| 摘要: | 皮膚具有維持體內生理恆定、阻擋外來物侵入的功能，此功能統稱為皮膚障壁功能。對於經常暴露在化學物質或有害物環境中之職業勞工，其皮膚障壁功能的優劣對於勞工的健康有相當重要的影響。職業駕駛因為日夜輪班生活作息不正常或久坐造成肥胖，罹患阻塞型睡眠呼吸中止症 (Obstructive Sleep Apnea, OSA) 之風險比一般人高，且 OSA 造成白天嗜睡與造成交通意外事故有很大的相關性，因此駕駛司機的睡眠問題是不容忽視的。另外，抽菸為台灣地區職業勞工常見的習慣與行為，它會對人體的呼吸、心血管及神經系統等方面產生負面的影響。以往研究指出皮膚在遭受到外界有害物的傷害會產生氧化壓力造成脂質與蛋白質過氧化，可能造成皮膚障壁功能受損，更嚴重者則產生皮膚疾病。OSA 與抽菸皆證實會產生反應性含氧物質 (reactive oxygen species, ROS) 造成體內氧化壓力升高，導致疾病產生，但對於 OSA 與抽菸行為是否會造成皮膚障壁功能的損害相關研究，目前仍付之闕如。因此，本研究目的為探討職業駕駛有睡眠呼吸中止症及抽菸習慣是否會造成皮膚障壁功能損害；另外，針對員工體內之氧化壓力指標 (8-OHdG、MDA) 進行量測，以釐清體內氧化壓力在 OSA 與抽菸對於皮膚障壁功能之損害所扮演的角色。
本研究以 131 名職業客運駕駛為研究對象，分別進行多頻式睡眠監測儀檢查 (polysomnography, PSG)、問卷調查、血液尿液樣本採集，血液樣本用以分析體內脂質過氧指標 — 丙二醛 (malondialdehyde,MDA)；尿液樣本則分析 DNA 傷害指標 — 8-OHdG (8-hydroxy-2-deoxyguanosine) 之含量。另外進行皮膚障壁功能包括基礎經皮水份散失 (transepidermal water loss, TEWL)、基礎皮膚含水量 (water contain, WC)、皮膚障壁完整度(barrier integrity) 及皮膚障壁修復率 (barrier recovery) 之量測。
依據 PSG 檢查之結果，將員工依 OSA 嚴重程度分為正常 (AHI<5) 49 人、輕度 (5≦AHI<15) 34 人以及中-重度 (AHI≧15) 48 人三組。三組的皮膚障壁功能在 TEWL 及皮膚修復率有統計上顯著差異，OSA 愈嚴重則 TEWL 及皮膚修復率則愈低。另外依問卷之調查，將員工分為有抽菸 87 人、沒抽菸 44 人。有抽菸的 TEWL 顯著的低於沒抽菸的員工，而皮膚修復率也有同樣的趨勢。
氧化壓力的部份，MDA 及 8-OHdG 尚未發現與 OSA 及抽菸有顯著相關，但在皮膚障壁完整度發現與 MDA 有顯著正相關 (p=0.002)；而皮膚修復率則與 8-OHdG 呈顯著負相關 (p=0.03)。
另外，我們也發現輕度 OSA 及中-重度 OSA 且又有抽菸的員工其TEWL 及皮膚修復率皆顯著低於沒有 OSA 且沒有抽菸的員工，顯示 OSA 越嚴重又加上抽菸的話，對皮膚障壁功能的損害就越嚴重。
本研究結果顯示，職業客運駕駛患有 OSA 或有抽菸習慣可能會損害其皮膚障壁功能，但氧化壓力在 OSA 與抽菸對於皮膚障壁功能之損害所扮演的角色仍需進一步釐清。
Skin barrier function is one of essential mechanisms for humans to maintain the physiology homeostasis and against the environmental hazards from dermal route. It’s very important to have the barrier in complete integrity due to frequently exposure to chemical hazards among workers. Professional bus drivers suffered from higher risk of obstructive sleep apnea (OSA) because of obesity associated with shift-work and/or long duration of sitting position. Previous studies have indicated that the OSA was highly correlated with traffic accident, a problem should be noticed in professional bus drivers. In addition, smoking is a common unhealthy behavior among industrial workers in Taiwan, and smoking has been documented as a hazard of human’s respiratory, cardiovascular and nerve systems. Previous studies have demonstrated that oxidative stress from environmental hazards or disease may cause the lipid and protein peroxidation and induce the damage of skin barrier function. Although OSA and smoking may associate with the increase of oxidative stress, little research has been done about the relationship between skin barrier function alteration and OSA/smoking among professional bus drivers. The purposes of this study are to explore whether OSA and smoking are associated with the perturbation of skin barrier, and to investigate the role of oxidative stress using DNA adduct index 8-hydroxy-2-deoxyguanosine (8-OHdG) and lipid peroxidation index malondialdehyde (MDA) as the indicators in professional bus drivers.
We recruited 131 professional drivers in this study to examine the apnea-hypopnea index (AHI) by polysomnography (PSG). Urine and blood samples were collected to determine 8-OHdG and MDA, respectively. Transepidermal water loss (TEWL), water contain (WC), barrier integrity and barrier recovery were used to estimate the skin barrier function alteration.
According to PSG testing results, all subjects were divided into four groups: control (AHI<5, n=49), mild OSA (5≦AHI<15, n=34) and moderate-severe OSA (AHI≧15, n=48). A significant negative correlation showed between OSA and TEWL and the barrier recovery among workers. In addition, according to the questionnaire, the subjects were grouped into 87 smokers and 44 non-smokers. The TEWL and barrier recovery were lower in smokers than in non-smokers. No significant difference was found between the oxidative stress and OSA and smoking. But, a significant positive correlation revealed between MDA and barrier integrity (p=0.002), while a significant negative correlation appeared between 8-OHdG and recovery (p=0.03). In addition, we also found that subjects who had both severe OSA and smoking habit had more serious damage to the skin barrier function.
In conclusion, OSA and smoking may alter the skin barrier function among professional bus drivers. However, future research should be conducted to investigate the mechanism of the oxidative stress index between OSA and smoking. |
