1.產後婦女使用生化湯與六個月時生活品質的關係 2.以極致液相層析/串聯式質譜儀分析尿液中五種鄰苯二甲酸酯類的代謝物:初步結果

1.Use of Sheng-Hua-Tang and health-related quality of life in postpartum women: a population-based cohort study in Taiwan 2.Determination of five phthalate metabolites in human urine using ultra-performance liquid chromatography/tandem mass spectrometry: preliminary results

曾郁晴(Yu-Ching Tseng)

指導教授 ： 陳保中

國立臺灣大學/公共衛生學院/職業醫學與工業衛生研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.00350

摘要

1. 摘要
研究背景: 婦女在產後使用生化湯 (內含當歸、川芎、桃仁、乾薑和炙甘草) 常見於華人所在的地區，但是對於產後婦女健康相關生活品質的益處尚需進一步的探討。
研究目的: 本研究主要目的是評估產後婦女使用生化湯的情形和未來生活品質的關係。
研究設計: 出生世代的追蹤性研究
研究族群: 本研究採用多階段分層的系統抽樣，由2005年的台灣出生登記檔選取24,200對媽媽及其嬰兒。一共有87.8 %的媽媽參與填答世代研究的結構性問卷。
研究方法: 收案的時間為2005年6月至2006年7月，於研究個案們產後6個月時進行家庭訪視。使用The Medical Outcomes Study 36-item Short-Form (SF-36)問卷比較生化湯使用情形對產後婦女生活品質的影響。
結果: 將產後沒有使用生化湯的媽媽和只有在產後一個月內使用生化湯的媽媽相比，發現後者對於 ”因生理功能而使角色受限” 和” 因情緒而使角色受限” 兩個分數有正向的影響；而一個月後仍然使用生化湯的媽媽，對這兩個分數則有負向的影響。此外以生化湯使用頻率來看，只要是在產後有使用生化湯的媽媽對上述兩個分數皆會顯著上升。
結論: 在產後一個月內使用生化湯對於媽媽健康相關生活品質有所幫助，尤其是 ”因生理功能而使角色受限” 和” 因情緒而使角色受限” 這兩個層面。但是產後持續使用生化湯超過一個月可能對生活品質有負向的影響。未來則需要更多研究來闡述這兩者之間的相關性。

2. 摘要
研究背景: 鄰苯二甲酸酯類 (Phthalates)為常見的塑化劑並廣泛應用於工業和日常生活中，而它們對於生殖系統和發育功能的危害受到關注。為了要評估人體對於鄰苯二甲酸酯類的內在暴露量，需要建立有效量測鄰苯二甲酸酯類代謝物濃度的方法。
研究目的: 本篇研究的主要目的是要改良過去高效液相層析/串聯式質譜儀的分析方法，進一步開發快速且靈敏度更佳的分析方法來評估尿液中五種鄰苯二甲酸酯類的濃度。
研究方法: 我們使用改良後的固相萃取步驟，酵素去醣化共軛技術 (enzymatic deconjugation)，搭配同位素稀釋技術和極致液相層析/串聯式質譜儀的分析方法來分析尿液中五種鄰苯二甲酸酯類，包括monomethyl phthalate (MMP), monoethyl phthalate (MEP), mono butyl phthalate (MBP), monobenzyl phthalate (MBzP), and mono-(2-ethylhexyl) phthalate (MEHP)。
研究結果: 五種待測物的固相萃取回收率和樣本前處理回收率分別為89 - 121 %, 79 - 105%。在MMP和MEP可以看到離子加強的效果 (ion enhancement)，而MBP， MBzP 和MEHP的離子抑制 (ion suppression) 分別為18%，20% 和68%。儀器的偵測極限範圍為0.36 pg到11.8 pg，而其定量極限範圍為1.19 pg至39.3 pg。
結論: 經由改良過後的前處理步驟，維持良好的固相萃取和樣本前處理的回收率。且藉由極致液相層析儀，我們提高了樣本的分析速度，每一個樣本只需要6.7分鐘就能有效分離五種鄰苯二甲酸酯類代謝物。而方法的偵測極限，定量極限，準確性和精確性需要進一步測量，才能證明此方法亦為準確，靈敏度佳的方法。

關鍵字

世代研究 ； 健康相關生活品質 ； 產後婦女 ； SF-36 ； 生化湯 ； 極致液相層析/串聯式質譜儀 ； 鄰苯二甲酸酯類代謝物 ； 固相萃取 ； 鄰苯二甲酸酯類分析

並列摘要

1. Abstract
Background: Although Sheng-Hua-Tang (comprising Radix Angelicae Sinensis, Ligustici Rhizoma, Semen Persicae, Zingiberis Rhizoma and Glycyrrhizae Radix) use during the postpartum has been popular in Chinese communities over a long period, its benefits have not been evaluated in terms of its effects on the health-related quality of life of postpartum women.
Objectives: This study aims to explore the relation between different patterns of Sheng-Hua-Tang use and the health-related quality of life in postpartum women.
Design: A longitudinal birth cohort follow-up study.
Settings and participants: We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. A structured questionnaire was successfully administered to 87.8% of the sampled population.
Methods: Subjects underwent a home interview 6 months after their deliveries between June 2005 and July 2006. The Medical Outcomes Study 36-item Short-Form (SF-36) was used to measure the quality of life of the women with different patterns of Sheng-Hua-Tang use.
Results: Compared with those who never used after delivery, the scores of role limitations due to physical health and emotional problems significantly increased in women who used Sheng-Hua-Tang within 1 month only but decreased in those who continuously used within 1 month and later. In addition, the scores of role limitations due to physical health and emotional problems significantly increased in women who used Sheng-Hua-Tang regardless of the frequency.
Conclusions: Sheng-Hua-Tang use during the first month of the postpartum period may have a positive effect on women’s health-related quality of life especially in terms of role limitations due to physical health and emotional problems. However, continuous use after the first month of the postpartum period might have a negative effect on women’s quality of life. Further studies are needed to replicate the results and elucidate the causal relations.

2. Abstract
Background: Phthalates are widely used as plasticizers in industry and our daily life and their hazards of reproductive and developmental dysfunction have been concerned. Validated analytical methods to measure the concentrations of phthalate metabolites in human are essential for assessing internal exposure to phthalates.
Objectives: The main objective of this study is to modify the previously high performance liquid chromatography - tandem mass spectrometry (HPLC-MS/MS) analytical methods, further develop a speedy and sensitive analytical method to assess the five phthalate monoesters in human urine.
Methods: The modified solid-phase extraction (SPE) procedure, enzymatic deconjugation technique, and isotope ultra-performance liquid chromatography - tandem mass spectrometry (UPLC-MS/MS) was used to analyze five phthalate monoesters, including monomethyl phthalate (MMP), monoethyl phthalate (MEP), mono butyl phthalate (MBP), monobenzyl phthalate (MBzP), and mono-(2-ethylhexyl) phthalate (MEHP) in urine.
Results: The SPE recoveries of the five phthalate monoesters ranged from 89 % to 121 %, and the sample pretreatment recoveries ranged from 79-105%. Ion enhancement effect was founded in MMP and MEP, ion suppression effect of MBP, MBzP and MEHP was 18 %, 20% and 68 %, respectively. Instrumental detection limits (IDLs) ranged from 0.36 pg to 11.8 pg and instrumental quantitation limits (IQLs) ranged from 1.19 pg to 39.3 pg, respectively. The IDL and IQL were lowest in MEHP, and highest in MMP.
Conclusions: The modified sample preparation processes maintain good SPE and sample pretreatment recoveries. And we developed a rapid analytical method for determination of five phthalate metabolites using isotopic UPLC-MS/MS due to the chromatographic time was only 6.7 min per run. The limit of detection (LOD), limit of quantification (LOQ), accuracy and precision of the method are still needed to calculate to manifest it is also a sensitive and accurate method.

並列關鍵字

Cohort studies ； health-related quality of life ； postpartum women ； SF-36 ； Sheng-Hua-Tang ； UPLC-MS/MS ； phthalate metabolites ； solid-phase extraction ； phthalate analysis

參考文獻

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