- 學位論文
Omega-3多元不飽和脂肪酸及運動復健介入對慢性阻塞性肺病患者骨骼健康之影響
Effects of omega-3 polyunsaturated fatty acids and exercise rehabilitation on bone health in patients with chronic obstructive pulmonary disease
摘要
慢性阻塞性肺病(chronic obstructive pulmonary disease, COPD)患者常見全身性發炎反應(systemic inflammatory)並合併骨質疏鬆(osteoporosis)，嚴重時會影響患者之體能活動以及生活品質。發炎因子包括C反應蛋白(CRP)、介白素-1 (IL-1)、介白素-6 (IL-6)、介白素-11 (IL-11)及腫瘤壞死因子-α (TNF-α) 等會促進蝕骨細胞之活性與增加蝕骨作用(bone resorption) 之速率，並抑制成骨作用，進而提高患者發生骨質疏鬆與骨折之風險。先前研究指出魚油之omega-3多元不飽和脂肪酸能夠抑制局部發炎，且能夠降低在低限穩定運動(steady-state submaximal exercise)時的心率與整體耗氧量；而肺部復健(pulmonary rehabilitation)及體能活動(physical activity)的介入則能減緩肺功能之惡化，並可能提升患者之生活品質。 本研究以GOLD (Global Initiative for Chronic Obstructive Lung Disease)第二期至第四期之COPD患者為對象，以魚油及肺部復健運動介入探討其骨質狀況與發炎反應之改變。於中山醫學大學附設醫院胸腔內科門診募集COPD患者為受試者共30位，以每日957mg EPA+ 638mg DHA之魚油補充劑介入共計6個月；在介入期間受試者自行以復健運動紀錄單勾選每日肺部呼吸練習以及運動訓練之項目及時間；相關問卷資料、活動能力及血液樣本於基線及每三個月收集，骨密度則於基線與六個月結束時進行檢測；血液分析項目包括蝕骨指標(ICTP，第一型膠原蛋白羧基端胜肽)與成骨指標(osteocalcin，骨鈣蛋白)以及發炎指標IL-6與高敏感性C反應蛋白(Hs-CRP)。 結果顯示與基線之資料比較，介入後六個月之骨質檢測結果與 IL-6及Hs-CRP雖未發現達顯著差異，但COPD患者經過六個月運動復健及魚油補充介入後在肺功能、活動能力指標及生活品質評估皆有顯著上升之趨勢；而骨骼代謝指標部分，成骨作用指標OST有上升之趨勢，而蝕骨作用指標ICTP則有下降之趨勢。 本研究結果顯示，以魚油及肺部復健運動介入可能延緩COPD患者骨質流失之速率以及肺功能之惡化，並可能改善其活動能力及生活品質。但介入的效果是否持續抑或延長介入的時間是否可達更顯著之效果，則有待持續觀察。
並列摘要
Systemic inflammation and osteoporosis are common complications in patients with COPD (chronic obstructive pulmonary disease). The level of physical activity and quality of life could be significantly affected in severe cases. Several inflammation markers (CRP, IL-1, IL-6, IL-11 and TNF-α) have been known to enhance osteoclastic activity and bone resorption, and to inhibit bone formation on the other hand, and thus increase the risk for osteoporosis and fractures in these patients. The results of earlier studies show that omega-3 polyunsaturated fatty acids of fish oil may inhibit local inflammation, and reduce the heart rate and overall oxygen consumption when performing steady-state submaximal exercise. In addition, intervention with pulmonary rehabilitation and physical activity may be able to slow down the deterioration of lung function and improve the quality of life in COPD patients. The current study was carried out to investigate the effects of omega-3 polyunsaturated fatty acids and exercise rehabilitation on bone health status and inflammatory response in COPD patients of GOLD II to IV. Thirty subjects with COPD were recruited from the outpatient clinic of chest medicine in Chung Shan Medical University Hospital, Taichung. Daily dose of fish oil supplementation was 957 mg of EPA plus 638 mg of DHA. The duration of intervention was 6 months. All subjects were asked to record the items and length of time of their daily home-based pulmonary rehabilitation and physical activity during the intervention. Data were collected at baseline and at the third and sixth month post-intervention, including the medical history, anthropometric measurements, blood samples, questionnaire and assessment of activity capacity, and lung function measurements as well. Bone mass were measured by dual-energy X-ray absorptiometry at baseline and at the sixth month post-intervention. Venous blood samples were analyzed for serum levels of markers for bone resorption (cross-linked carboxy-terminal telopeptide of type I collagen, ICTP) and bone formation (osteocalcin, OST), as well as inflammation markers, including IL-6 (interleukin-6) and Hs-CRP (high sensitivity C-reactive protein). The results showed that the mean bone mineral density at lumbar spine and femoral neck, and inflammation markers 6 months post-intervention did not significantly differ from baseline. However, there appeared to be trends toward an increase in the result of activity capacity (six-minute walking distance) and improvement in lung function measurements, and a downward trend in St George’s Respiratory Questionnaire (SGRQ) scores was also observed. At six months post-intervention, there were also trends observed for an elevation in serum level of OST, and a decrease in serum ICTP, although not statistically significant. In conclusion, supplementation of fish oil and intervention with pulmonary rehabilitation may slow down the rate of bone loss and the deterioration of lung function, and may improve activity capacity and quality of life in patients with COPD. Whether the effects sustain or if a longer period of time for intervention is necessary to observe significant effects need to be further studied.