目的：台灣工作年齡人口死亡主因之一為慢性肝病和肝硬化，可能演變為肝癌。造成肝纖維化的常見原因包括肝炎、酒精濫用、肝脂肪變性及重金屬暴露等。評估肝纖維化的方式分為侵入性和非侵入性，其中非侵入性的FIB-4指數(Fibrosis-4 index, FIB-4 index)被廣泛應用於預測肝纖維化程度。本研究旨在分析台灣工作年齡人口的FIB-4指數與血漿中重金屬濃度間的關係，以探索重金屬對肝纖維化發展的影響。

方法：進行回顧性橫斷式研究，蒐集年齡介於15至64歲間接受健康檢查的受檢者資料。依照FIB-4指數將受檢者資料分為有、無肝纖維化兩組進行比較，並藉由統計方法分析FIB-4指數與血漿中重金屬濃度間之相關性。

結果：本研究487名受檢者中，無肝纖維化組血鋅濃度顯著高於有肝纖維化組。進一步迴歸分析發現，血鋅濃度與FIB-4指數呈顯著負相關，血鉛濃度則呈顯著正相關，即血鋅濃度越高者肝纖維化程度越低，血鉛則相反。這些關聯在校正其他可能干擾因子後仍然存在，證明鋅對肝纖維化具明確保護效果，而鉛則可能促進肝纖維化的發展。

結論：本研究結果顯示部分有害重金屬暴露以及必需金屬元素的缺乏可能與勞動力人口的肝纖維化發展相關。未來期望有更多大規模本土族群資料，以深化重金屬暴露與肝傷害間的影響機制理解。

Objective: One of the primary causes of death among the working-age population in Taiwan is chronic liver disease and cirrhosis, which could potentially progress into liver cancer. Common causes of liver fibrosis include hepatitis, alcohol abuse, hepatic steatosis, and exposure to heavy metals. Liver fibrosis is evaluated through invasive and non-invasive methods, with the non-invasive FIB-4 index (Fibrosis-4 index) widely used to predict the severity of liver fibrosis. This study aims to analyze the relationship between the FIB-4 index and the concentration of heavy metals in the plasma of the working-age population in Taiwan, to explore the impact of heavy metals on the progression of liver fibrosis.

Method: This is a retrospective cross-sectional study, gathering data from individuals aged 15 to 64 who have undergone health checks. Based on the FIB-4 index, the subjects were divided into two groups, those with and without liver fibrosis, for comparison. The correlation between the FIB-4 index and the concentration of heavy metals in plasma was analyzed statistically.

Results: Among the 487 subjects included in this study, the blood zinc concentration in the non-fibrosis group was significantly higher than that in the fibrosis group. Further regression analysis found a significant negative correlation between blood zinc concentration and the FIB-4 index, and a significant positive correlation with blood lead concentration. That is, higher levels of blood zinc are associated with lower levels of liver fibrosis, while the opposite is true for blood lead. These correlations persisted even after adjusting for other potential confounding factors, indicating that zinc provides a clear protective effect against liver fibrosis, while lead may promote its progression.

Conclusion: The study results suggest that exposure to certain harmful heavy metals and deficiencies in essential metal elements may be related to the development of liver fibrosis in the working-age population. In the future, more large-scale data from indigenous groups are expected, to deepen our understanding of the potential impact of heavy metal exposure on liver damage.