空氣汙染暴露與糖尿病及其併發症之關係探討

Abstract

根據世界衛生組織估計，2014年全球成年人糖尿病盛行率為8.5%，2012年約莫有三百七十萬例死亡人數可歸因於高血糖，且其中43%於七十歲以前死亡。糖尿病可能導致身體許多部位之併發症，進而影響生活品質與增加過早死亡的風險。其併發症包括：各類心血管系統疾病、失明、腎衰竭和下肢截肢等。懷孕期間的高血糖，亦會增加胎兒死亡及其他併發症之風險。 本研究係利用台灣出生世代研究-第六個月的調查問卷以及全民健康保險研究資料庫-2005年百萬承保抽樣歸人檔做為健康結果與共變數之資料來源，環保署空氣品質監測站資料為暴露資料來源，探討空氣汙染暴露對孕婦妊娠糖尿病發生及後續發展第二型糖尿病的影響以及空氣汙染暴露對於糖尿病族群常見之微血管併發症之影響。 研究結果發現，懷孕婦女在懷孕中第一及第二孕程的一氧化氮暴露與其妊娠糖尿病發生風險增加有關。且懷孕婦女在懷孕期間若被診斷患有妊娠糖尿病，其後續發展第二型糖尿病的風險顯著較高；然而，空氣汙染物暴露雖與懷孕婦女產後發展第二型糖尿病無顯著相關；但患有妊娠糖尿病之懷孕婦女，暴露交通相關之空氣汙染物，產後發展第二型糖尿病風險較高，為一易感族群。此外，在糖尿病族群中，懸浮微粒空氣汙染物暴露與糖尿病視網膜病變發生有顯著相關。

According to World Health Organization estimated, the global prevalence of diabetes mellitus in adults (DM) was 8.5% in 2014. A total of 3.7 million deaths related to high blood glucose levels in 2012, and 43% of these deaths was under the age of 70. DM is a leading cause of complications in many parts of body that impact meaningfully on quality of life and also increases the overall risk of dying prematurely. The complications include cardiovascular diseases, blindness, kidney failure and lower limb amputation. Higher blood glucose levels during pregnancy increases the risk of fetal death and other complications. In this serial study, we applied the sixth-month questionnaire of Taiwan Birth Cohort Study (TBCS) and National Health Insurance Database (NHIRD)- Longitudinal Health Insurance Database 2005 (LHID-2005) as data source of health outcome and covariates, and air monitoring data from Taiwan Environmental Protection Administration as exposure data source to do following studies. 1.) Investigate the association between air pollution exposure and gestational diabetes mellitus (GDM) 2.) Assess the effect of air pollution exposure on developing type 2 diabetes mellitus in pregnant women 3) Evaluate the risk of diabetic retinopathy occurrence for exposure air pollution in diabetics The main findings of this serial study were as following: 1) Nitrogen oxide exposure during the first and second trimester is associated GDM occurrence. 2) The risk of developing type 2 DM is greater in pregnant women who had been diagnosed as having GDM during pregnancy. Although, air pollution exposure is not statistically significant associated with developing postpartum type 2 DM, Exposure to traffic-related air pollutants, pregnant women with GDM have higher risk of postpartum type 2 DM. 3) In diabetics, exposure to particulate matter air pollutants is significantly related to diabetic retinopathy occurrence.