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系統識別號 U0026-1808201622293700
論文名稱(中文) 台灣地區長期細懸浮微粒暴露與第2型糖尿病發病風險之關聯研究
論文名稱(英文) Effect of Long-term Exposure to Fine Particulate Matter on Incidence of Type 2 Diabetes in Taiwan
校院名稱 成功大學
系所名稱(中) 環境醫學研究所
系所名稱(英) Institute of Environmental and Occupational Health
學年度 104
學期 2
出版年 105
研究生(中文) 李佳穎
研究生(英文) Chia-Ying Li
學號 S76034023
學位類別 碩士
語文別 中文
論文頁數 89頁
口試委員 指導教授-蘇惠貞
共同指導教授-吳治達
口試委員-郭浩然
口試委員-潘文驥
中文關鍵字 細懸浮微粒  第2型糖尿病  發病率  世代追蹤研究 
英文關鍵字 Cohort Study  Fine Particulate Matter  Diabetes  Incidence 
學科別分類
中文摘要 過去已有研究發現,長期暴露於較高細懸浮微粒濃度下可能導致糖尿病之發生。然而,有關亞洲地區之實證研究證據現階段仍屬匱乏,且對於劑量效應並未探討。基於此,本研究整合台灣地區細懸浮微粒長期監測資料及第2 型糖尿病發病資訊,以探討台灣地區長期細懸浮微粒暴露對第2 型糖尿病之影響。在研究材料方面,本研究利用全民健康保險研究資料庫中的承保抽樣歸人檔(Longitudinal Health Insurance Database 2000, LHID 2000) 之世代追蹤資料,依據2001年至2012年間有服用糖尿病降血糖藥物且一年內至少三次以上診斷為糖尿病(ICD-9: 250),並排除20歲以下及研究期程前被診斷為糖尿病者等標準,以篩選本研究分析之第2型糖尿病患者;細懸浮微粒暴露資料取自行政院環境保護署空氣品質監測網,在刪除離島與缺漏值後,採用2006年到2012年全台共71個測站之細懸浮微粒每小時監測數據,並採用地理資訊系統 (Geographic Information Systems, GIS) 中之克利金模型 (Ordinary Kriging) 模擬研究對象就醫鄉鎮細懸浮微粒暴露濃度值。研究方法共包含二個階段,首先,本研究透過ArcGIS中空間統計模組 (Spatial Statistics) 探討台灣地區第2型糖尿病在研究期間發病情形之空間分布狀況;之後,以Cox 比例風險模型 (Cox Proportional Hazards Model),在校正可能干擾因子 (Confounder) 之情況下,探討細懸浮微粒與第2型糖尿病發病率之相關性與劑量效應關係。
研究結果顯示,自2001年起共納入505,151位民眾作為研究族群,研究追蹤期間共有48,611位糖尿病新發病患者,平均發病年齡 (±SD) 為57.8 (±13) 歲,全台平均發生率為1.14%。細懸浮微粒全台濃度平均 (±SD) 為33.24 (±8.27) μg/m3。統計分析之結果顯示,於校正性別、年齡、共病症與社會經濟因子之情況下,PM2.5每增加一個IQR (12.03 μg/m3),糖尿病發病風險上升4.9% (HR=1.049; 95% CI: 1.033, 1.065),其劑量效應呈現U型,約在27 μg/m3後風險有上升的情形。
綜合本研究之結果可知,台灣地區長期細懸浮微粒暴露會增加第2型糖尿病發病之風險。
英文摘要 Long-term PM2.5 exposure may contribute to elevated incidence of type 2 diabetes, but the results were not always significant. Furthermore, empirical research evidence relating PM2.5 and diabetes is still lack in Asian countries. This study assessed the association between PM2.5 and type 2 diabetes in Taiwan. The retrospective cohort study was conducted from 1st January, 2001 through 31st December, 2012. Health information of participants was retrieved from the LHID 2000 of the NHIRD. Incidence of diabetes was defined as participants who were diagnosed for diabetes (ICD 9 code: 250) more than 3 times in a year. A 7-year (2006-2012) exposure to PM2.5 was estimated using Oridinary Kriging (ArcGIS) to approximate participants’ long-term exposure to particle pollutants. With the adjustment for individual-level variables, comorbidities, and environmental factors, the Cox proportional hazards models were used to investigate the associations between PM2.5 exposure and type 2 diabetes incidence. Of the 505,151 eligible participants enrolled in the study, a total of 48,611 newly developed diabetes cases were identified in the study period. The averaged 7-year exposure to PM2.5 was 32.6 μm/m3. The adjusted HR (95% CI) per IQR increment of PM2.5 was 1.049 (95% CI = 1.033 to 1.065). Long-term exposure to PM2.5 increased the risk of type 2 diabetes in the population of Taiwan. These findings add to the growing evidence that PM2.5 is a potential risk factor for type 2 diabetes.
論文目次 摘要 I
Extended Abstract II
致謝 X
目錄 XI
表目錄 XIV
圖目錄 XV
壹、 研究背景 1
貳、 文獻回顧 5
一、 國內外懸浮微粒趨勢變化 5
2.1.1 懸浮微粒之定義 5
2.1.2 懸浮微粒分類與組成 5
2.1.3 細懸浮微粒 (PM2.5) 對人體之危害 8
二、 國內外糖尿病研究之近況 10
2.2.1 胰島素傳訊 (Insulin Signaling) 與胰島素抗性 (Insulin resistance) 10
2.2.2 糖尿病分類 11
2.2.3 第2型糖尿病致病機轉 11
2.2.4 第2型糖尿病流行病學 13
三、 細懸浮微粒 (PM2.5) 與第2型糖尿病關聯之研究證據 13
2.3.1 細懸浮微粒與第2型糖尿病中間機制之實驗證據 14
2.3.2 細懸浮微粒與第2型糖尿病之流行病學研究 16
參、 研究材料與方法 19
一、 研究材料 19
3.1.1 第2型糖尿病資料庫 19
3.1.2 細懸浮微粒觀測資料 20
3.1.3 細懸浮微粒之空間推估 22
3.1.4 社會經濟統計資料 23
二、 研究方法 24
3.2.1 應用空間自相關指標以探討第2型糖尿病之空間分布 24
3.2.2 探討細懸浮微粒對第2型糖尿病發病率之影響 27
3.2.3 劑量效應評估 (Dose-Response Assessment) 29
肆、 研究結果 30
一、 描述性統計 30
4.1.1 細懸浮微粒 (PM2.5) 濃度與時空分布 30
4.1.2 研究族群的描述統計特性 30
4.1.3 第2型糖尿病狀態 31
二、 統計分析成果 32
4.2.1 單變項與第2型糖尿病發病風險 32
4.2.2 細懸浮微粒暴露模式分析 33
4.2.3 敏感度分析 33
4.2.4 分層分析 34
4.2.5 劑量效應關係 35
伍、 討論 36
一、 時空分布分析 36
5.1.1 細懸浮微粒 (PM2.5) 的濃度與來源 36
二、 相關流行病學研究與本研究之比較 39
5.2.1 整體結果比較 39
5.2.2 細懸浮微粒 (PM2.5) 暴露濃度與時間 42
5.2.3 研究族群人口統計差異 43
三、 劑量效應關係 45
四、 研究優勢與限制 46
5.3.1 研究優勢 46
5.3.2 研究限制 47
陸、 研究結論與建議 50
柒、 參考文獻 51
捌、 附錄 65

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