(一) HEV 濃度與抽煙之相關
本研究之結果發現，非抽煙者體內之 HEV 值為 58.3 pmol/g Hb ， 抽煙者為 205.9 pmol/g Hb，抽煙者與非抽煙者之 HEV 值達統計上顯 著差異(p<0.0001)，且抽煙者比非抽煙者高出 4 倍之多(如表三)。
Törnqvist(1986)(2)之 研 究 指 出 ， 非 抽 煙 者 為 58±25 pmol HEV/g globin，抽煙者 HEV 濃度為 389±138 pmol/g globin，而 Bader(1995)(10) 之研究結果，非抽煙者 HEV 為 46 pmol HEV/g globin，抽煙者為 171 pmol/g globin，Muller (1998)(47)表示抽煙者與非抽煙者 HEV 值相差 5 倍，本研究之結果皆與過去文獻值一致，證實抽煙者與非抽煙者體內 之 HEV 值有顯著差異，且 HEV 值可作為評估長期抽煙之生物指標。
然而，非抽煙者體內之 HEV 值最高達 325 pmol/g Hb，其原因為體內 HEV 來源除了抽煙外，尚有少部分來自二手煙之暴露、空氣污染及 內生性來源。而將抽煙者之香煙種類分為國內及國外煙後，發覺抽國 內香煙者體內之 HEV 值比抽國外香煙者高，但沒有達統計上顯著差 異，顯示國內香煙與國外香煙之 EO 含量並沒有明顯差異。
而本研究針對研究對象之家人及同事抽煙情形調查，為了解其暴 露於二手煙之情形，表七、表八中控制抽煙變項後，發現只有抽煙者 之家人抽煙與否與 HEV 值達統計上顯著差異(p=0.0131)，此結果顯示 二手煙之來源很多，除了家中及工作場所外，可能尚有其他來源，如 公共場所、室內外之空氣污染等，故僅由家人及同事之抽煙與否探討 研究對象之暴露二手煙情形可能仍無法完全代表其暴露二手煙情 形。但不論抽煙與否，家中有成員抽煙者其體內之 HEV 值，皆比家 中無人抽煙者之 HEV 值有偏高之趨勢，可能因為工作場所有空調，
關，可能因為有抽煙習慣者，平常會與家人一起抽煙，而非抽煙者反 而會限制家人在家中抽煙。
Bailey(1988)(46)之研究結果表示，每天抽煙支數與 HEV 值之相關 性為 7.1 pmol HEV/g globin/cig.，且抽煙支數與 HEV 值間之相關係數 r 為 0.537(p<0.01)，Bader(1995)(10)亦指出抽煙與 HEV 相關為 11 pmol HEV/g globin/cig.，而 Törnqvist(1992)(42)表示 HEV 值與每天抽煙支數 間沒有顯著相關，但其相關性為 9.4 pmol/g globin/cig.。由表九、表十 二 之 結 果 發 現 每 天 抽 煙 支 數 與 HEV 值 間 達 統 計 上 明 顯 相 關 (p<0.0001)，與文獻之結果相符，但本研究中抽煙者平均每天僅抽 12.7 支煙，且半數以上每天皆抽 10 支煙以下，與文獻中平均每天抽 20 支 煙以上(2)有些差距。另外，本研究中每天抽煙支數與 HEV 值之相關 為 8.8 pmol/g globin/cig./day，與過去文獻結果差異不大。抽煙者之抽 煙年數及抽煙包年與體內 HEV 值皆有顯著相關(p<0.0001)，證實 HEV 值在體內具有生物累積效應，為評估長期暴露良好之生物指標。但不 論針對非抽煙者及抽煙者而言，其 HEV 值變異皆不小，可能因為人 體內有內生性來源，且個人感受性不同之緣故。
根據表十三之複迴歸分析，其中只有抽煙與否、每天抽煙支數與 體內 HEV 值達統計上顯著相關，證實抽煙與 HEV 值間有顯著相關，
且解釋力(R2=0.3603)達統計上顯著意義。
(二) 暴露劑量與抽煙之相關
本研究結果發現，抽煙者之 EO 暴露劑量比非抽煙者高出近 4 倍，兩者間達統計上顯著相關(p<0.0001)。因劑量計算公式是參考文 獻中之參數值求得的，與 HEV 值有顯著相關者，與暴露劑量皆有顯 著相關，及每天抽煙支數、抽煙年數及包年皆明顯與暴露劑量達統計 上顯著相關(p<0.0001)。結果顯示抽煙者所暴露到之 EO 劑量會比非 抽煙者高，即非職業暴露者，EO 之暴露來源主要來自於抽煙。
(三) 致癌風險與抽煙之相關
本研究結果發現，抽煙者因抽煙暴露到 EO 所造成之癌症風險值 比非抽煙者高出 3 倍多。而癌症風險是由暴露劑量計算求得，故與暴 露劑量相關者，亦會與癌症風險相關，即每天抽煙支數、抽煙年數及 包年與致癌風險皆達統計上顯著相關(p<0.0001)。Törnqvist(56)指出長 期暴露於 1-10 pmol N-alkylvaline/g globin 會造成癌症之風險為 10-6-10-5，本研究是以文獻中之參數帶入[34]式中求得，而求出之風險 值與 HEV 值之關係，與文獻之結果相差不多。
本研究所求得抽煙者之平均致癌風險較一般人(10-6) 高出 100 倍，而非抽煙者也高出 10 倍，可能原因除了外在暴露及內生性所產 生之 HEV 外，環境中尚有許多致癌物質。
陸 結論與建議
一、結論
1. Modified Edman Degradation Method 能敏感測定體內 HEV 之含量。
2. 本研究所測得非抽煙者之 HEV 值為 58.3 pmol/g Hb ，抽煙者為 205.9 pmol/g Hb，結果與過去文獻相符，而抽煙者體內之 HEV 值 明顯比非抽煙者高出 3 倍多，證實 HEV 為評估因抽煙暴露到環氧 乙烷良好之長期生物指標。
3. 本研究以 HEV 值計算體內環氧乙烷劑量，進而估算外在環氧乙烷 暴露之劑量及個人致癌風險，發現抽煙者之暴露劑量及致癌風險 皆明顯較非抽煙者為高，表示非職業暴露 EO 者，其 EO 暴露主要 來源為抽煙，且長期抽煙會使癌症發生率增加。
二、建議
本研究主要針對抽煙與非抽煙者進行探討，未來可針對環氧乙 烷職業暴露收集更多研究樣本，建立國人體內HEV濃度值之資料。
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表一 問卷基本資料
表二 抽煙與其他變項之相關
表三 各變項與 HEV 值之比較 10-30 min(N=68) 30 min 以上(N=33)
140.4±125.3 0.8049 喝茶
無(N=81) 有(N=68)
117.0±107.7
145.8±154.1 0.1827 喝咖啡
無(N=110) 有(N=39)
136.3±137.4
112.6±111.7 0.3339 飲食習慣
素食(N=2) 葷食(N=147)
188.1±211.8
129.3±130.8 0.5312
a平均值±標準差
49
表四 抽煙與 HEV 值之比較
變項 非抽煙(N=77) 抽煙(N=69) p HEV 濃度
(pmol/g Hb) 58.3±45.6 a 205.9±151.4 <0.0001 暴露劑量 Dexp
(ppm⋅h) 259.2±202.8 915.1±673.0 <0.0001 風險(x 10-6) 41.5±32.5 146.4±107.7 <0.0001
a 平均值±標準差
* HEV: N-(2-hydroxyethyl)valine
表五 抽煙者之香煙不與 HEV 值之比較
變項 國內香煙
(N=29)
國外香煙
(N=40) p HEV 值
(pmol/g Hb) 227.0±164.4a 190.6±141.5 0.3289
a 平均值±標準差
50
表六 性別與 HEV 值之比較
非抽煙者 抽煙者
性別 性別
變項
變項