烏腳病盛行地區居民之早期砷暴露和皮膚癌之病例對照研究

Early Arsenic Exposure and Cancer-A Community-Based Case-Control Study in an Endemic Area of Blackfoot Disease

陳淑媛(Shu-Yuan Chen) ； 余幸司(Hsin-Su Yu) ； 陳國熏(Gwo-Shing Cheng) ； 郭宗禮(Tsung-Li Kuo) ； 陳建仁(Chien-Jen Chen)

《中華民國公共衛生學會雜誌》 12卷1期 (1993/03) Pp. 1-9

https://doi.org/10.6288/JNPHARC1993-12-01-01

摘要

台灣西部沿岸有較高的皮膚砷癌盛行率，其中以烏腳病地區最高。本研究的目的在於瞭解飲水改善後，烏腳病盛行地區的皮膚砷中毒症盛行率；探討砷暴露指標和皮膚砷中毒症的關係；並評估調整其他危險因子後，累積神暴露量對皮膚瘤的影響。本研究選擇烏腳病盛行率最高的嘉義縣布袋鎭好美、復興、新民三里的30歲以土居民爲研究族群，進行以社區爲基礎的病例對照研究。總共有914名當地居民在1989年1至2月接受健康檢查和問卷訪視。結果發現皮膚色素沈著過多症、角化症和皮膚瘤的盛行率（及患者平均年齡）分別是13.1%（57.7歲），4.9%（58.0歲）和5.9%（61.1歲）。年齡調整後之皮膚癌盛行率皆隨飲用深井水年數或飲水累積砷暴露量的增加而上升。飲用深井水年數爲＜10，10-19，20-29和30年以上者，其年齡－性別調整後皮膚癌盛行率，分別是3.5%，3.9%，4.8%和9.8%；而累積暴露量爲0，1-9，10-29，30年ppm以上者，該調整盛行率分別是0%，1.1%，7.0%和11.1%。經調整和皮膚癌有顯著統計相關的危險因子，包括年齡、性別、工作日曬史、家族烏腳病或皮膚癌既往史、血清麩丙酮轉氨基酶濃度、食用曬乾番薯簽年數、以及鹽田工作史後，飲水累積砷暴露量仍與皮膚癌盛行率呈現劑量效應關係。

關鍵字

砷 ； 皮膚癌 ； 病例對照研究

並列摘要

Chronic arsenicism of the skin has been- documented to be extraordinarily high on the southwestern coast of Taiwan, especially in the endemic area of blackfoot diease (BFD). The specific aim of this study is to estimate the prevalence of chronic arsenicism among residentsin the BFD-endemic area after the discontinuation of drinking artesian well water. Arsenic exposure and skin lesions including hyperpigmentation, hyperkeratosis and cancer were studied. Residents aged 30 years old or more in the BFD-hyperendemic villages were recruited as study subjects for this community-based case-control study. A total of 914 residents in Homei, Fuhsin and Hsinming villages were examined by dermatologists during the period from January to February, 1989. The prevalence (mean age of the affected) of hyperpigmentation, hyperkeratosis and non- melanoma skin cancers were 13.1% (57.7 years), 4.9% (58.0 years) and 5.9% (6.1 years), respectively. There was a dose-response relationship between cumulative arsenic exposure and the age-sex-adjusted prevalence of skin lesions. The age-sex-adjusted prevalence of skin cancers for those who had consumed artesian well water for ＜10, 10-19, 20-29 and 30+ years were 3.5%, 3.9%, 48% and 9.8%, respectively. The prevalence was 0%, 1.1%, 7.0% and 11.1%, respectively, for those who had a cumulative arsenic exposure level of 0, 1-9, 10-29, 30+ ppm-years. This dose-response relationship remained significant after adjusting for other risk factors significantly associated with the development of chronic arsenicism of the skin including age, sex, a familial history of BFD and skin cancer, an elevated alanine transaminase level, frequent consumption of dried sweet potato (used as an indicator of undernourishment), as well as a history of working in salt fields.

並列關鍵字

Arsenic ； Skin Cancer ； Case-Control Study