| 摘要: | 皮膚障壁功能與皮膚健康、毒性化學物質吸收與皮膚疾病有關，因此皮膚狀態優劣對於職場勞工是很重要的一環。隨著社會的改變，使得勞工所遭受到的壓力也越來越多。過去文獻顯示，心理壓力會造成體內荷爾蒙如皮質醇上升，進而導致皮膚障壁功能損傷。噪音為環境及職場主要壓力源之一，亦會造成體內荷爾蒙之改變。然而，過去卻少有文獻探討噪音引起之壓力與皮膚障壁功能的關聯性。飛機維修人員為噪音高暴露族群，其職場環境亦有機溶劑如正己烷、丁酮之暴露。研究指出部份有機溶劑可能傷害皮膚障壁功能，勞工長期暴露正己烷、丁酮與皮膚障壁功能關聯之研究卻很少。本研究的目的主要為：（1）噪音對於皮膚障壁功能之關聯性（2）正己烷、丁酮暴露與皮膚障壁功能之關聯性（3）探討噪音與有機溶劑共同暴露對皮膚障壁功能之影響（4）探討體內荷爾蒙含量上升是否為噪音與有機溶劑造成皮膚障壁功能損害可能機制。本研究以實際職場研究為起點，選取44位飛機維修人員為研究對象，針對噪音、正己烷、丁酮暴露員工進行工作現場調查與暴露評估，以工作時間以及內容為基礎，將所有員工分為噪音暴露組、有機溶劑暴露組、噪音與有機溶劑共同暴露組、控制組共四組，進行問卷調查及皮膚障壁功能量測，並蒐集勞工之血液樣本進行皮質醇、腎上腺素與正腎上腺素荷爾蒙之分析，進一步探討這些暴露及中間因子與皮膚障壁功能損傷之關聯性。職場研究結果發現，噪音工作單位之音量皆為超過法規之高噪音暴露，有機溶劑工作單位皆使用濃度大於90%以上之高濃度有機溶劑。比較噪音暴露組與控制組後發現，皮膚障壁完整度受到噪音影響而改變，且3、6、24小時之皮膚障壁修復率皆顯著小於控制組。控制可能影響因子後發現有機溶劑暴露造成經皮水分散失顯著升高，噪音改變皮膚障壁完整度且造成6小時障壁修復率損傷，且噪音與有機溶劑共同暴露顯示有交互作用存在，會使修復率升高，進一步探討發現控制有機溶劑影響後，噪音會對6小時修復率造成傷害，而有機溶劑與噪音共同暴露會影響噪音與皮膚障壁功能傷害之機制，使6小時皮膚障壁恢復率上升。荷爾蒙分析結果發現，本研究之噪音會造成勞工體內正腎上腺素顯著上升，並發現與皮膚障壁完整度呈現正相關之趨勢，且與6小時皮膚障壁修復率呈現負相關的趨勢，但未達統計顯著。綜合以上結果，噪音可能會改變皮膚之完整度並對皮膚障壁修復功能造成損傷，且噪音造成之正腎上腺素荷爾蒙上升是可能的潛在機制。有機溶劑則會對基礎經皮水分散失造成傷害，並可能影響噪音與皮膚修復功能之間的修復機制。
Skin barrier function is associated with skin health, skin absorption, and skin diseases. In modern occupations, stress has been an important health issue among workers. Previous studies have postulated that psychological stress increases the cortisol level, and induces the skin barrier function perturbation. Noise, a common factor associated with stress in occupation environment, has been demonstrated as a risk factor affecting hormone level. However, limited studies have focused on the relationship between skin barrier function and noise exposure at work. Aircraft maintenance workers constantly expose to high noise and organic solvents, such as n-hexane and methyl ethyl ketone (MEK) at work. Previous studiesalso have demonstrated that organic solvent exposure may induce the damage of skin barrier function. To our knowledge, limited research has investgated the skin barrier disruption after long-term exposure to n-hexane and MEK among aircraft maintenance workers. The objective of this study is to investigate the skin barrier function alteration associated with noise and/or organic solvent exposure. In addition, we explored the levels of cortisol, epinephrine and nor-epinephrine and the potential mechanism of skin barrier function damage caused by noise. After visiting occupational settings in central Taiwan, a total of 44 aircraft maintenance workers were recruited to this study. We defined all study subjects into four types of study group, including noise exposure only, solvent exposure only, simultaneously exposure to noise and solvent, and control group. Blood specimens and questionnaires were collected. We measured the hormone level and confounding factors for workers. Skin barrier function index, such as transepidermal water loss (TEWL) and skin recovery were measured to estimate the barrier disruption. The relationship between environmental exposure, skin barrier function, and hormone level were estimated after the information had collected. Comparisons between noise group and control group showed that noise changed the barrier integrity and induced the alteration of 3, 6 and 24 hours recovery. After controlling the affecting factors, the basal TEWL was elevatated after organic solvent exposure, and there was a change in barrier integrity and a perturbation of 6h recovery caused by noise exposure. Moreover, there was an interaction because of the co-exposure of noise and solvent. After the further controling for solvent effect, noise caused the damage of 6h recovery, and the co-exposure of noise and solvent altered the mechanism between noise and 6h recovery. The results of hormone analysis postulated that noise caused a remarkable increase in nor-epinephrine, which showed the positive trend with barrier integrity and negative trend with 6h recovery. In summary, noise can cause the change of barrier integrity by stratum corneum thickening and induce the alteration of barrier recovery. The increase of hormone (ex: nor-epinephrine) levels induced by noise exposure might be the potential mechanism leading to barrier alteration. Organic solvents can cause the damage of basal TEWL and affect the potential mechanism between noise and skin barrier recovery. |
