| 摘要: | 背景與目的：流行病學研究顯示長期飲用含砷地下水和心血管疾病風險是有相關的。這篇研究首先在探討台灣西南沿岸烏腳病盛行地區，糖尿病、高血壓、高血脂、代謝症候群、及慢性腎臟病(chronic kidney disease, CKD)之盛行率，進一步探討慢性腎臟病與砷暴露之相關性。
方法：本研究於1996年到2000年為台南市學甲區及北門區四十歲以上之居民施行健康篩檢調查。參與研究之居民共有4361人，其中學甲區2886人，北門區1475人。其中有慢性腎臟病為722人，對照組1229人。使用邏輯式回歸來分析計算慢性腎臟病和砷暴露及其它的相關性，並用勝算比及95%信賴區間來表示。
結果：在烏腳病盛行區糖尿病、高血壓、高血脂、代謝症候群、及慢性腎臟病之盛行率為23.1%、53.4%、75.3%、15.6%和37.0%。多變項邏輯式回歸結果顯示慢性腎臟病主要相關因子為年齡、性別、高血壓和尿酸異常。年紀50-60歲、60-70歲及70歲以上相較於50歲以下者之勝算比依序為1.77 (95% CI = 1.12-2.82)、6.76 (95% CI = 4.33-10.5)、9.79 (95 % CI = 5.97-16.1)，p值皆小於0.001。高血壓和尿酸異常和慢性腎臟病之風險在統計上有相關，其勝算比為分別為1.68 (95 % CI =1.29-2.19)和3.86 (95% CI=2.80-5.31)。雖然在累積砷濃度暴露，病例組之濃度高於對照組，但在校正其他因子後，和慢性腎臟病相關之顯著性消失。
結論：本研究之結果顯示年齡、性別、高血壓、尿酸異常和慢性腎臟病有相關性。然而在本研究中我們不能發現砷暴露和慢性腎臟病的關係。
Background and Aims: Epidemiological studies show that chronic exposure to arsenic in groundwater has associated with elevated risks for cardiovascular disease. This study first investigated the prevalence of diabetes, hypertension, hyperlipidemia, metabolic syndrome, and chronic kidney disease (CKD) in the arseniasis-endemic areas in southwestern Taiwan. Second, this study investigated risk factors of CKD in the endemic area and the correlation between arsenic exposure and CKD risk.
Methods: A Health screening survey was applied to the residents aged over 40 in Beimen and Xuejia in Tainan City from 1996 to 2000. A total of 4361 people participated in the health check-up, 2886 from Beimen and 1475 from Xuejia. Among them, 722 were diagnosed as CKD cases, and 1229 were in the control group. Odds ratios (ORs) and 95% confidence intervals (CIs) for the association between risk factors and CKD were estimated using logistic regression.
Results: The prevalences of diabetes, hypertension, hyperlipidemia, metabolic syndrome, and CKD among the participants in arseniasis-endemic areas were 23.1 %, 53.4 %, 75.3 %, 15.6 % and 37.0 %, respectively. Multivariate logistic regression found that age, sex, hypertension and hyperuricemia had correlation with risk of CKD. Compared to residents <50 years of age, the ORs of CKD were 1.77 (95% CI = 1.12-2.82), 6.76 (95% CI = 4.33-10.5) and 9.79 (95 % CI = 5.97-16.1) for those aged 59, 69, and over 70 years and older, respectively. Men were less likely to have CKD than women (OR = 0.70, 95 % CI = 0.50-0.98). Hypertension and hyperuricemia were also significant risk factor of CKD with OR = 1.68 (95% CI=1.29-2.19) and OR = 3.86 (95 %CI = 2.80-5.31), respectively. Although the arsenic exposure was higher in CKD cases than in controls, this association disappeared after adjusting for other risk factors of CKD.
Conclusions: Among residents in the arseniasis-endemic areas, arsenic exposure was not significant associated with CKD. However, the CKD risk was higher for women, the elderly and those with hypertension and hyperuricemia. |
