2012-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/644017摘要：過去三十年，隨著工業進步與生活富裕，肥胖、糖尿病、心臟血管疾病，及癌症則同時快速增加，除了飲食生活習慣外，環境汙染漸漸被視為是重要的致病原因。研究環境汙染與心臟血管疾病及代謝有關疾病的相關性，顯得越來越重要。因為若能找出環境汙染與疾病相關，我們有機會藉由減少暴露或環境控制，達到預防及減少疾病的發生，這在公共衛生上是非常重要的。近年來有愈來愈多證據支持內分泌干擾化學物質（Endocrine disrupting chemicals,簡稱EDCs）與肥胖和代謝疾病相關。例如全氟碳化合物(perfluorinated chemicals, 簡稱PFCs)，塑化劑(Phthalates)以及雙酚A (Bisphenol A)等。我們在台灣年輕成年人的研究，亦發現血清中PFNA (perfluorononanoic acid）與Adiponectin 成正相關，而且與甲狀腺功能指標（free thyroxin T4)呈正相關。進一步的分析，我們亦發現PFOS（perfluorooctanesulfate）與頸動脈內中皮層厚度相關，而且我們也發現基因多型性APOE 有交互作用。我們將對過去三年(2009-2011)在台大醫院參加本人冠心病與對照組研究，已經收案的無冠心病的中年人622 位，皆已接受標準的75 克葡萄糖耐量檢驗，且已有留存血液及尿液檢體者。他們皆已有各種血液生化發炎指標之測量值，也有微白蛋白尿，以及頸動脈硬化及主動脈血管彈性，及心臟血管功能檢查之結果。第一年可直接進行環境汙染物測定，由尿液測量塑化劑以及雙酚A 代謝物，由血清測量全氟碳化合物。短期我們可以及早研究並檢定上述三種內分泌干擾化學物質，是否與心臟代謝疾病有關。在第二年至第三年(2013-2014)我們將邀請這622 位回台大醫院接受第二次的心血管健康檢查追蹤，並留取血液、尿液及頭髮。以及非侵襲性心血管構造及功能檢查。進行第二次測量塑化劑以及雙酚A 代謝物，以及血清全氟碳化合物。我們將有機會回答長時間(平均四年)暴露上述三種內分泌干擾化學物質對心臟代謝疾病的新發生是否有關。總之，藉由已建立的心血管疾病研究世代，測量每個人其檢體中內分泌干擾化學物質或其代謝物的濃度，我們可以快速得到結果，回答這些廣泛存在我們環境中的汙染物，其可能的心臟血管代謝疾病健康效應。由長期世代的追蹤檢查及重複收集檢體，可以了解這三種內分泌干擾化學物質是否促發新的心臟血管代謝疾病，若能證明其因果關係，在心臟血管代謝疾病預防上是非常重要的。<br> Abstract: As the economic development and progressive industrialization, the lifestyle ofwesternization accompanied with rapid growth of obesity, diabetes, cardiovascular disease,and cancer was noted during past 20 years. In addition to eating behavior and sedentarylifestyle, environmental pollutants have been ascribed the possible etiologies ofcardiometabolic diseases. Investigation of the associations between environmental pollutantsand cardiometabolic diseases became more and more important. Because we may have theopportunity to prevent and decrease the disease through preventing exposure orenvironmental control if we can identify which pollutant is harmful to human health.There are growing evidences support endocrine disrupting chemicals (EDCs) areassociated with obesity and diabetes, such as perfluorinated chemicals (PFCs), phthalates,and bisphenol A, etc. Our studies in a cohort of adolescents and young adults in Taipei havedemonstrated serum levels of perfluorononanoic acid (PFNA) positively associated withserum adiponectin and free thyroxin (T4). Another result found that serum levels ofperfluorooctane sulfate (PFOS) associated with carotid intima-media thickness. These seriesstudies confirmed PFCs play the role of EDCs in human health.This study aims to investigate the possible health effects of PFCs, phthalate, andBisphenol A on cardiometabolic diseases in middle-age healthy control subjects, who werefree of coronary heart disease (CHD) recruited for participating the study of work-relatedfactors and cardiovascular events in patients with CHD in National Taiwan UniversityHospital during 2009-2011. These participants all have blood and urine samples collectedand received series of blood test for biochemistry, complete blood count, inflammationmarkers, and microalbuminuria, etc. In addition, noninvasive cardiovascular assessments,including carotid atherosclerosis, aortic pulse wave velocity, and Dynapulse cardiovascularfunction. In the first year, we will study the associations between the above three EDCs andcardiometabolic diseases through direct measurement of the urine metabolites of phthalatesand bisphenol A, and serum levels of PFCs. In the second and third year, we will re-call backthese 622 subjects to receive follow-up cardiovascular health examination as the samestudies with first ones during 2009-2011. The second blood and urine samples also will becollected again to measure the urine metabolites of phthalates and bisphenol A, and serumlevels of PFCs. The associations and incidence of cardiometabolic diseases will be evaluatedwith levels of EDCs. The progression of cardiovascular diseases also will be assessed.In conclusion, take advantage of existing cohort study for those participants with urineand blood samples; we can test the associations between EDCs and cardiometabolic diseasesin a cross-sectional design. In the follow-up study, we can answer the causal relationsbetween EDCs and cardiometabolic diseases. Through this study, we can confirm therelations between EDCs and cardiometabolic disorders in ethnic Chinese living in Taiwan.內分泌干擾化學物質心臟代謝疾病全氟碳化合物塑化劑雙酚Aendocrine disrupting chemicalscardiometabolic disordersperfluorinated chemicalsphthalatesbisphenol A