中醫門診病患與一般民眾服用中藥之金屬暴露與健康風險評估

Metal Exposure and Health Risk Assessment of the Traditional Medical Outpatients and General Population who take Chinese Herbal Medicine

朱子賢(Tzu-Hsien Chu)

指導教授 ： 韓柏檉

臺北醫學大學/公共衛生暨營養學院/公共衛生學研究所/碩士(2000年)

摘要

中藥在國人的生活中一直都扮演著重要的角色，許多慢性病人擔心長期服用西藥或注射合成藥物會危害健康而尋求中醫藥治療。然而其成分複雜，來源不一，為了確保健康，在病例與日增多之同時，更應重視其管理。 過去的研究多著重中藥之有機成分、作用機轉和其金屬濃度之測定，然而部份毒性金屬可能因生物累積作用而對人體造成危害。有鑑於此，本研究希望能透過問卷之設計與訪視，調查台北市民對中藥之消費行為，並測定中藥內金屬濃度，以進行致癌和非致癌金屬暴露之風險估算，進而擬定可接受之每日安全服用量與可接受之中藥中重金屬濃度。 本研究採集之藥品可分為常用生藥材、科學中藥和複方湯藥。以火焰式原子吸收光譜儀分析藥品所含之金屬銅（Cu）、鋅（Zn）和錳（Mn）之濃度；以石墨式原子吸收光譜儀分析藥品所含之金屬鉛（Pb）、鎘（Cd）、硒（Se）、砷（As）、鉻（Cr）、錫（Sn）和汞（Hg）之濃度。結果大致均符合標準，唯有生藥材中之廣橘皮、百合、白朮、斷續、黨參中之Cd超過目前已知中國植物藥Cd含量值0.3 ppm。若將各類藥品以疾病別分類，估算民眾服用之標的危害商數（Target Harzard Quotient，THQ）和標的致癌風險（Target Cancer Risk，TR），結果發現各疾病別服用藥物之Cu、Zn、Mn、Cr、Sn、Pb、Cd、As、Se、Hg個別和整體之THQ均小於基準安全值1；As之TR在各疾病別長期（30年）服用之科學中藥和複方湯藥之TR均高出可接受風險值五倍以上。若以中藥服用期間估計，發現一般民眾若服用湯藥複方不超過10年或服用科學中藥不超過1年，和中醫門診病患服用湯藥複方不超過5年或服用科學中藥不超過1年，其TR值均未超過可接受風險基準值1?10-6。基於公共衛生為維護大眾健康及安全之考量，因此呼籲民眾服用中藥之前應詢問臨床中醫師及專家學者之意見，千萬不可自行服用來路不明或標示未清之中藥，而相關衛生單位更應嚴格掌控中藥中各種有害物質含量，以確保民眾健康。 希望藉此研究成果作為維護國民健康之參考，以降低因服用中藥而造成身體危害之風險，以便採取有效之預防與管理措施。

關鍵字

中藥 ； 金屬暴露 ； 健康風險評估

並列摘要

Chinese herbal medicine plays an important role in the life of Chinese. People with chronic conditions would take Chinese herbal medication, because they fear for the negative effect of medication on health if they were take it for a long period of time. Despite of its popularity, past studies have shown some Chinese herbal medication contains poisonous metals which might be harmful to human body by bioaccumulation. Thus, this study attempts to measure heavy metal concentration in herbal medications, to assess the risk of cancer due to consumption, and to determine the acceptable daily dosage. Data were collected through structured questionnaire, interviews, and laboratory measurement of the metal concentration in Chinese herbal medicine. Here classes of collected Chinese herbal medicine are raw medicinal substances, scientific Chinese herbal medicine and prescribed liquid medicine. The concentration of Cu, Zn, and Mn is analyzed by the FLAAS. The concentration of Pb, Cd, Se, As, Cr, Sn and Hg is analyzed by the GFAAS. Most of the metal concentrations are below the regulatory level. Only the Cd in Kuan-gui-peel, Pai-ho, Pai-shu, Hsü-tuan, Tang-shên, is 0.3 ppm value more than the regulation of herbal medicine in China. Classifying all descriptions of medicine by diseases and assessing Target Cancer Risk (TR) and Target Hazard Quotient (THQ) of medicine taken by people, the total THQ and the individual Cu, Zn, Mn, Cr, Sn, Pb, Cd, As, Se, Hg in medicine taken for different diseases are lower than the acceptable safety value 1. The TR of As in scientific Chinese herbal medicine taken for various diseases in a long term (30 years) and TR in prescribed liquid medicine are over 5 times higher than the acceptable risk value. Evaluating by the term of taking Chinese herbal medicine, liquid medicine prescription taken less than 10 years, scientific Chinese herbal medicine taken less than 1 year, liquid medicine prescription taken less than 5 years by outpatients or scientific Chinese herbal medicine taken less than 1 year, it also find that the TR of these medicines are not more than the acceptable risk value 1?10-6. The findings call for tighter control on herbal medication, and more public awareness in its negatives effects on health.

並列關鍵字

Chinese herbal medicine ； metal exposure ； health risk assessment

參考文獻

Abdulla M, Behbehani A and Dashti H. Dietary intake and bioavailability of trace elements. Biological Trace Element Research, 1989; 21: 173-178.

Anna KD and Stephen PM. Safety issues in herbal medicine: Implications for the health professions. Medical Journal of Australia, 1997; 166: 538-541.

Artacho R, Ruíz-López MD, Gámez C, Puerta A and López MC. Serum concentration and dietary intake of Zn in healthy institutionalized elderly subjects. Sci Total Environ, 1997; 205: 159-165.

Becker W and Kumpulaine J. Contents of essential and toxic mineral elements in Swedish. Br J Nutr, 1991; 66: 151-160.

Biego GH, Joyeux M, Hartemann P and Debry G. Daily intake of essential minerals and metallic micropollutants from food in France. Sci Total Environ, 1998; 217: 27-36.