在化學工業上，醋酸乙烯酯(vinyl acetate, VA)主要用於生產聚醋酸乙烯酯及與其他烯烴的共聚物，聚醋酸乙烯酯用途為水性塗料、黏合劑、壓克力纖維及紙張塗料等。醋酸乙烯酯在體內會經由羧酸酯酶迅速水解成乙醛及乙酸，乙醛再經由乙醛脫氫酶氧化形成乙酸後排出體外。在職業容許暴露濃度方面，我國勞動部對於醋酸乙烯酯及乙醛之八小時時量平均容許濃度(PEL-TWA)分別訂定於10 ppm (35 mg/m3)及100 ppm (180 mg/m3)。職業暴露之報告指出，暴露於醋酸乙烯酯之勞工曾抱怨鼻子、喉嚨、皮膚及眼睛會產生刺激的現象。在動物實驗指出於醋酸乙烯酯暴露之下，於外耳道皮脂腺、鼻腔、口腔、唇、舌、食道及前胃、肺及子宮會增加惡性腫瘤之發生，且亦有精子異常、睪丸重量減少及降低精子產生之情形，而暴露乙醛會產生鼻黏膜發炎、嗅覺上皮細胞退化及增加肺部殘氣量。但國內過去鮮少針對醋酸乙烯酯暴露之勞工進行暴露與健康影響探討，因此難以瞭解國內相關行業勞工的暴露實態，本研究之目的為建立醋酸乙烯酯使用作業勞工之暴露實態，並進一步探討暴露與健康效應之關係。
本研究完成三間醋酸乙烯酯使用工廠之現勘訪視及採樣，共完成三間工廠之區域空氣中醋酸乙烯酯及乙醛暴露濃度採樣分析，70名作業勞工之呼出氣體中醋酸乙烯酯及乙醛之暴露濃度採樣分析，26名作業勞工之空氣中醋酸乙烯酯及乙醛之個人暴露濃度採樣分析，以及血液樣本之採集和相關健康指標分析、問卷與個人時間活動模式調查。研究結果顯示，在區域、個人空氣及呼出氣體樣本中，醋酸乙烯酯暴露濃度皆低於方法偵測極限，而三間工廠之區域空氣中乙醛濃度範圍為3.1 - 40268.5 μg/m3，勞工之個人空氣中乙醛暴露濃度範圍為7.8-123.1 μg/m3，呼出氣體乙醛暴露濃度範圍為72.2-2628.6 μg/m3，全數勞工之乙醛暴露濃度均符合作業環境空氣中容許濃度標準。依據區域空氣中乙醛之濃度分布顯示，愈接近反應槽及產品包裝區，空氣中乙醛濃度愈高，進一步檢視醋酸乙烯酯自貯存槽至反應槽之輸送管線及設備元件，顯示輸送管線及相關設備密閉良好，逸散量極低下導致勞工個人空氣及呼出氣體中醋酸乙烯酯暴露濃度均未檢出。然而，由於醋酸乙烯酯的水溶性極高，且各廠在製程中皆使用水作為原料與醋酸乙烯酯反應，因此在製程中醋酸乙烯酯已水解反應形成乙醛，故勞工開啟反應槽及進行產品包裝等作業時均暴露到較高量之乙醛，而非醋酸乙烯酯。
本研究利用終生平均每日暴露劑量(Life-time Average Daily Dose, LADD)作為暴露指標以評估長期暴露乙醛是否會造成健康危害，將計算而得之暴露指標進一步與鼻咽癌篩檢、過敏源檢測、生化檢查及鼻炎症狀評估量表(Sino-Nasal Outcome Test 22, SNOT-22)進行逐步迴歸分析，並校正年齡、身體質量指數(Body Mass Index, BMI)、性別、抽菸、喝酒，而免疫球蛋白E (IgE)另校正SNOT-22後，結果顯示，暴露指標(取log值)與麩草醋酸轉胺酶 (Aspartate aminotransferase, GOT) (β= -4.843, p=0.016)、尿素氮 (Blood urea nitrogen, BUN) (β= -1.584, p=0.023)呈現顯著負相關，文獻指出其可能機轉為乙醛會與糖解作用之中間產物反應並鍵結於帶有胺基之轉胺酶上，進而抑制GOT之活性，而先前動物及人類流行病學文獻中未探討乙醛暴露是否會對BUN造成影響，而本研究僅從統計分析之角度發現兩者間呈顯著負相關，因此兩者間之關係還須進行相關研究加以證實。進一步，排除5位EB病毒囊鞘IgA 抗體 (EBV-VCA-IgA) outlier值後，暴露指標與EBV-VCA-IgA呈現顯著正相關(β= 0.013, p=0.043)，而暴露指標(取log值)與SNOT-22、SNOT-22(取log值)具邊緣性統計正相關(β= 2.765, p=0.086; β= 0.173, p=0.074)，表示長期暴露乙醛可能會潛在引發鼻炎及鼻咽癌之發生。本研究亦利用逐步迴歸分析法探討暴露指標與生殖荷爾蒙間之關係，於校正年齡、腰臀比、荷爾蒙藥物、使用黏著劑，而雌二醇 (Estradiol, E2)及睪固酮 (Testosterone, T)再以性荷爾蒙結合蛋白 (Sex hormone-binding globulin, SHBG)進行校正後，結果顯示，暴露指標(取log值)與雄烯二酮 (Androstenedione, AD)呈顯著負相關(β= -0.184, p=0.039)，暴露指標(取log值)與促濾泡激素 (Follicle-stimulating hormone, FSH)、FSH(取log值)呈顯著正相關(β= 2.095, p=0.010; β= 0.141, p=0.002)，表示長期暴露乙醛可能會干擾生殖荷爾蒙之作用。
由於三間工廠之勞工個人空氣中醋酸乙烯酯均未檢出，故以區域、個人及呼出氣體中乙醛濃度進行風險評估計算，以區域空氣中乙醛濃度計算結果指出，有15個區域採樣點之危害指標 (Hazard Index, HI)大於1，以個人空氣中乙醛濃度計算結果指出，有9人(27%)之HI大於1，但以呼出氣體中乙醛濃度進行計算後三廠70位勞工之HI均大於1。在致癌風險部份，1個區域採樣點之致癌風險高於10-3，個人及呼出氣體中乙醛之致癌風險評估結果均小於10-3，為可接受之風險。
建議未來針對同時使用醋酸乙烯酯及水進行反應合成之醋酸乙烯酯使用廠進行勞工暴露評估時，應進行乙醛之暴露實態調查及管理，尤其在製程區反應槽附近進行反應聚合作業及包裝區之勞工應加強管控空氣中乙醛濃度，而執行健康檢查時亦應納入乙醛暴露可能產生之健康危害相關之檢查項目。

The objectives of present study are to assess the exposure profile for vinyl acetate using workers, explore the association between vinyl acetate and acetaldehyde exposure and adverse health effects and assess the availability of exhaled air as biological monitoring marker. The area, personal exposure and exhaled air levels of vinyl acetate and acetaldehyde were collected and analyzed for seventy workers recruited from three vinyl acetate using plants. Because vinyl acetate will react with water and then transform to acetaldehyde, higher levels of acetaldehyde were determined near the reactor and resulted in an increasing acetaldehyde exposure for the workers. After adjusting alcohol drinking and time activity pattern, the significantly correlated between the acetaldehyde level in exhaled breath and those in personal exposure air was found, it means that the exhaled air levels of acetaldehyde could be a good biological monitoring marker. We use exhaled acetaldehyde levels to calculate life-time average daily dose and assess the relationship betwwn long-term acetaldehyde exposure and healthy outcomes. After adjusting age, body mass index (BMI), sex, smoking and alcohol drinking, exposure index were significantly positively associated with EBV-VCA-IgA that exclude the five workers of outlier levels. The exposure index were significantly negatively associated with aspartate aminotransferase (GOT), blood urea nitrogen (BUN). After adjusting age, waist-to-hip ratio, taking hormone medicine and using adhesive, exposure index were significantly positively associated with follicle-stimulating hormone (FSH) and were significantly negatively associated with androstenedione (AD). It means that long-term exposure to acetaldehyde may occur the potential effect of nasopharyngeal carcinoma, and reduced the GOT activity and the reproductive hormones could be interfered. The results of health risk assessment of acetaldehyde exposure shows that hazard index (HI) for noncarcinogenic risk of area air in 15 area sampling points, personal air in 9 workers and exhaled breath in all workers were higher than 1. The carcinogenic risk of acetaldehyde exposure in one area sampling points were higher than acceptable risk (10-3).

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