著之意義（OR; CI: 1.42; 0.96-2.12, 1.41; 0.94-2.10, and 1.71; 1.10-2.66）。由此結果顯示，粗懸浮顆粒PM10-2.5的暴露濃度會增加台灣男性鼻咽癌的發生風險。
總結來說，根據我們的研究結果顯示，細懸浮顆粒PM2.5的暴露與慢性阻塞性肺疾有密切關聯，而粗懸浮顆粒PM10-2.5的暴露也會增加男性鼻咽癌之風險，因此未來除了菸害防治之外，空氣汙染的改善對國民呼吸道健康也是一個重要的課題。

關鍵字

空氣污染物中的懸浮顆粒

並列摘要

Part I: Association between chronic obstructive pulmonary disease and PM2.5 in Taiwanese nonsmokers
Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in the world. Not much is known regarding the influence of non-smoking-related risk factors on COPD in Taiwan. We examined the relationship between exposure to particulate matter < 2.5 μm (PM2.5) and COPD among nonsmokers in Taiwan.
Methods: This population-based study involved 3941 nonsmoking Taiwanese adults who were recruited in the Taiwan Biobank project between 2008 and 2015. Air pollution data between 2006 and 2011 were obtained from the air quality monitoring database (AQMD). COPD was the outcome of interest and was identified using the National health insurance Research Database (NHIRD). The data were analyzed using multiple logistic regression models.
Results: Compared with the lowest quartile (PM2.5=29.38), exposure to PM2.5 in the highest quartile (> 38.98 μg/m3) was significantly associated with COPD (OR, 1.29; CI 1.01–1.65) after multivariate adjustments. However, exposures to concentrations of 32.07–38.98 μg/m3 (OR, 1.12 CI 0.88–1.44) and 29.38–32.07 μg/m3 (OR, 1.09 CI 0.84–1.41) showed positive but non-significant associations. However, the test for trend was significant (Ptrend=0.043). The ORs for exposure to sulfur dioxide (SO2), ozone (O3), carbon monoxide (CO) and NOx (nitrogen oxides) were not significant.
Conclusions: Based on our data, exposure to PM2.5 at concentrations greater than 38.98 μg/m3 increased susceptibility to COPD among Taiwanese nonsmokers. Combatting COPD would involve integrating tobacco control and pollution management strategies.

Part II: Association between coarse particulate matter (PM10-2.5) and nasopharyngeal carcinoma among Taiwanese men
Background: The nasopharyngeal tract traps mainly coarse particles in inhaled air. Soluble carcinogenic compounds, endotoxins, and trace metals contained in these particles are potential causes of inflammation and oxidative stress which could enhance carcinogenesis. The aim of this study was to determine the association between coarse particulate matter (PM10-2.5) and nasopharyngeal cancer (NPC).
Methods: A total of 521,098 men (355 cases and 520,743 non-cases), aged ≥40 years were included in this study. Data were retrieved from the Taiwan Cancer Registry, the Adult Preventive Medical Services Database, and the Air Quality Monitoring Database.
Results: PM10-2.5 was significantly associated with a higher risk of NPC after adjusting for SO2, NOx, O3, age, body mass index, smoking, alcohol drinking, betel nut chewing, exercise, hypertension, diabetes, and hyperlipidemia. With PM10-2.5<20.44 μg/m3 as the reference, the ORs and 95% CIs were 1.47; 1.03–2.11, 1.34; 0.94–1.91, and 1.68; 1.16–2.44 for 20.44≤PM10-2.5<24.08, 24.08≤PM10-2.5<29.27, and PM10-2.5≥29.27 μg/m3, respectively. PM10-2.5 remained significantly associated with a higher risk of NPC after further adjustments were made for the aforementioned covariates and PM2.5. The ORs; 95% CIs were 1.42; 0.96 to 2.12, 1.41; 0.94 to 2.10, and 1.71; 1.10 to 2.66 for 20.44≤PM10-2.5<24.08, 24.08≤PM10-2.5<29.27, and PM10-2.5≥29.27 μg/m3, respectively.
Conclusion: PM10-2.5 was significantly associated with a higher risk of NPC in Taiwanese men.

並列關鍵字

Association

參考文獻

Anderson, H., Spix, C., Medina, S., Schouten, J., Castellsague, J., Rossi, G., Zmirou, D., Touloumi, G., Wojtyniak, B., Ponka, A., 1997. Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: results from the APHEA project. Eur. Respir. J. 10, 1064–1071.

Cheng, S.-L., Chan, M.-C., Wang, C.-C., Lin, C.-H., Wang, H.-C., Hsu, J.-Y., Hang, L.-W., Chang, C.-J., Perng, D.-W., Yu, C.-J., 2015. COPD in Taiwan: a national epidemiology survey. Int. J. Chronic Obstr. Pulm. Dis. 10, 2459.

DeVries, R., Kriebel, D., Sama, S., 2016. Low level air pollution and exacerbation of existing COPD: a case crossover analysis. Environ. Health 15, 98.

DeVries, R., Kriebel, D., Sama, S., 2017. Outdoor air pollution and COPD-related emergency department visits, hospital admissions, and mortality: a meta-analysis. COPD 14, 113–121.

Guo, C., Zhang, Z., Lau, A.K., Lin, C.Q., Chuang, Y.C., Chan, J., Jiang, W.K., Tam, T., Yeoh, E.-K., Chan, T.-C., 2018. Effect of long-term exposure to fine particulate matter on lung function decline and risk of chronic obstructive pulmonary disease in Taiwan: a longitudinal, cohort study. Lancet Planet. Health 2, e114–e125.