室內空氣清淨技術介入對工業區氣喘病人健康改善之成效評估

Evaluation of the effectiveness of air purifier in homes of patients with asthma in industrial area

廖冠瑜(Kuan-Yu Liao)

指導教授 ： 陳培詩

高雄醫學大學/健康科學院/公共衛生學系公共衛生學碩士班/碩士(2021年)

摘要

研究背景
高雄市是一座位於南台灣的工業重鎮，又以工業發展為主的小港地區，都市發展時難以避免在工業製造或交通運輸的過程中產生許多不同種類的空氣汙染物。室內空氣污染物的來源分為兩類，一類是室內來源，另一類則是來自室外，例如工廠或是汽機車排放。平均而言，人們一天之中在室內環境中的時間超過80％ ，並且已經有研究表示，與室外環境空氣污染相比，室內空氣污染可能對發病率和死亡率造成相同甚至更高的風險。然而在過去的相關研究中，我們看到使用空氣淨化技術來改善室內空氣品質的相關文獻中大多在所測量的空氣汙染物種類不超過三種或是健康效應項目未一致，因此需要進一步做系統性的研究。
研究目的
評估室內空氣淨化的介入是否可以改善受試者健康。
方法
對高雄市的36名受試者中進行了一項交叉介入試驗。在每位受試者家中的客廳和臥室各放置一台空氣清淨機，交替使用真空氣清淨機或假空氣清淨機各13天，假空氣清淨機為移除三合一濾網，並在中間間隔2週的時間做為重置期(不做任何介入)。測量了室內空氣汙染物，包含空氣動力學直徑小於或等於1、2.5、4和10微米(particulate matter with an aerodynamic diameter ≤1, 2.5, 4, 10µm, PM1, PM2.5, PM4, PM10)的懸浮微粒、總懸浮微粒(Total particulate matter, Total PM)、超細微粒(Ultrafine particles, UFP)、二氧化碳(Carbon dioxide, CO2)、一氧化碳(Carbon monoxide, CO)、二氧化氮(Nitrogen dioxide, NO2)、二氧化硫(Sulfur dioxide, SO2)、總揮發性有機化合物(Total Volatile Organic Compounds, TVOC)、甲醛(Formaldehyde, HCHO)、細菌、真菌和內毒素，以及健康狀況，包含肺功能、血壓、呼出一氧化氮(Fractional exhaled nitric oxide, FeNO)和呼吸道症狀。同時，也評估受試者血液中5種新興的生物標記物—¬小分子核糖核酸(microRNA, miRNA)。
結果
與使用假空氣清淨機相比，使用真空氣清淨機時，室內客廳PM1、PM2.5、PM4、PM10、Total PM、NO2、真菌和內毒素濃度顯著降低。在健康方面，介入13天後，與使用假空氣清淨機相比，使用真空氣清淨機時，收縮壓(Systolic blood pressure, SBP)顯著下降6.2%和舒張壓(Diastolic blood pressure, DBP)顯著下降3.3%；在大多數的肺功能參數，例如用力肺活量百分比預測值(Forced vital capacity percent predicted, FVC%predicted)、第1秒用力呼氣容積百分比預測值(Forced expiratory volume at 1 second percent predicted, FEV1%predicted)、第3秒用力呼氣容積百分比預測值(Forced expiratory volume at 3 second percent predicted, FEV3%predicted)、最大中間呼氣流速百分比預測值(Maximum mid-expiratory flow, MMEF%predicted)和25%分點呼氣流量百分比預測值(Forced expiratory flow at 25% percent predicted, FEF25%predicted)，以及FeNO和症狀分數有改善趨勢。其中使用真空氣清淨機時，與介入前相比，第7天的搔癢/打噴嚏症狀風險為0.47倍，顯著降低。相關性分析顯示內毒素變化量與SBP變化量顯著正相關；UFP變化量與FeNO變化量呈顯著正相關；FEV1%predicted、FEV1/FVC%predicted、MMEF%predicte變化量與PM(PM1、PM2.5、PM4、PM10)變化量呈顯著負相關。在新興生物標記物miRNA中，改善室內空氣品質7天後，miR-199a-5p、miR-222-3p、miR-146a-5p、miR-21-5p有增加的趨勢。
結論
本研究初步證明了改善室內空氣品質對健康的有利影響以及改變miRNA的分佈，因此，未來應該進一步評估更多的人群或探討更長時間的空氣清淨機介入在日常生活中對於改善人類健康的影響。

關鍵字

空氣汙染物 ； 空氣清淨機 ； 血壓 ； 肺功能 ； 呼出一氧化氮 ； 症狀 ； 小分子核糖核酸

並列摘要

Background
Kaohsiung City is an important industrial area in southern Taiwan, and Siaogang District dominated by industrial development. It is difficult to avoid the production of many different types of air pollutants in the process of industrial manufacturing or transportation during urban development. The sources of indoor air pollutants are divided into two categories, one is from indoor sources, and the other is from outdoor sources, such as emissions from factories or automobiles. On average, people spend more than 80% of the time in an indoor environment per day, and previous studies have shown that compared with outdoor environmental air pollution, indoor air pollution may pose the same or even higher risk of morbidity and mortality. However, it only evaluated less than three types of air pollutants or few health effect indicators in previous studies using air purification technology to improve indoor air quality. Therefore, further systematic research is needed.
Aim
To evaluate whether the intervention of indoor air purifier intervention improves the health of subjects.
Method
We conducted a randomized crossover trial among 36 subjects in Kaohsiung City. An air purifier was placed in the living room and bedroom of each subject's home. The true air purifier or the sham air purifier were alternately used for 13 days, while the sham air purifier was removed three-in-one filter, and an interval of 2 weeks as the washout period (without any intervention).We measured indoor air pollutants, including particulate matter with an aerodynamic diameter ≤1, 2.5, 4, 10µm(PM1, PM2.5, PM4, PM10), Total PM, ultrafine particles(UFP), carbon dioxide(CO2), carbon monoxide(CO), nitrogen dioxide(NO2), sulfur dioxide(SO2), Total Volatile Organic Compounds(TVOC), formaldehyde(HCHO), bacteria, fungi and endotoxin, and health conditions, including lung function, blood pressure, fractional exhaled nitric oxide(FeNO) and respiratory symptoms. At the same time, five emerging biomarkers, miRNA, in the blood of subjects were also measured.
Result
Compared with using sham air purifiers, the concentration of PM1, PM2.5, PM4, PM10, Total PM, NO2, fungi and endotoxin significantly decreased in living room when using true air purifiers. After intervention of 13 days, compared with using sham air purifiers, systolic blood pressure (SBP) significantly decreased by 6.2% and diastolic blood pressure (DBP) significantly decreased by 3.3% when using true air purifiers. Most of lung function parameters, including forced vital capacity percent predicted (FVC%predicted), forced expiratory volume at 1 second percent predicted (FEV1%predicted), forced expiratory volume at 3 second percent predicted (FEV3%predicted), maximum mid-expiratory flow (MMEF%predicted) and forced expiratory flow at 25% percent predicted (FEF25%predicted) have an improving trend. In addition, FeNO and symptom scores also have an improving trend. Among them, when using true air purifiers, the risk of itching/sneezing symptoms on day 7 was 0.47 times of background with statistical significance). Correlation analysis showed that endotoxin was significantly positively correlated with SBP; UFP was significantly positively correlated with FeNO; FEV1%predicted, FEV1/FVC%predicted, and MMEF%predicte was negatively correlated with PM (PM1, PM2.5, PM4, PM10). Among the emerging biomarkers miRNA, miR-199a-5p, miR-222-3p, miR-146a-5p, and miR-21-5p have an increasing trend after 7 days of improving indoor air quality.
Conclusion
This study initially proved the beneficial effects of improving indoor air quality on health and changing the distribution of miRNAs. Therefore, in the future, we should further evaluate more people or explore the impact of longer air purifier intervention in daily life on improving human health.

並列關鍵字

Air pollution ； Air Purifiers ； Blood pressure ； Lung function ； FeNO ； Fractional exhaled nitric oxide ； Symptom ； microRNA

參考文獻

Air quality guidelines for Europe. (2000).

Apte, Fisk, & Daisey. (2000). Associations between indoor CO2 concentrations and sick building syndrome symptoms in U.S. office buildings: an analysis of the 1994-1996 BASE study data. Indoor Air, 10(4), 246-257. doi:10.1034/j.1600-0668.2000.010004246.x

Bainbridge, Farley, McLaughlin, Graham, Marks, Nakatsu, Brien, & Smith. (2002). Carbon monoxide decreases perfusion pressure in isolated human placenta. Placenta, 23(8-9), 563-569. doi:10.1053/plac.2002.0845

Bartlett, Kennedy, Brauer, Van Netten, & Dill. (2004). Evaluation and a predictive model of airborne fungal concentrations in school classrooms. Ann Occup Hyg, 48(6), 547-554. doi:10.1093/annhyg/meh051

Belanger, & Triche. (2008). Indoor combustion and asthma. Immunol Allergy Clin North Am, 28(3), 507-519, vii. doi:10.1016/j.iac.2008.03.011