口腔黏膜病變與嚼食檳榔、抽菸、喝酒之相關研究

摘要為瞭解單純嚼食檳榔，或檳榔、酒併用，檳榔、菸併用或檳榔、菸、酒三種併用方法對口黏膜病變影響的差別。本研究收集了牡丹鄉衛生所牙科門診中經口腔病理專科醫師診斷為口腔黏膜病變陽性患者為主要對象，共108位進行分析。另外以當地居民中與前述病變者之性別、年齡層及嚼食檳榔情形相同，並經牙醫師目視為非口腔黏膜病變者為配對組，進行問卷訪視共配對89位。問卷輸入藉MSAccess設計資料鍵入螢幕，完成資料建檔後，以JMP及SAS統計軟體進行統計分析。由研究結果發現，檳榔、菸、酒併用的各種吃法中口腔黏膜病變種類皆以OSF佔的比例最多（34.9﹪-47.1﹪），其次為hyperparakeratosis（15.0﹪-21.1﹪）、epithelial hyperplasia（11.8﹪-27.9﹪）或hyperorthokeratosis（0﹪-17.6﹪）只是在次序上有所不同。曾有嚼食檳榔習慣者得OSF及acanthosis的機率高於抽菸及喝酒習慣者；有抽菸習慣者得hyperorthokeratosis的機率高於嚼食檳榔或喝酒習慣者，且抽菸數量大於兩包者得此病的機率越高，而喝酒習慣者與口腔黏膜病變種類並無顯著差異。在檳榔、菸、酒併用不同吃法中，所有嚼食者在年齡及嚼食檳榔的數量上並沒有顯著差異。單獨嚼食檳榔者在12種經病理診斷之口腔黏膜病變中（OSF、epithelial hyperplasia、hyperparakeratosis、acanthosis、hyperorthokeratosis、dysplasia 、squamous cell carcinoma、verrucous carcinoma、mucositis、ulcer、candidiasis、lichen planus）出現10種病變，而且共存病變高達四種（OSF+ epithelial hyperplasia+ hyperparakeratosis+ dysplasia），皆比其他併用吃法者多。比較經病理診斷為口腔黏膜病變與配對組研究中，前者教育程度較低、有較高比例的嚼食檳榔習慣、平均嚼食檳榔數量較多、嚼食檳榔時間也較長，單獨嚼食檳榔者較多，且皆達統計上顯著差異。以conditional logistic regression分析口腔黏膜致病因子，單純嚼食檳榔者有4.31倍的機率會得口腔黏膜病變，檳榔、菸併用者有4.86倍的機率會得口腔黏膜病變、每日嚼食檳榔30顆者有2.56倍機率會得口腔黏膜病變，皆達顯著性差異。經事後比較（Tukey-kramer）分析，檳榔、菸併用者比單純嚼食檳榔者有1.13倍的機率得口腔黏膜病變，但未達顯著性。關鍵字：單純嚼食檳榔者，檳榔、酒併用，檳榔、菸併用，檳榔、菸、酒併用，口腔黏膜病變。

關鍵字

單純嚼食檳榔者；檳榔；酒併用；檳榔；菸併用；檳榔；菸；酒併用；口腔黏膜病變

並列摘要

Abstract This study aims to discuss the differences among the oral mucosal diseases respectively resulting from pure betel quid chewing, mixed use of betel quid and alcohol, mixed use of betel quid and cigarettes and mixed use of betel quid, cigarettes, and alcohol. 108 sufferers, whose oral mucosal diseases were diagnosed positive by the stomatological doctors in the dental out-patient department, public health office of Mutan county, were obtained as the main subjects in this study. Subsequently, according to the sufferers’ sex, age and their habits of betel quid chewing, 89 local habitants who were diagnosed as non-sufferers of oral mucosal diseases by dentists merely by sight, were selected as the paired group to match with the sufferers by means of questionnaires, which were later entered in the computer through MSAccess, and then statistical analysis was carried out with the statistic software JMP and SAS after all data were filed. It was found in this study that the association between oral mucosal diseases and betel chewing , smoking and drinking ,and oral submucous fibrosis (OSF) account for the highest percentage, followed by hyperparakeratosis , epithelial hyperplasia or hyperorthokeratosis which may vary in sequence. A betel quid chewer has higher probability of getting OSF and acanthosis than a smoker and a drinker; a smoker has higher probability of getting hyperorthokeratosis than a betel quid chewer and a drinker, especially those smoking more than 2 packets of cigarettes per day have an even higher probability; drinking shows no statistical significance to the types of oral mucosal lesions. In terms of the diverse combination of betel quid chewing, smoking and drinking, age shows no statistical significance to the quantity of betel quid chewed. Hence, it is known that the mere use of betel quid without smoking and drinking will not diminish the likelihood of contracting oral mucosal diseases, contrarily it contributes to even greater chance of getting more types of oral mucosal disease and other coexistent diseases. In the studies to compare the oral mucosal lesions and the paired group, the oral mucosal lesions group had a lower education level. The betel quid chewing percentage，quantity of betel quid chewed every day，and the number of years that betel quid is chewed were higher in the OSF group than the paired group. A conditional logistic regression model was adopted to analyze the risk factors of all these lesions，a pure betel quid chewer has 4.31-fold probability of contracting oral mucosal diseases while a mixed user of betel quid and cigarettes has 4.86-fold probability, and a chewer of up to 30 betel quid a day has a 2.56-fold probability. They all show a significant difference. By means of post analysis, a mixed user of betel quid and cigarettes has a 1.13-fold probability of getting oral mucosal diseases. Key words：pure betel quid chewer，mixed betel quid and alcohol，mixed betel quid and smokes，mixed betel quid、smokes and alcohol ，oral mucosal disease.