液態還原型輔酶Q10補充劑對小兒擴張型心肌症病童心臟功能、氧化壓力及生活品質之影響

Effects of liquid ubiquinol supplement on cardiac function, oxidative stress, and quality of life in children with pediatric dilated cardiomyopathy

張博盛(Po-Sheng Chang)

指導教授 ： 林娉婷

中山醫學大學/健康管理學院/營養學系碩士班/碩士(2018年)

摘要

小兒擴張型心肌症（pediatric dilated cardiomyopathy，PDCM）為心臟肌肉功能失調導致擴大之心臟疾病。輔酶Q10是一種脂溶性之抗氧化營養素，其以還原型式參與抗氧化循環。本研究目的為給予PDCM病童液態還原型輔酶Q10補充劑（10毫克/公斤體重）對其心臟功能、氧化壓力及生活品質之影響。本臨床介入性試驗共招募10名PDCM病童，介入二十四週。研究期間利用心臟超音波測量病童之心臟功能；採集血液檢體測量心臟相關血液生化數值（肌酸激酶、心肌型肌酸激酶、B型利鈉胜肽及N端B型利鈉胜肽）、氧化壓力（丙二醛）、抗氧化酵素活性（超氧歧化酶、過氧化氫酶、麩胱甘肽過氧化酶及麩胱甘肽還原酶）、輔酶Q10濃度、抗氧化營養素（β-胡蘿蔔素、維生素A及維生素E）濃度；利用問卷評估病童之生活品質。結果發現，介入後血漿輔酶Q10（p < 0.01）、維生素E濃度（p = 0.02）及抗氧化酵素活性（超氧歧化酶，p = 0.01；麩胱甘肽還原酶，p = 0.09）顯著較介入前上升。介入十二週後之心臟功能－左心室射血分率（p = 0.04）及左心室縮短分率（p = 0.05）較介入前顯著上升；末期收縮容積則輕微下降（p = 0.06）。在生活品質評估方面，PDCM病童之整體生活滿意度、健康狀況滿意度、活動力、食慾及對未來之期望分數皆較介入前顯著上升（p < 0.05）。此外，介入二十四週之血漿輔酶Q10濃度與肌酸激酶活性呈顯著負相關（r = -0.75，p < 0.05）；超氧歧化酶活性與心輸出量（r = 0.59，p = 0.07）及心輸出指數（r = 0.69，p < 0.05）呈顯著正相關。因此，本研究認為PDCM病童可藉由補充液態還原型輔酶Q10補充劑，提升體內輔酶Q10濃度與抗氧化酵素（超氧歧化酶）活性，輔助改善心臟功能，進而提升病童生活品質整體滿意度。

關鍵字

液態還原型輔酶Q10 ； 抗氧化 ； 氧化壓力 ； 心臟功能 ； 生活品質 ； 小兒擴張型心肌症

並列摘要

Pediatric dilated cardiomyopathy (PDCM) is a poorly contracting dilated left ventricular due to cardiac muscle dysfunction. It is well known that coenzyme Q10 (ubiquinone) is a lipid-antioxidant nutrient, which may transform to ubiquinol involved in the antioxidant cycle. The purpose of this study was to assess the effects of liquid ubiquinol supplement (10 mg/kg body weight) on cardiac function, oxidative stress, and quality of life in children with PDCM. A total of 10 children diagnosed as PDCM were recruited in this study and intervened for 24 weeks. The cardiac function was assessed by echocardiography. Blood samples were collected to measure the levels of CK, CK-MB, BNP, NT-pro BNP, oxidative stress (MDA), antioxidative enzymes activity (SOD, CAT, GPx, and GR), coenzyme Q10, and antioxidants vitamins (β-carotene, vitamin A, and vitamin E). Quality of life assessment were measured by questionnaire. After 24 weeks of supplementation, the levels of plasma coenzyme Q10 (p < 0.01), vitamin E (p = 0.02), and antioxidative enzymes activity (SOD, p = 0.01; GR, p = 0.09) were significantly increased than the baseline. The values of cardiac ejection fraction (p = 0.04) and fractional shortening (p = 0.05) were slightly increased; end-systolic volume were slightly decreased (p = 0.06) after 12 weeks of supplementation. With regard to the quality of life assessment, the scores for life satisfaction, health status, vitality, appetite, and expectations for future life significantly increased after supplementation (p < 0.05). In addition, the level of plasma coenzyme Q10 was significantly negative correlated with CK activity (r = -0.75, p < 0.05), SOD activity were significantly positive correlated with cardiac output (r = 0.59, p = 0.07) and cardiac index (r = 0.69, p < 0.05). Thus, the present study suggested that supplementation of liquid ubiquinol to PDCM children may increase the level of coenzyme Q10 and antioxidative enzymes activity (SOD), and complementary improve cardiac function to ameliorate their quality of life.

並列關鍵字

liquid ubiquinol ； antioxidation ； oxidative stress ； cardiac function ； quality of life ； pediatric dilated cardiomyopathy

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