2016-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/643596摘要：隨著工業進步與生活富裕，肥胖與糖尿病及癌症則同時快速增加，生態與環境汙染日益嚴重，環境汙染漸漸被視為是重要的致病原因，而且是全球疾病負擔重要危險因子。研究環境汙染與心臟血管疾病的相關性，越來越重要。在環境污染中，最一致性且最廣泛影響的就是空氣汙染。室內空氣汙染被認為比室外空污更嚴重，對心臟血管疾病影響不容忽略。而暴露內分泌干擾化學物質，也被認為是心臟代謝疾病的重要致病因子。本研究每年將從台大心臟血管中心邀請200 位年齡介於20~80 歲的冠心病病患，住大台北地區且有病歷確診為心肌梗塞或心導管檢查證實者，以及他們未得冠心病的兄弟姊妹200 位對照組參與，持續三年。參加者接受問卷、非侵入性心臟與肺功能檢查、空腹血液及尿液收集。除了將用歐盟ESCAPE方法，使用土地使用迴歸模式及居家住址衛星定位，算出每個人一年的空氣汙染暴露量。我們也將用受測者過去從2004 年到現在的居家住址，再與環保署大台北地區十八個監測站做連結，再用衛星定位每一受測者居家住址，使用土地利用回歸模式，估算每一受測者過去十年的空污暴露量。我們也將測量每位參加者體內的內分泌干擾化學物質暴露，包括尿中塑化劑及血液全氟碳化合物。問卷包含基本資料、睡眠品質、環境暴露問卷以及飲食生活習慣等。我們將邀請病患及對照組各50~100 位，進行24 小時血壓、心臟血管功能(心脈儀)及連續心電圖監測，以及同步居家24 小時空氣品質監測：包含空氣懸浮微粒(PM1,2.5,4,10)、CO、CO2、溫溼度、VOC 總量、及甲醛等。並以TSI 儀器濾紙蒐集24 小時PM2.5 懸浮微粒，居家也將放置VOC 被動式採樣器(3M Organic Vapor Monitor 3500)蒐集二週，後續進行金屬及化學成分分析。本研究注重在冠心病病人與其對照組的比較，包括環境暴露評估(包括短期與長期)與心臟血管功能同時間同步監測、生物機轉、流行病學、及介入評估(下一階段接續研究)。希望由此證明環境暴露與心血管健康的相關性，並提出完整的心血管疾病預防策略。<br> Abstract: The prevalence of obesity, type 2 diabetes, and cardiovascular diseases (CVDs) grew rapidly followingthe industrialization and urbanization under the global economic development. Among environmental factors,numerous epidemiological studies have consistently reported that ambient air pollution, especially particulatematters (PM), is associated with cardiovascular morbidity and mortality. Indoor air pollution was consideredmore severe than outdoor air pollution and the subsequent cardiovascular effects can never be overestimated.In addition, endocrine disrupting chemicals (EDCs) also play an important role of pathogenesis ofcardiometabolic diseases.This study aims to recruit 200 coronary heart disease (CHD) patients and their non-CHD siblingcontrols (200 subjects) every year and for a continuous 3 years from Cardiovascular Center, National TaiwanUniversity Hospital. Patients have to be within 20-80 years-old and have hospital documents with acutemyocardial infarction or angiographic confirmation with CHD. Every participant will receive a series ofexaminations, including basic information, structural questionnaires (WHOQOL, CES-D, environmentalexposure, sleep quality, work stress, and lifestyle), noninvasive cardiovascular function (Holter ECG andDynapulse) and pulmonary function test, fasting blood sampling, and first morning urine collection. Subjects’exposure to phthalates and perfluorinated chemicals will be measured.We will apply land-use regression (LUR) models developed by the European Study of Cohorts for AirPollution Effects (ESCAPE) to estimate each subject’s one-year average exposure to traffic-related airpollutants with particulate matter diameters less than 10 μm (PM10) and 2.5 μm (PM2.5) and the absorbancelevels of PM2.5 (PM2.5 abs), nitrogen oxide (NO2), and NOx in Taipei. In addition, we will obtain eachparticipant’s living address since 2004 for assessing the short-term and long-term accumulated air pollutionexposure and cardiovascular effects. Air pollution levels will be obtained from the Air Quality MonitoringNetwork of the Environmental Protection Administration of Taiwan, from the 18 monitoring stations that arelocated within the Taipei metropolitan area. And, each subject’s long-term air pollution exposure will becalculated since 2004 by LUR. We will also invite 50-100 patients and another 50-100 controls to performin-house 24-h monitoring of volatile organic compounds (VOSc) (ppb RAE 3000, portable Handheld VOCmonitor) and collect VOCs for 14 days by using a 3M Organic Vapor Monitor 3500 (for further GC massanalysis), and PM mass concentrations (TSI DustTrak DRX Aerosol Monitor 8533) for PM1.0, 2.5, 4.0 and 10 fora continuous 24-h at the living room for each participant’s house. In addition, in-house 24-h monitoring offormaldehyde and CO2, CO, temperature and humidity will be completed for each participant. Meanwhile, areal-time 24-h continuous cardiovascular function monitoring will be performed with Holter and Dynapulsefor participants agreed to receive in-house air quality monitoring.In conclusion, we plan to complete a complete study of comparison between CHD patients andnon-CHD sibling controls by real-time monitoring of environmental exposure assessment (air quality andEDCs) and cardiovascular function simultaneously. The biologic mechanism and epidemiology ofenvironmental pollutants and CVDs will be explored. The study can provide an in-depth recommendation forCVDs prevention.空氣汙染內分泌干擾化學物質心臟血管功能冠狀動脈心臟病居家24 小時空氣品質監測Air pollutionendocrine disrupting chemicalscardiovascular functioncoronary heart diseasein-house air quality monitoring