多氯聯苯/多氯夫喃中毒者對健康相關生活品質之影響

Abstract

背景 1979年(民國68年)4月起，台灣中部之彰化縣及台中縣約有2000人因食用多氯聯苯污染之米糠油致皮膚、肝功能、眼部分泌腺等之異常，以及疲勞等症狀，稱為油症。之後研究發現，油症中毒者並不只暴露於多氯聯苯，且暴露於其加熱後之副產物–多氯呋喃。由於多氯聯苯及多氯呋喃均為代謝極慢之化學物質，可以長期留在人體中，而其脂溶性高，亦會長期在環境中蓄積並經由食物鏈在生物體的脂肪蓄積，形成生物濃縮效應，因此中毒者乃遭受長期之體內暴露。 目的： 本研究的主要目的為評估比較約三十年前暴露多氯聯苯之油症患者，其健康相關生活品質與一般民眾是否有差異。 方法： 用台灣簡明版世界衛生組織生活品質問卷，針對年齡介於31-65歲之油症患者，於2008年6月，進行問卷郵寄訪查，使用WHO-QOL 簡明版作評量工具作評估。同時針對有完整回覆問卷之油症患者，自2001年台灣國民健康調查生活品質資料庫中找出其年齡、性別、居住縣市別配對之對照組，以一比三配對，與油症患者作相關生活品質分析之比較。並使用可能影響生活品質之變項，進行多變項迴歸分析，以調整可能之干擾變項。 結果： 總計油症患者回覆有效問卷279份，因此自2001年台灣國民健康調查生活品質資料庫中找出其年齡、性別、居住縣市別配對之對照組837名，比較其生活品質量表結果。油症患者與對照組之得分為：生活品質總得分為52.4±8.9、58.2±6.1 (總分為80 分)；各範疇方面，生理健康範疇為14.0±2.3、15.5±1.9 (總分20 分)，社會關係範疇為13.0±2.5、14.7±1.9 (總分20 分)，心理範疇為12.7±2.8、14.2±1.9 (總分20 分)，環境範疇為12.6±2.3、13.9±1.8 (總分20 分)。兩組之間在總分及各項範疇方面，以Student’s T-檢定比較均有統計上顯著差異。 使用多變項迴歸分析以調整干擾變項之結果，在調整了性別、年齡、教育程度、婚姻狀態、工作有無、吸菸、飲酒等因子之後，油症暴露在生活品質總分及其各項範疇方面均有負面之影響。對於生活品質問卷之各別題目，使用多變項迴歸分析以調整干擾變項，在調整了性別、年齡、教育程度、婚姻狀態、工作有無、吸菸、飲酒等因子之後，油症之多氯聯苯及多氯呋喃暴露，在生理範疇：疼痛不適、活力、睡眠、活動工作能力；心理範疇：正負面感受、思考記憶、身體意象、自尊、個人信念；社會支持範疇：個人關係、社會支持、是否被尊重以及性生活；環境範疇：身體安全保障、家居環境、財務資源、社會照護、娛樂休閒、資訊技能以及想吃食物是否能吃到等生活品質評估項目均會造成負面之影響。 結論： 雖然多氯聯苯米糠油之暴露乃約三十年前發生，經過本研究使用世界衛生組織之評估中毒者在2008年之生活品質，並與對照組比較之結果，首度發現中毒者的總健康相關生活品質，以及其在生理健康、心裡健康、社會支持、環境等四個範疇確實比一般族群的生活品質有顯著的較差。本研究之結果可提供國家相關單位施行健康照護政策之參考，作為彌補這群公害之患者健康的損失，提升他們因中毒而降低的生活品質的考量資料。

Background and Purpose: Polychlorinated biphenyls (PCBs) and Polychlorinated dibenzofurans (PCDFs) are lipophilic pollutants and are known to cause multiple health outcomes in exposed animals and humans. In 1979, approximately 2000 people in central Taiwan were exposed to rice oil contaminated with PCBs and their heat-degradation products, mainly PCDFs, and many manifested by fatigue, skin disorder, abnormal liver function, and other symptoms. No study has documented the health-related quality of life among people exposed to PCBs/PCDFs in the past 30 years. Objectives: This study aimed to determine whether quality of life (QOL) was affected in people exposed to PCBs/PCDFs, as compared to the QOL obtained from background population selected from the National Health Interview Survey (NHIS) in 2001 in Taiwan. Methods: A total of 1,231 exposed subjects with previous PCBs/PCDFs exposure were invited to assess their quality of life by WHO quality of life-BREF (WHOQOL- BREF) Taiwanese version Questionnaire in 2008. Similar survey was done in 2001 in the NHIS study. For those exposed subjects satisfactorily completed the QOL questionnaire, comparisons were obtained from the QOL results randomly sampled from those background individuals matched for age, sex, and county using 1:3 match. Results: A total of 279 exposure subjects (23%) satisfactorily completed the questionnaire. Between the exposed and unexposed referents, the scores of overall QOL were 52.4±8.9, 58.2±6.1. As for individual domains, those of physical health were 14.0±2.3, 15.5±1.9, those of psychological health 12.7±2.8, 14.2±1.9, those of social relationships 13.0±2.5, 14.7±1.9, and those of environment 12.6±2.3, 13.9±1.8. In overall and individual domain scores, exposed people were significantly lower than those of the background population. After adjusted for age, education, gender, occupation, marriage, smoking and drinking, the exposed scored lower than the background in all overall health and individual domains; as well as the following QOL question items: energy, sleep, work capacity, ability to concentrate, bodily appearance, respected/feeling of acceptance, sexual life, and lacking of discomfort/pain. Conclusion: Exposure to PCBs/PCDFs 29 years ago seemed to have adverse effects on overall score of quality of life, as well as on various aspects of quality of life, namely, physical, psychological, social, and environmental domains.