1) 痰細胞化生之流行病學調查(2) 嚴重急性呼吸道症候群死亡之血液生化預測因子

Abstract

(1) Epidemiology of sputum metaplasia In Taiwan, the annual mortality rate from lung cancer was approximately similar to the incidence rate of the disease in 1991~1993. Pulmonary diseases, including lung cancer, have been associated with the exposure to environmental tobacco smoking (ETS) and cooking oil fumes in addition to smoking. This study evaluated the detection of metaplsia in sputum and investigated corresponding prevalence and risk factors for metaplsia in sputum among general residents in Taipei areas. These associations were also evaluated for restaurant employees as separate sample. Study subjects being recruited in 2000~2001 received a pulmonary X-ray examination, completed a self-reported questionnaire for information on socio-demographic characteristics and life-style, and provided a specimen of the first sputum in the morning. This study included a total of 513 volunteer persons, recruited from Keelung City (158), Taipei City (130), and Taipei County (225). The results indicated that the subjects with metaplasia in sputum were younger than those without metaplasia in sputum, and had the best health status. The proportion of smokers among those with metaplasia in the sputum specimen was 35.7% or 1.4 times higher than that with no metaplasia in the sputum. After adjusting for age, gender, residential town and education, it was found that cooking and smoking history were significantly associated with developing metaplsia in sputum (p<0.05). Particularly, the odd ratio（OR） of metaplasia in sputum was 7.6 （95% confidence interval (CI)=1.5-39.2）for smokers with cooking, compared with smokers with no cooking or rarely cooked. In addition, the risk of metaplsia for smokers was 1.7~1.9 times higher than ex-smokers and non-smokers. No difference was found in the risk of metaplsia between ex-smokers and non-smokers. These results implied that smoking was likely related to the development of metaplsia in sputum. Using cigarette filter and emphysema were also risk factors of metaplasia positive for smokers. This study recruited 59 restaurant employees and 126 community residents in Taipei city/county. Restaurant employees were younger, with larger portion of females and lower education level, and more prevalent in cooking oil fume exposure at home than community residents. The restaurant chefs had the highest prevalence rate (13.3%) of calcification at pulmonary X-ray and metaplasia (45.5%) in sputum examinations. The prevalence of metaplasia in sputum for restaurant chefs was 1.2 times higher than restaurant staff (36.4%) and 1.9 times higher than cook assistants (23.5%). The study results suggest that the development of metaplasia in sputum is likely associated with cooking and smoking. Improved ventilation while cooking and smoking cessation may reduce the likelihood of developing the metaplasia in sputum. (2) Hematological and Biochemical Factors in Predicting SARS Fatality in Taiwan Severe acute respiratory syndrome (SARS) has a high fatality rate (10.9%) worldwide. We examined the epidemiological and clinical patterns associated with deaths for all SARS patients. Plasma C-reactive protein (CRP) is an important indicator of inflammation. We also investigated factors associated with the CRP concentration among SARS patients in Taiwan. Using initial data in medical records reported by hospitals to the Center for Disease Control in Taiwan, we analyzed whether hematological, biochemical and arterial blood gas measures for patients predict the fatality for 346 SARS patients. Both fatalities (n=73 or 21.1%) and survivors had elevated plasma concentration of initial CRP with higher average in fatalities (47.7±43.3 mg/L) than in survivors (24.6±28.2 mg/L), and low lymphocytes counts in both fatalities(814 /mL±378 /mL)and survivals(1019 /mL±480 /mL). After controlling for age and sex, the multivariate model showed that patients with neutrophils higher than 7000 /mL were at the highest risk of fatality (odds ratio [OR] = 6.4, 95% confidence interval [CI] = 1.1-36.0). Other significant conditions independently associated with deaths included CRP (OR=5.8) and lactic acid dehydrogenase (LDH, OR=4.2). This study also found SARS patients with chronic obstructive pulmonary disease, cerebrovascular accident and/or cardiac diseases had a higher average level of CRP approximately 61.5 mg/L. Compared with survivors with no dyspnea, the age-sex-adjusted odds ratios in patients with CRP levels greater than 47.5 mg/L were 6.0 (95% CI = 1.8-20.3) for fatalities with dyspnea, 3.5 (95% CI = 1.3-9.0) for survivors with dyspnea, and 2.8 (95% CI = 1.0-7.4) for fatalities with no dyspnea. Neutrophil counts, and CRP and LDH levels are important predictors of deaths from SARS. The initial CRP not only is a marker associated with the progress of SARS, but also can be used to predict the severity of the coronavirus infection.