國人不孕症盛行率調查及環境賀爾蒙壬基苯酚與男性精液品質相關性探討

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Title:	國人不孕症盛行率調查及環境賀爾蒙壬基苯酚與男性精液品質相關性探討
Authors:	張嘉晃;Chia-Huang Chang
Contributors:	中國醫藥大學：環境醫學研究所碩士班
Keywords:	飲食;不孕症;健保歸人檔;壬基苯酚;DNA氧化損害能力指標;diet;infertility;National Health Insurance;nonylphenol level;8-hydroxydeoxyguanosine
Date:	2006-06-08
Issue Date:	2009-08-11 16:56:29 (UTC+8)
Abstract:	不孕症隨著工業化的發展似乎有越來越嚴重的趨勢，其中男性精液品質降低的證據也經過許多研究證實。環境賀爾蒙壬基苯酚具有弱的雌激素作用，並具生物累積作用，推測可能對精液品質下降也有影響。本研究首先利用健保歸人檔探討台灣不孕盛行情況，區分病因別、年齡、區域別、都市化程度分別探討不孕症盛行率，以及不孕症婦女懷孕情形。另外於中部一不孕症診所執行一橫斷式研究，探討環境賀爾蒙壬基苯酚與男性精液品質的相關性；100位男性同意並參與此試驗，透過問卷訪視，收取社會人口學變項、生活習慣、飲食習慣等資訊。並收集男性尿液，分別利用高效能液相層析儀及酵素連結免疫吸附分析法分析壬基苯酚內在暴露量及DNA氧化損害能力指標(8-hydroxydeoxyguanosine)。自1996年至2003年，台灣不孕症盛行情形，女性遠比男性高(576-681/105 vs. 73-133/105)，男性及女性不孕的就診病患分別集中於30-35歲及25-35歲。男性不孕的病因大多屬於非特異性(88%)，女性不孕的病因除了非特異性(77%)，無卵性月經也佔了多數(18%)。依都市化程度去觀察女性不孕症盛行的情形，自1998年後，都市化高地區的女性不孕症較盛行。八年間總計有3078名女性不孕者，其中47%經治療而懷孕成功。依據尿液分析，男性研究對象的壬基苯酚內在暴露量平均為16.4 μg/g creatinine，在生活習慣上，長期服用保健食品者其壬基苯酚含量高於未服用保健食品者(19.7 vs. 14.2μg/g creatinine, p < 0.05)，蛋類及沙拉的攝取較多者，壬基苯酚內在暴露量有增加的趨勢。尿液壬基苯酚濃度與氧化損害能力有顯著的相關。在評估精子數目正常與否與壬基苯酚內在暴露量的差異，精子數目不正常男性相對於正常男性有較高的壬基苯酚濃度(20.2 vs. 14.0 μg/g creatinine )。壬基苯酚濃度超過17.37 μg/g creatinine，精子數目不正常的相對危險性為4.31，控制其他因子後為4.85，皆達到統計上顯著關係。男性的精子數目可能與壬基苯酚內在暴露量有相關，尿液壬基苯酚濃度較高的男性，需進ㄧ步配合飲食調查來釐清。 The prevalence of infertility is in increasing trend among populations in the industrial countries. The decrement of sperm quality among populations has been also proved by several researches. One of the evidences has been associated with environmental hormone. Nonylphenol, one of environmental hormones possessing weak oestrogenic effect and biological accumulation, may result in abnormal semen quality. The reimbursement claim data for medical services obtained from the National Health Insurance (NHI) program were used to analyze the prevalence of infertility and the pregnancy rate among infertile women with medical assistances. In addition, a cross-sectional study was conducted at an infertile clinic in Middle Taiwan. With IRB approval and informed consented, 100 males were recruited to this study. A questionnaire consisted of information on socio-demographic characteristics, lifestyle, and dietary consumption was completed by each participant and a urine specimen was collected. Urinary nonylphenol level and 8-hydroxydeoxyguanosine were detected using high performance liquid chromatography and ELISA kit, respectively. The infertility clinic provided the information on sperm quality examined for the participants. From 1996 to 2003, 3078 women and 605 men received infertile cares in a cohort of 200,000 established in the NHI program. The prevalence rate of infertility in females were higher than that in males (576-681/105 VS. 73-133/105 or). Approximately 80% infertile males and 87% females were in ages 30 to 39 years. Among infertile persons, 88％ males and 77％ females were diagnosed as unspecified origin. Around 47% of 3078 infertile females became pregnant after medical assistances. The average urinary nonylphenol level measured for the 100 males recruited at the infertile clinic was 16.4μg/g creatinine. The average concentration of urinary nonylphenol was higher in men who used healthy food than in men who didn’t use (19.7 vs. 14.2μg/g creatinine, p < 0.05). Urinary nonylphenol level increased with the increment of consumption of egg and salad. There was significant association between urinary nonylphenol level and 8-hydroxydeoxyguanosine. Males with abnormal sperm concentration have higher urinary nonylphenol level than those with normal sperm concentration (20.2 vs. 14.0 μg/g creatinine). The odds ratio of abnormal sperm concentration was 4.31 for men with the urinary nonylphenol level excess 17.37 μg/g creatinine, compared with men with the level below 12.15 μg/g creatinine. After adjusting for other variables, the odds ratio increased slightly to 4.85 (p < 0.05). Males exposed to nonylphenol may associate with the decrement of sperm concentration. Males with higher urinary nonylphenol level need to be investigated on their food consumption in advance.
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