第五章 討論
第三節 應用與建議
1. 由於國內目前沒有統一的參考值可供參考，本研究已蒐集目前現 有健康年輕成年人之血鉛值，可供臨床以及未來研究參考，建議 政府相關單位可以列出一般族群的各類重金屬之參考值供臨床以 及未來研究深入探討。
2. 身高與血鉛的關係以及機轉至今尚未明確，本研究雖有看出有負 的相關趨勢，但本研究為二手資料無法確認其因果關係，建議將 來的研究可以深入探討其因果關係。
參考文獻
(英文部分)
Aggett PJ. Aspects of neonatal metabolism of trace metals. Acta Paediatr Suppl 1994;
402: 75-82.
Alexander J. Selenium. Novartis Found Symp 2007; 282: 143-9; discussion 149-53, 212-8.
Apostoli P, Baj A, Bavazzano P, Ganzi A, Neri G, Ronchi A, et al. Blood lead reference values: the results of an Italian polycentric study. Sci Total Environ 2002; 287: 1-11.
ATSDR. Public health statement - Copper. 2004.
ATSDR. Toxicological profile for lead.. 2006
Ballew C, Khan LK, Kaufmann R, Mokdad A, Miller DT, Gunter EW. Blood lead concentration and children's anthropometric dimensions in the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994. J Pediatr 1999; 134: 623-30.
Batariova A, Spevackova V, Benes B, Cejchanova M, Smid J, Cerna M. Blood and urine levels of Pb, Cd and Hg in the general population of the Czech Republic and proposed reference values. Int J Hyg Environ Health 2006; 209: 359-66.
Becker K, Kaus S, Krause C, Lepom P, Schulz C, Seiwert M, et al. German
Environmental Survey 1998 (GerES III): environmental pollutants in blood of the German population. Int J Hyg Environ Health 2002; 205: 297-308.
Benton D, Cook R. Selenium supplementation improves mood in a double-blind crossover trial. Psychopharmacology (Berl) 1990; 102: 549-50.
Bhutta ZA, Bird SM, Black RE, Brown KH, Gardner JM, Hidayat A, et al.
Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials. Am J Clin Nutr 2000; 72: 1516-22.
Bleys J, Navas-Acien A, Guallar E. Serum selenium and diabetes in U.S. adults.
Diabetes Care 2007; 30: 829-34.
Boran P, Tokuc G, Vagas E, Oktem S, Gokduman MK. Impact of zinc
supplementation in children with acute diarrhoea in Turkey. Arch Dis Child 2006; 91: 296-9.
Bremner I. Manifestations of copper excess. Am J Clin Nutr 1998; 67: 1069S-1073S.
Brodkin E, Copes R, Mattman A, Kennedy J, Kling R, Yassi A. Lead and mercury
for severe pneumonia in very young children: double-blind placebo-controlled trial. Lancet 2004; 363: 1683-8.
CDC. Adult blood lead epidemiology and surveillance--United States, 2002. MMWR 2004; 53: 578-82.
Centeno JA, Mullick FG, Martinez L, Page NP, Gibb H, Longfellow D, et al.
Pathology related to chronic arsenic exposure. Environ Health Perspect 2002;
110 Suppl 5: 883-6.
Chang SH, Cheng BH, Lee SL, Chuang HY, Yang CY, Sung FC, et al. Low blood lead concentration in association with infertility in women. Environ Res 2006;
101: 380-6.
Chen CL, Hsu LI, Chiou HY, Hsueh YM, Chen SY, Wu MM, et al. Ingested arsenic, cigarette smoking, and lung cancer risk: a follow-up study in
arseniasis-endemic areas in Taiwan. JAMA 2004; 292: 2984-90.
Chiou HY, Chiou ST, Hsu YH, Chou YL, Tseng CH, Wei ML, et al. Incidence of transitional cell carcinoma and arsenic in drinking water: a follow-up study of 8,102 residents in an arseniasis-endemic area in northeastern Taiwan. Am J Epidemiol 2001; 153: 411-8.
Clark LC, Combs GF, Jr., Turnbull BW, Slate EH, Chalker DK, Chow J, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group. JAMA 1996; 276: 1957-63.
Duzgoren-Aydin NS. Sources and characteristics of lead pollution in the urban environment of Guangzhou. Sci Total Environ 2007; 385: 182-95.
Eife R, Weiss M, Barros V, Sigmund B, Goriup U, Komb D, et al. Chronic poisoning by copper in tap water: I. Copper intoxications with predominantly
gastointestinal symptoms. Eur J Med Res 1999; 4: 219-23.
Finley JW. Bioavailability of selenium from foods. Nutr Rev 2006; 64: 146-51.
Finley JW, Penland JG. Adequacy or deprivation of dietary selenium in healthy men:
clinical and psychological findings. J Trace Elem Exp Med 1998: 11-27.
Friberg L, Vahter M. Assessment of exposure to lead and cadmium through biological monitoring: results of a UNEP/WHO global study. Environ Res 1983; 30:
95-128.
Frisancho AR, Ryan AS. Decreased stature associated with moderate blood lead concentrations in Mexican-American children. Am J Clin Nutr 1991; 54:
516-9.
Fukui Y, Ezaki T, Tsukahara T, Moriguchi J, Furuki K, Okamoto S, et al. Lead levels in urine of never-smoking adult women in non-polluted areas in Japan, with references to cadmium levels in urine. Ind Health 2004; 42: 415-23.
325-31.
Halfdanarson TR, Kumar N, Li CY, Phyliky RL, Hogan WJ. Hematological
manifestations of copper deficiency: a retrospective review. Eur J Haematol 2008; 80: 523-31.
Hamadani JD, Fuchs GJ, Osendarp SJ, Huda SN, Grantham-McGregor SM. Zinc supplementation during pregnancy and effects on mental development and behaviour of infants: a follow-up study. Lancet 2002; 360: 290-4.
Hodkinson CF, Kelly M, Alexander HD, Bradbury I, Robson PJ, Bonham MP, et al.
Effect of zinc supplementation on the immune status of healthy older
individuals aged 55-70 years: the ZENITH Study. J Gerontol A Biol Sci Med Sci 2007; 62: 598-608.
Hopenhayn-Rich C, Biggs ML, Smith AH. Lung and kidney cancer mortality associated with arsenic in drinking water in Cordoba, Argentina. Int J Epidemiol 1998; 27: 561-9.
Huff JD, Keung YK, Thakuri M, Beaty MW, Hurd DD, Owen J, et al. Copper
deficiency causes reversible myelodysplasia. Am J Hematol 2007; 82: 625-30.
Hughes MF. Biomarkers of exposure: a case study with inorganic arsenic. Environ Health Perspect 2006; 114: 1790-6.
IARC. Some metals and metallic compounds. 1998.
IARC. Overall Evaluations of Carcinogenicity to Humans. 2008.
Iyengar V, Wolttlez J. Trace elements in human clinical specimens:evaluationof literaturedata to identify reference values. Clinical Chemistry 1988; 34.
Kaewboonchoo O, Saleekul S, Powwattana A, Kawai T. Blood lead level and blood pressure of bus drivers in Bangkok, Thailand. Ind Health 2007; 45: 590-4.
Kaltreider RC, Davis AM, Lariviere JP, Hamilton JW. Arsenic alters the function of the glucocorticoid receptor as a transcription factor. Environ Health Perspect 2001; 109: 245-51.
Kamel F, Umbach DM, Munsat TL, Shefner JM, Hu H, Sandler DP. Lead exposure and amyotrophic lateral sclerosis. Epidemiology 2002; 13: 311-9.
Knekt P, Marniemi J, Teppo L, Heliovaara M, Aromaa A. Is low selenium status a risk factor for lung cancer? Am J Epidemiol 1998; 148: 975-82.
Kok FJ, de Bruijn AM, Hofman A, Vermeeren R, Valkenburg HA. Is serum selenium a risk factor for cancer in men only? Am J Epidemiol 1987; 125: 12-6.
Korrick SA, Schwartz J, Tsaih SW, Hunter DJ, Aro A, Rosner B, et al. Correlates of bone and blood lead levels among middle-aged and elderly women. Am J Epidemiol 2002; 156: 335-43.
Kosnett MJ, Wedeen RP, Rothenberg SJ, Hipkins KL, Materna BL, Schwartz BS, et
myelopathy. Arch Neurol 2004; 61: 762-6.
L'Abbate N, Cassano F, Rana F, Gagliardi T, Giacomantonio A. Blood lead and erythrocyte protoporphyrin levels in the general population of an area in southern Italy. Med Lav 1991; 82: 336-40.
Lin JL, Lin-Tan DT, Hsu KH, Yu CC. Environmental lead exposure and progression of chronic renal diseases in patients without diabetes. N Engl J Med 2003; 348:
277-86.
Lin JL, Tan DT, Hsu KH, Yu CC. Environmental lead exposure and progressive renal insufficiency. Arch Intern Med 2001; 161: 264-71.
Liou SH, Wu TN, Chiang HC, Yang GY, Yang T, Wu YQ, et al. Blood lead levels in Taiwanese adults: distribution and influencing factors. Sci Total Environ 1996;
180: 211-9.
Lundstrom NG, Englyst V, Gerhardsson L, Jin T, Nordberg G. Lung cancer development in primary smelter workers: a nested case-referent study. J Occup Environ Med 2006; 48: 376-80.
Lustberg M, Silbergeld E. Blood lead levels and mortality. Arch Intern Med 2002;
162: 2443-9.
Min KB, Min JY, Cho SI, Kim R, Kim H, Paek D. Relationship between low blood lead levels and growth in children of white-collar civil servants in Korea. Int J Hyg Environ Health 2008; 211: 82-7.
Muntner P, Menke A, DeSalvo KB, Rabito FA, Batuman V. Continued decline in blood lead levels among adults in the United States: the National Health and Nutrition Examination Surveys. Arch Intern Med 2005; 165: 2155-61.
Naha N, Chowdhury AR. Inorganic lead exposure in battery and paint factory: effect on human sperm structure and functional activity. J UOEH 2006; 28: 157-71.
National Research Council. Arsenic in Drinking Water: 2001 Update. Washington, DC:National Academy Press 2001.
Navas-Acien A, Bleys J, Guallar E. Selenium intake and cardiovascular risk: what is new? Curr Opin Lipidol 2008; 19: 43-9.
Navas-Acien A, Selvin E, Sharrett AR, Calderon-Aranda E, Silbergeld E, Guallar E.
Lead, cadmium, smoking, and increased risk of peripheral arterial disease.
Circulation 2004; 109: 3196-201.
Oldereid NB, Thomassen Y, Purvis K. Selenium in human male reproductive organs.
Hum Reprod 1998; 13: 2172-6.
Osendarp SJ, van Raaij JM, Arifeen SE, Wahed M, Baqui AH, Fuchs GJ. A randomized, placebo-controlled trial of the effect of zinc supplementation during pregnancy on pregnancy outcome in Bangladeshi urban poor. Am J Clin Nutr 2000; 71: 114-9.
Prasad AS. Zinc deficiency. BMJ 2003; 326: 409-10.
Press NA. Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids. . 2000.
Rayman MP. The importance of selenium to human health. Lancet 2000; 356: 233-41.
Rayman MP. Selenium in cancer prevention: a review of the evidence and mechanism of action. Proc Nutr Soc 2005; 64: 527-42.
Roy M, Kiremidjian-Schumacher L, Wishe HI, Cohen MW, Stotzky G.
Supplementation with selenium and human immune cell functions. I. Effect on lymphocyte proliferation and interleukin 2 receptor expression. Biol Trace Elem Res 1994; 41: 103-14.
Salonen JT, Alfthan G, Huttunen JK, Pikkarainen J, Puska P. Association between cardiovascular death and myocardial infarction and serum selenium in a matched-pair longitudinal study. Lancet 1982; 2: 175-9.
Schaumberg DA, Mendes F, Balaram M, Dana MR, Sparrow D, Hu H. Accumulated lead exposure and risk of age-related cataract in men. JAMA 2004; 292:
2750-4.
Schwartz J, Angle C, Pitcher H. Relationship between childhood blood lead levels and stature. Pediatrics 1986; 77: 281-8.
Selevan SG, Rice DC, Hogan KA, Euling SY, Pfahles-Hutchens A, Bethel J. Blood lead concentration and delayed puberty in girls. N Engl J Med 2003; 348:
1527-36.
Smith AH, Goycolea M, Haque R, Biggs ML. Marked increase in bladder and lung cancer mortality in a region of Northern Chile due to arsenic in drinking water.
Am J Epidemiol 1998; 147: 660-9.
Soldin OP, Hanak B, Soldin SJ. Blood lead concentrations in children: new ranges.
Clin Chim Acta 2003; 327: 109-13.
Sole E, Ballabriga A, Dominguez C. Lead exposure in the general population of the Metropolitan Area of Barcelona: blood levels and related factors. Sci Total Environ 1998; 224: 19-27.
Stamoulis I, Kouraklis G, Theocharis S. Zinc and the liver: an active interaction. Dig Dis Sci 2007; 52: 1595-612.
Staudinger KC, Roth VS. Occupational lead poisoning. Am Fam Physician 1998; 57:
719-26, 731-2.
Stranges S, Marshall JR, Natarajan R, Donahue RP, Trevisan M, Combs GF, et al.
Effects of long-term selenium supplementation on the incidence of type 2 diabetes: a randomized trial. Ann Intern Med 2007; 147: 217-23.
Suadicani P, Hein HO, Gyntelberg F. Serum selenium concentration and risk of
relation to the biosynthesis of selenoproteins. Biol Trace Elem Res 1997; 56:
63-91.
Thomas, Socolow RH, Fanelli JJ, TG. S. Effects of reducing lead in gasoline: An analysis of the international experience. Environ Sci Technol 1999; 33.
Vahidnia A, van der Voet GB, de Wolff FA. Arsenic neurotoxicity--a review. Hum Exp Toxicol 2007; 26: 823-32.
Vainio H, Sorsa M. Chromosome aberrations and their relevance to metal carcinogenesis. Environ Health Perspect 1981; 40: 173-80.
Wang W, Liu X, Zhao L, Guo D, Tian X, Adams F. Effectiveness of leaded petrol phase-out in Tianjin, China based on the aerosol lead concentration and isotope abundance ratio. Sci Total Environ 2006; 364: 175-87.
Wastney ME, Aamodt RL, Rumble WF, Henkin RI. Kinetic analysis of zinc metabolism and its regulation in normal humans. Am J Physiol 1986; 251:
R398-408.
Weisskopf MG, Wright RO, Schwartz J, Spiro A, 3rd, Sparrow D, Aro A, et al.
Cumulative lead exposure and prospective change in cognition among elderly men: the VA Normative Aging Study. Am J Epidemiol 2004; 160: 1184-93.
White MA, Sabbioni E. Trace element reference values in tissues from inhabitants of the European Union. X. A study of 13 elements in blood and urine of a United Kingdom population. Sci Total Environ 1998; 216: 253-70.
WHO. Trace elements in human nutrition and health. WHO, Food and Agriculture Organisation, International Atomic Energy Agency expert group. 1996.
WHO. Arsenic Air Quality Guidelines Second Edition. 2000.
WHO. Arsenic and Arsenic Compounds. 2nd ed. Environmental Health Criteria 224.
Geneva:World Health Organization. 2001a.
WHO. Health in the Context of Sustainable Development. 2001b.
WHO. Zinc. Environmental Health Criteria 221 World Health Organization 2001c.
Williams DM. Copper deficiency in humans. Semin Hematol 1983; 20: 118-28.
Wu MM, Kuo TL, Hwang YH, Chen CJ. Dose-response relation between arsenic concentration in well water and mortality from cancers and vascular diseases.
Am J Epidemiol 1989; 130: 1123-32.
Yoshizawa K, Ascherio A, Morris JS, Stampfer MJ, Giovannucci E, Baskett CK, et al.
Prospective study of selenium levels in toenails and risk of coronary heart disease in men. Am J Epidemiol 2003; 158: 852-60.
Zhang ZW, Moon CS, Shimbo S, Watanabe T, Nakatsuka H, Matsuda-Inoguchi N, et al. Further reduction in lead exposure in women in general populations in Japan in the 1990s, and comparison with levels in east and south-east Asia. Int Arch Occup Environ Health 2000; 73: 91-7.
plasma mass spectrometry: a comparison with graphite furnace atomic absorption spectrometry. Sci Total Environ 1997; 205: 179-87.
(中文部分)
行政院環保署.環境資料庫.http://edb.epa.gov.tw/envdb2/.引用 2008/06/22 林意凡、王榮德. 2002. 鉛危害之防治. 健康世界 202 期.
莊弘毅、吳聰能. 2003. 不同國籍鉛作業勞工血壓與血鉛值之相關性探討：三年 追蹤研究.
吳威德、吳聰能. 2007. 新移民女性 DNA 損傷與血中重金屬之相關因子探討 張偉翔、吳聰能、楊俊毓. 2006. 餐飲學校學生廚房實作課程與齲齒、聽力損失
之相關性探討
表4-1：地區別及血中重金屬濃度的分布狀況(個數=423)
表4-2：性別、地區與年齡的血中重金屬濃度分佈情形
表4-3：地區分層之性別、年齡和血中重金屬濃度(鉛、砷)分佈情形
表4-4：地區分層之性別、年齡和血中重金屬濃度(鋅、銅、硒)分佈情形
表4-5：多變項廻歸模式評估相關因子對血中重金屬濃度的影響-中區
3. *：P<0.05；**：P<0.01；***：P<0.001 4. Adjusted R2：Adj R2
表4-6：多變項廻歸模式評估相關因子對血中重金屬濃度的影響-北區
3. *：P<0.05；**：P<0.01；***：P<0.001 4. Adjusted R2：Adj R2
表4-7：推估母群體各重金屬 90%和 95%的分佈
sensitivity
1-specificity
sensitivity
1-specificity
sensitivity
1-specificity
sensitivity
1-specificity
a. b.
曲線下面積0.78 曲線下面積 0.80
c. d.
曲線下面積0.71 曲線下面積 0.68 4-1：以年齡、性別、居住地作為血中鉛的預測因子之 ROC curve (Receiver Operating Characteristic Curve)
註：a. 血鉛值以 1 μg /dL 為切點 b. 血鉛值以 2 μg /dL 為切點 c. 血鉛值以 3 μg /dL 為切點
sensitivity
1-specificity
sensitivity
1-specificity
sensitivity
1-specificity
sensitivity
1-specificity
e. f.
.
曲線下面積0.75 曲線下面積 0.74
g. h.
曲線下面積0.90 曲線下面積 0.90 4-1 續：以年齡、性別、居住地作為血中鉛的預測因子之 ROC curve (Receiver Operating Characteristic Curve)
註：e. 血鉛值以 5 μg /dL 為切點 f. 血鉛值以 6 μg /dL 為切點 g. 血鉛值以 7 μg /dL 為切點 h. 血鉛值以 8 μg /dL 為切點
表4-8：性別、年齡、居住地、血鉛值與身高的簡單相關分析