1.探討出生前後二手菸暴露對嬰幼兒神經行為發展之影響 2.探討中藥從業人員血中重金屬濃度和腎臟功能之關係

1. Prenatal and Postnatal Exposure to Environmental Tobacco Smoke and Children’s Neurobehavioral Development at 6 to 18 Months of Age 2. Association between heavy metal levels in blood and renal function among Chinese herbalists

周珊安(Shan-An Chou)

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(2008年)

https://doi.org/10.6342/NTU.2008.00929

摘要

一、探討出生前後二手菸暴露對嬰幼兒神經行為發展之影響

目標：評估出生前後二手菸暴露，對六到十八個月大嬰幼兒神經行為發展之影響。

方法：本研究藉由「台灣出生世代研究(TBCS)」評估出生前後暴露於二手菸對神經行為發展之影響。總共1,496 對母親及小孩為我們研究的對象，分別在嬰幼兒六個月大和十八個月大時利用問卷做兩次量測，評估二手菸之暴露情形（有、無）和其神經行為發展狀況（包括粗動作、精細動作、語言溝通、身邊處理及社會能力）。並利用multiple linear regression 分別分析嬰幼兒六個月大和十八個月大之神經行為發展狀況。

結果：本研究發現，出生前後暴露到二手菸，對十八個月大嬰幼兒之精細動作發展有顯著的影響。此外，隨著暴露時間越長，對十八個月大嬰幼兒之精細動作發展影響，有更顯著的趨勢。

結論：出生前後二手菸的暴露可能會影響嬰幼兒之神經行為發展。而嬰幼兒在十八個月大前，若暴露到二手菸就可能影響其日後神經行為表現。特別是在精細動作發展方面，在嬰幼兒十八個月大時就可以看到影響。

二、探討中藥從業人員血中重金屬濃度和腎臟功能之關係

目標：探討中藥從業人員血中重金屬濃度和腎臟功能之關係。

方法：本研究藉由6,581 位一般民眾和168 位中藥從業人員來評估血中重金屬濃度和腎臟功能之關係。總共有6,749 位受試者為我們研究的對象，而所有受試者被分成三組：一般族群、低重金屬濃度中藥從業人員、高重金屬濃度中藥從業人員。重金屬高低濃度的切點，砷、鎘、汞、鉛，分別為4.70, 1.75, 21.83,35.87 µg/L。重金屬濃度是使用Agilent 7500C inductively coupled plasma-mass spectrometry (ICP-MS)來做分析；而腎臟功能則是使用simplified Modification of Diet in Renal Disease (MDRD) Study公式來計算GFR的值。並利用multiple linear regression 分析一般族群和中藥從業人員血中重金屬濃度和腎臟功能之間的關係。

結果：本研究發現，在單金屬分析時，在四種金屬均可看到腎絲球過濾率有顯著地降低；但在多金屬分析時，則發現只有鎘和鉛對腎絲球過濾率有些許影響。然而，經過我們進一步分析後，發現若是鎘和鉛均屬於高濃度的那一組，他們的腎絲球過濾率會顯著的降低 (β, -10.71; S.E., 4.80)。

結論：中藥從業人員的腎臟功能確實比一般族群較差。特別是若其血中鎘和鉛濃度均較高，那對腎臟功能影響是最顯著的。

關鍵字

環境菸害 ； 二手菸 ； 神經行為發展 ； 兒童健康 ； 中草藥 ； 中藥從業人員 ； 腎功能 ； 重金屬

並列摘要

1. Prenatal and Postnatal Exposure to Environmental Tobacco Smoke and Children’s Neurobehavioral Development at 6 to 18 Months of Age

Objectives: The purpose of this study was to evaluate the associations between prenatal and postnatal environmental tobacco smoke (ETS) exposure and neurobehavioral development of the early childhood at 6 to 18 months of age.

Methods: It is the pilot study of the population-based Taiwan Birth Cohort Study. A total of 1,496 infant-parent pairs had completed data to be recruited in our study. ETS
exposure was measured twice with the questionnaire at 6 and 18 months of age. The classification of a combined effect of ETS exposed periods (prenatal period to 6 months
and 7 months to 18 months) and ETS exposed status (yes or no) was stratified into four groups. Then, we also evaluated twice their neurobehavioral development status by the Taiwan Birth Cohort Study scale, including gross-motor, fine-motor, language/communication (language), and social/self-care ability (social). The covariate
variables were maternal nationality, maternal education, marital status, infant sex, and gestational age for adjustment.

Results: In the multiple linear regression analysis, we found the fine-motor of the scale were significant effects among the four groups at 18 months of age by ETS exposure.
Furthermore, significant trend of ETS exposed periods with neurobehavioral developmental delay at 18 months of age was revealed in the study.

Conclusions: In the present study, we found that ETS exposure was associated with the early childhood neurobehavioral development. Before 18 months of age, if children ever exposed ETS, their neurobehavioral development might be affected. Therefore, the
neurodevelopment of the early childhood may be vulnerable under ETS exposure, particularly in fine-motor performance, and could detect at the early age of 18 months.

2. Association between heavy metal levels in blood and renal function among Chinese herbalists

Objectives: The purpose of this study was to investigate the association between heavy metal levels in blood and renal function among Chinese herbalists.

Methods: A total of 6,581 general populations and 168 Chinese herbalists had completed data to involve our study. All subjects were stratified into three groups as well: general populations, heavy metal concentration below sixty percentile among Chinese herbalists, and above sixty percentile among Chinese herbalists. The heavy metals were analyzed by Agilent 7500C inductively coupled plasma-mass
spectrometry (ICP-MS), and the sixty percentile cut-off point of arsenic, cadmium, mercury, and lead concentration were 4.70, 1.75, 21.83, and 35.87 µg/L. Then, we used simplified Modification of Diet in Renal Disease (MDRD) Study equation to estimate glomerular filtration rate (GFR) levels to assess renal function. The covariate variables were age, sex, race, BMI, education, marital status, systolic pressure, diastolic pressure, smoking, alcohol consumption, betel nut chewing, and exercise for adjustment.

Results: In the single-metal analysis, we found significant negative effects on the GFR levels in four metals by the multiple linear regression analysis. However, there
were the borderline associations between multi-metal analysis and the GFR levels in cadmium and lead. Furthermore, we found that there was a significant effect (β,-10.71; S.E., 4.80) on the both cadmium and lead concentrations above sixty percentile group.

Conclusions: In the present study, we found Chinese herbalists’ GFR levels were significantly declines compared with general population, and the significant decline on GFR levels appeared on both high levels of cadmium and lead group. In future study, the heavy metal levels in blood may decline continually, and multi-metal and
low-dose exposure may be the critical and important form which modern people worthily concern.

並列關鍵字

environmental tobacco smoke ； children ； neurobehavioral development ； Chinese Herbal Medicine ； Chinese Herbalist ； Renal function ； Chronic Kidney Disease ； Heavy metals

參考文獻

18. DiFranza JR, Aligne CA, Weitzman M: Prenatal and postnatal environmental tobacco smoke exposure and children's health. Pediatrics 2004, 113(4 Suppl):1007-1015.

21. DiFranza JR, Aligne CA, Weitzman M, DiFranza JR, Aligne CA, Weitzman M: Prenatal and postnatal environmental tobacco smoke exposure and children's health. Pediatrics 2004, 113(4 Suppl):1007-1015.

11. Robinson JS, Moore VM, Owens JA, McMillen IC, Robinson JS, Moore VM, Owens JA, McMillen IC: Origins of fetal growth restriction. Eur J Obstet Gynecol Reprod Biol 2000, 92(1):13-19.

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