背景：因應國內多元的產業，勞工工作的態樣也跟著不同，多國已有研究長時間夜間工作可能對健康產生生理節律紊亂、疲勞、加重心血管及其他相關疾病等衝擊。勞動部於2018年公告，為強化相關工作人員之健康保護及建立本土資料，爰依職業安全衛生法第二十條第一項第三款規定，雇主應提供長時間夜間工作之勞工施行特定項目健康檢查，並實施為期二年之臨時性檢查，俾作為後續保護勞工身心健康相關政策措施擬定之參據。隨著生產自動化以及貿易全球化，從事長時間夜間工作的勞工日益增加，健康檢查可以早期診斷相關疾病，以便早期介入。

目的：本研究旨在評估公告特定檢查項目之於所定義之長時間夜間工作者是否足以作為預測工作對健康影響的早期指標。

方法：本研究以橫斷性研究 (cross-sectional study)分析某教學醫院於2019年及2020年依勞動部「指定長期夜間工作之勞工為雇主應施行特定項目健康檢查之特定對象」公告，實施為期二年之臨時性健康檢查之資料。另經由文獻探討，尋找可能與長時間夜間工作相關的健康檢查項目，納入分析，並以縱貫性研究 (longitudinal study)分析兩年都接受檢查人員的資料，評估該院的檢查結果是否符合文獻，且經由文獻找到的健檢項目是否足以作為預測長時間夜間工作對健康影響的早期指標。

結果：經由文獻探討，發現高敏感度C反應蛋白 ( hs-CRP)、嗜中性球淋巴球比例( NLR)、尿酸 ( uric acid ; UA )及糖化血色素 ( HbA1c )的異常可能與長時間夜間工作相關，故納入分析。本研究收集該院共1113位員工的資料，有311位 ( 28.0% )的長時間夜間工作者，其中79.1%為女性，年齡的中位數及四分位全距分別為29及11歲。分析結果顯示代謝症候群的患病率是9.0%，與長時間夜間工作未有統計上顯著相關，唯獨長時間夜間工作者腰圍異常佔比顯著較多 (30.2%比23.4%，p=0.02)。在校正了各種可能會影響心血管與代謝疾病的危險因子後，長時間夜間工作者之高敏感度C-反應蛋白升高的勝算比是0.81 (95% 信賴區間[CI]：0.26－2.59)、長時間夜間工作者尿酸升高的勝算比是0.40 (95% CI: 0.05－3.37)，糖化血色素升高的勝算比是1.03 (95% CI: 0.27－5.32)；這些變項與長時間夜間工作並無顯著相關。然而，長時間夜間工作者嗜中性球淋巴球比例增加的勝算比為25.97 (95% CI: 9.10－74.11)，具統計上顯著相關。我們也發現將這2年有參加長時間夜間工作者與次年未參加長時間夜間工作的健檢結果比較，參與長時間夜間工作比非長時間夜間工作者，腰圍變小的勝算比是2.57 (95% CI: 1.02－7.28)。
結論：指定長時間夜間工作特定健康檢查的項目已包括在原有的法定「一般健康檢查｣的項目中，而且除腰圍以外，本研究未發現這些項目與長時間夜間工作有統計上顯著的相關性。此外，從事長期夜間工作者嗜中性球淋巴球比例較未與從事長時間夜間工作者高，但本研究受限資料的收集，無法進一步評估其與長時間夜間工作的相關性。建議進行較長時間與較大族群的縱貫性研究評估，找出適當的檢查頻率，才能做到及早進行預防管理。

The Ministry of Labor announced in 2018 that in order to strengthen the protection of relevant workers and obtain information on local workers, employers shall provide employees who work long hours at night with specific items of health checkup. The purpose of this study was to evaluate whether those specific items are sufficient for early detection of the related health effects. This study analyzed data from health checkups in 2019 and 2020 at a teaching hospital. Through a literature search and review, it was found that high-sensitivity C-reactive protein (hs-CRP), neutrophil-lymphocyte ratio (NLR), uric acid (UA), and glycosylated hemoglobin (HbA1c) may be related to long-term night shift work. This study collected data on a total of 1113 employees of the hospital, among whom 311 (28%) were long-term night shift workers. Of the long-term night shift workers, 79.1% were females, and the median age was 29 years old (interquartile range: 11 years). The results of the analysis showed that the prevalence of metabolic syndrome in long-term night shift workers was 9.0%, which was similar to that of the regular workers, but the prevalence of over-sized waist circumference was higher in long-term night shift workers (30.2% vs. 23.4%, p=0.02). After adjusted for age, sex, long-term night shift work was associated with elevated NLR, with an OR of 25.97 (95% CI: 9.10－74.11). In the analyses of data from participants who received health checkups in both years, we found a decrease in the prevalence of having a waist circumference above the normal range in the second year (OR=2.57, 95% CI: 1.02－7.28). According to the results of this study, WBC classification for calculating NLR may be added to the health checkup for workers engaged in long-term night shift work, but studies with larger populations and longer follow-ups are needed to confirm our findings and identy the optimum frequency of health checkup.

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