聚?樹脂合成皮作業勞工職業性二甲基甲醯胺暴露 對健康狀況及免疫功能的影響; Health and immunologic effects of occupational N,N-dimethylformamide exposure among polyurethane synthetic leather workers

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题名:	聚?樹脂合成皮作業勞工職業性二甲基甲醯胺暴露對健康狀況及免疫功能的影響;Health and immunologic effects of occupational N,N-dimethylformamide exposure among polyurethane synthetic leather workers
作者:	劉興潮;Liu Shing-Chaur
贡献者:	中國醫藥大學環境醫學研究所
关键词:	二甲基甲醯胺;單甲基甲醯胺;健康效應;免疫功能;免疫球蛋白;N,N-Dimethylformamide（DMF）;N-methylformamide（NMF）;health effects;immunologic effects;immunoglobulin
日期:	2004
上传时间:	2010-01-20 16:00:33 (UTC+8)
摘要:	二甲基甲醯胺（DMF）是工業上經常使用的有機溶劑，它和水及大部分的有機溶劑如丙酮、苯、乙醇、四氯化碳等均具有良好的混溶性，因此經常使用在人造皮製造業及低碳脂肪族提煉製程中。合成皮作業勞工可能因吸入逸散於作業環境中之二甲基甲醯胺的蒸氣、霧滴，或因皮膚直接接觸含二甲基甲醯胺溶劑之物料，甚至是作業環境中之二甲基甲醯胺的蒸氣從皮膚滲透入體內，而致職業暴露。流行病學研究已證實二甲基甲醯胺是肝臟毒性的物質，勞工過度暴露會造成肝臟的損傷，其他可能的健康危害包括中樞神經系統、血液學、接觸性皮膚炎及接觸性結膜炎等。動物實驗已證實DMF具免疫毒性，但人類的資料至今仍闕如，由於暴露DMF勞工極可能已潛在著遭受職業性免疫毒害。因此，為達到預防職業性疾病，保障勞工健康之目的，有必要針對二甲基甲醯胺暴露勞工之免疫狀況，作一概括性的了解。所以本研究以血液學及血清免疫球蛋白IgG、IgM、IgA及IgE等周邊血液免疫功能指標來探討二甲基甲醯胺對免疫功能的影響。並嘗試探討職業性二甲基甲醯胺暴露，在生理學、血液學、生化學及個人自覺症狀等健康狀態之影響。研究以中部某一聚?樹脂合成皮工廠為研究母群體，西元2004年3月在該工廠內之作業屬DMF暴露的勞工為主，並依其暴露嚴重度共隨意選取88位DMF暴露勞工為研究對象。其中DMF暴露狀況是以作業環境測定、個人生物偵測及累積暴露三種方式來評估，並以自覺症狀、生理學資料、血液學檢查值、生化學檢查值及六個免疫功能指標作為健康狀況的評估指標，並考量人口學因子、生活習慣、工作狀態及個人病史等研究之中介變項。 88名研究對象，其平均年齡為41.3?8.6歲，平均工作年資為143.5?77.0月，男性佔87.5%。其經個人採樣之作業環境DMF平均濃度為6.4±4.8 ppm，尿液中NMF代謝濃度平均為22.9±23.0 mg/g cre.。與作業環境DMF暴露濃度及累積暴露濃度有關的自覺症狀為疲倦，且DMF暴露濃度偏高組其疲倦症狀得分顯著高於暴露濃度偏低組。在DMF暴露與健康的關係方面，經多變項迴歸分析控制年齡、疾病史、抽菸及喝酒習慣等變項後，發現DMF暴露與肝、腎功能異常並無明顯相關，但與免疫功能有關，當DMF暴露濃度愈高時，免疫球蛋白G、免疫球蛋白E異常率會顯著增加，且免疫球蛋白M濃度會顯著下降，免疫球蛋白E濃度會顯著增加，顯示DMF對人體具有免疫毒性。 DMF對人體確實是一毒害物質。本研究中發現部份高暴露勞工，因沒有明顯的不適症狀，而忽略了個人防護裝備的穿戴，因此在勞工的教育訓練方面，仍需加強宣導，以期建立良好正確的衛生習慣，達到預防職業性疾病，保障勞工健康之目的。此外，作業環境中之DMF濃度亦應儘可能控制至更低。; N,N-Dimethylformamide（DMF）is an organic solvent that is used intensively in the production of synthetic leather and resins, above all as a result of its ready miscibility with water and various organic compounds. In exposed workers its absorption occurs through inhalation of vapors and by direct contact with its liquid form, vapors can also be absorbed through the skin. DMF known to cause a variety of adverse health effects, in particular, it is hepatotoxic. Moreover, although there is only inadequate evidence for its carcinogenicity in experimental animals, DMF is possibly a testicular carcinogen in humans. The immune system plays a crucial role in health, however previous studies showed DMF has effects on immunotoxicity in animal model, but there is no data in human nowadays. Therefore the objective of the current study is to evaluate the health and immunological effects among DMF–exposed workers. The study population includes about eighty-eight convenience subjects which were selected from polyurethane synthetic leather factory. All participants were interviewed with a standard self-administered questionnaire to obtain demographic data, lifestyle habits, perceived symptoms and occupational history, in addition, physiological data were also gathered. DMF exposure levels of workers were assessed by the personal air sampling, urinary NMF（N-methylformamide） concentration in post-shift and the cumulative exposure dose. Immunological effects were evaluated by white blood cells（WBC）, percentage of lymphocytes, and immunoglobulin（Ig）G, M, A, and E levels in serum. In addition, various hematologic and biochemical parameters were also analyzed. The mean age of the study subjects was 41.3 years and the mean duration of their work was 143.5 months. The mean level of DMF in air among was 6.4 ppm and the mean concentration of NMF in urine was 22.9 mg/g cre in study workers. Based on the levels of DMF in air, all workers were classified into two groups in workplace. Adjusting the other factors（age, gender, work duration, smoking and alcohol consumption, history of disease）, the levels of IgM in workers exposed to DMF were significant lower than the control groups, but the levels of IgE were significant higher than the control groups. Ajusting the same variables, high exposure DMF group had high risk in the abnormal proportion of serum IgG and IgE. This finding indicated that exposure to DMF has a detrimental effect on the immune system. Exposure to DMF has a statistically significant toxic influence on the immune system, but this conclusion warrants a further complete investigation of the mechanism in immunologic effect. It is evident that workers exposed to DMF in the polurethane synthetic leather factory must be reduced to minimum and must use the adequate control devices.
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