||Exploration for biomarkers of sick building syndrome: feasibility study of allostatic load model
||Institute of Environmental and Occupational Health
indoor air quality
sick building syndromes
allostatic load model
病態建築症候群 (Sick building syndrome, SBS) 係指人員在不良的室內環境內產生非特異性的症狀，但當離開此環境後，症狀則會減緩或消失。然而，個人因子如壓力等亦會引發人員產生類似SBS之症狀。目前研究採用的SBS評估方法多僅能呈現環境或個人因素等單一因子對SBS的影響，以至於無法更清楚瞭解影響SBS的主要因子，進而降低SBS的風險。回顧晚近文獻發現適應負荷模式 (Allostatic load model) 為一可反映環境與個人因子對個體生理機能造成影響之客觀指標。因此，本研究嘗試利用線性迴歸模式探討適應負荷模式與職場員工SBS的關係，及其表現是否會受到室內環境汙染物的濃度變化及個人因子的影響，並與過去研究採用的8-OHdG比較，以瞭解適應負荷模式的適用性。本研究共收集70人的健康指標、生物檢體及所處空間的環境品質指標，經分析發現 (1)可培養性真菌濃度與適應負荷模式有顯著相關，而8-OHdG則與相對濕度和光照度有顯著相關；(2) 適應負荷模式與8-OHdG和受試者的SBS表現均無顯著關係，但適應負荷中與代謝系統和受試者SBS的表現有顯著關係 (p<0.05)；(3) 利用適應負荷模式的生物指標初步建構評估SBS嚴重程度之方程式為SBS總積分=0.311一秒用力吐氣量 (l) +0.276肌酸酐 (mg/dl) +0.189正腎上腺素 (μg/g creatinine) +0.117每週工作時數 (hr)-0.426性別 (女性:0；男性:1) -0.321種族 (漢人:1；非漢人:2)。此方程式之解釋力為40.1%，且達統計上顯著意義 (p=0.001)。本研究為第一篇探討適應負荷模式和SBS關係之研究，研究雖僅發現可培養性真菌濃度與適應負荷模式有顯著相關，且僅適應負荷模式中的代謝系統與SBS有顯著關係，但仍初步證實環境暴露與適應負荷模式有關，且適應負荷模式與SBS有關。因此，本研究結果也提供未來探討SBS影響因子的方向，以更深入釐清影響SBS的因素進而降低其風險。
Sick building syndromes (SBS) include a group of non-specific symptoms, usually disappearing after leaving the suspected environments. Meanwhile, personal stress is also linked to reporting symptoms almost identical to those mentioned above. To assess the SBS, most studies have either taken the approach of questionnaires interview, or by measuring 8-OHdG levels only. None of the above can be considered to serve as a comprehensive surrogate for SBS severity. Allostatic load model, on the other hand, has been reported as an objective biomarker to reflect the effect of environmental exposure or personal stress. This study therefore aimed to assess the feasibility of using allostatic load model to characterize SBS and to examine the potential associations among environmental concentrations, personal factors and biomarkers of interest (8-OHdG). Health indicators and bio-samples (saliva and urine) were collected for 70 subjects, some of which were used to calculate allostatic Score. The quality of indoor air where these subjects worked was also measured. Results showed that allostatic load scores were significantly correlated with total culturable fungi, and 8-OHdG levels were with relative humidity and light intensity. No significant relations were found between allostatic load score and reporting SBS, but effect of metabolic system included in allostatic load model was positively associated with SBS. Association between 8-OHdG levels and reporting SBS was of no significance. Based on the study results, we proposed a model for estimating SBS severity as the following: SBS index= 0.311*forced expiratory volume in 1 second (FEV1, L)+0.276*creatinine (mg/dl) +0.189*norepinephrine (μg/g creatinine)+0.117*working hour (hr)-0.426*gender (female as 0, male as 1)-0.321*race (han as 1, nonhan as 2) (R2=0.401, p=0.001). This study was the first study to characterize the relation among allostatic load scores, reporting SBS, and environmental factors.
第一章 序論 1
1-1 研究緣起 1
第二章 文獻回顧 4
2-2 室內環境品質與人體健康效應 5
2-2-1建築物相關疾病 (Building Related Illness) 5
2-2-2病態大樓症候群 (Sick Building Syndrome) 7
2-3 生理指標發展現況與限制 10
2-4 適應性負荷模式 (Allostatic Load Model) 13
2-4-1 適應性負荷模式的發展 14
2-4-2 適應性負荷模式的應用 14
第三章 研究方法 17
3-1 研究對象選取 17
3-1-1 研究空間選取 17
3-1-2 受試者選取 17
3-4 適應負荷模式分數計算 22
3-5 問卷調查 23
3-5-2 生活品質分數計算 25
第四章 結果 28
4-1 研究場址之基本特徵 28
4-2 受試者基本特徵 29
4-4 受試者所處室內環境因子分佈 34
4-5 適應負荷模式 (含所計算的指標) 與尿液中8-OHdG分佈 40
4-6 受試者SBS盛行率分佈 42
4-7 基本特性、生活品質及環境因子與適應負荷模式和8-OHdG的關係 44
4-8 適應負荷模式和8-OHdG與SBS表現的關係 49
4-10 小結 55
第五章 討論 57
5-1 受試者SBS盛行率分佈 57
5-5-2 受試者尿液中8-OHdG與受試者SBS表現之關係 67
第六章 結論與建議 71
附錄一 臺灣版世界衛生組織生活品質問卷使用授權書 88
附錄二 同意臨床試驗證明書 89
附錄三 臨床試驗規範訓練結業證書 90
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