人造石產業勞工健康效應研究

Abstract

背景與目的 近年來，人造石材的製造與加工已成為高濃度可呼吸性結晶型二氧化矽的職業暴露來源，而長期暴露已知會導致不可逆且進行性的矽肺症。相較於傳統矽肺症，人造石相關矽肺症有罹病者年輕化、死亡率升高的趨勢。然而目前較少文獻探討人造石產業可呼吸性結晶型二氧化矽暴露對勞工肺功能下降程度與早期偵測指標之影響。因此我們的研究針對台灣人造石產業勞工，評估兩年追蹤期間肺功能變化，並希望能發現人造石相關矽肺症早期偵測指標。 方法 2022年時針對兩間人造石製造廠勞工進行橫斷式研究，並於2024年重新邀請勞工進行追蹤與橫斷式研究。透過自填式問卷了解受試者工作史，並進行肺功能檢查，包含用力吐氣第一秒量(FEV1)及用力吐氣量(FVC)。2024年額外進行呼氣測試，包含呼氣一氧化氮(FeNO)、呼氣一氧化碳(FeCO)，以及生物標記物分析。 研究使用工作暴露矩陣與空氣採樣結果評估受試者個人可呼吸性結晶型二氧化矽(RCS)累積暴露，並以問卷調查結與暴露加權因子，將受試者分為高、低暴露組。透過RCS暴露程度，討論健康效應，包含肺功能異常、吐氣測試結果與生物樣本標記物分析，並將性別、年齡、身體質量指數、教育程度等納入校正分析。研究中使用相關係數探討肺功能測試之間的關聯性，以t檢定分析肺功能變化跟不同暴露組之間的差異。線性回歸與多元線性回歸用於評估暴露與健康效應之間的劑量反應關係，羅吉斯回歸則以估計不同暴露水準與肺功能異常風險之關聯性。 結果 為期兩年的觀察中，人造石產業勞工肺功能呈現顯著下降，平均每年FEV1與FVC分別降低108.12 mL (SD = 77.72)與101.35 mL (SD = 105.23)。每增加1 mg/m3-year的累積可呼吸性結晶型二氧化矽暴露，FEV1與FVC分別下降15.03 mL (95% 信賴區間 −25.17至−4.89, p = 0.005) 與19.76 mL (95% 信賴區間 −34.78至−4.78, p = 0.01)。在早期偵測指標方面，發現高暴露與高累積暴露組的受試者有更高比例的限制型與阻塞型肺部異常，且發生風險亦顯著提高。此外，高暴露組之血液樣本生物標記物分析也相較低暴露組高，顯示其作為人造石產業勞工健康早期偵測指標之潛力。 結論 人造石製造產業勞工隨時間發生顯著肺功能下降，並與累積可呼吸性結晶型二氧化矽暴露呈現劑量反應關係。初步結果亦支持使用呼氣測試與血液生物標記物作為早期偵測健康效應之評估工具。建議未來研究可擴大樣本規模、延長追蹤時間並擴大生物標記分析範圍，以增進人造石相關肺部損傷之早期偵測與防治策略。

Background Artificial stone manufacturing and processing have emerged as a significant occupational source of high respirable crystalline silica (RCS) exposure. Prolonged exposure to RCS is known to cause silicosis, a progressive and irreversible lung disease. Compared to traditional silicosis, artificial stone-associated silicosis affects younger workers and progresses more rapidly. Despite increasing global concern, few studies have evaluated lung function changes or explored early markers among artificial stone workers. This study aimed to evaluate the longitudinal changes in lung function over a two-year period among artificial stone workers and to explore potential markers that may serve as early indicators of artificial stone-associated silicosis. Materials and Methods In 2022, workers from two artificial stone manufacturing plants were examined in a cross-sectional study. The participants were invited again for a follow-up examination in 2024. In the two visits, data on job histories were collected using self-reported questionnaires. Lung function tests, including forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC), were performed at baseline and the end of the study period. In 2024, additional assessments included fractional exhaled nitric oxide (FeNO), fractional exhaled carbon monoxide (FeCO), and biomarker analyses using blood and urine samples. Cumulative exposure was estimated using air sampling data and job-exposure matrices. Spearman’s correlation coefficients were calculated to explore the association between field-based and hospital-based pulmonary test values. Paired t-tests were used to evaluate changes in lung function; two-sample t-tests assessed the differences between divided groups of workers. Multiple linear regression models assessed exposure-response relationships, while logistic regression estimated the odds of lung function impairment in relation to exposure levels. Results Longitudinal analysis revealed an average annual decline of 108.12 mL (SD = 77.72) in FEV1 and 101.35 mL (SD = 105.23) in FVC. Each 1 mg/m3-year increase in cumulative RCS exposure was associated with a 15.03 mL/year reduction in FEV1 (95% CI −25.17 to −4.89, p = 0.005) and a 19.76 mL/year reduction in FVC (95% CI −34.78 to −4.73, p = 0.01). In the study of exploring early indicators for artificial stone workers, high and high cumulative exposure groups exhibited a greater prevalence and increased odds of both restrictive and obstructive impairments. Additionally, elevated levels of selected biomarkers were observed in high-exposure groups, suggesting their potential as early indicators of silica-related lung damage. Conclusion Artificial stone workers demonstrate significant lung function decline over time, closely linked to cumulative RCS exposure in a dose-dependent manner. Preliminary evidence also supports the utility of blood-based biomarkers in identifying early respiratory effects. Further research with larger cohorts, extended follow-up, and expanded biomarker profiling is warranted to enhance early detection and intervention strategies.