魚油補充對慢性阻塞性肺病患者骨骼健康狀況、活動能力及生活品質之影響

Effects of fish oil supplementation on bone health status, physical performance, and quality of life in patients with chronic obstructive pulmonary disease

林昀柔(Yun-Jou Lin)

指導教授 ： 林以勤

中山醫學大學/健康管理學院/營養學研究所/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00132

摘要

慢性阻塞性肺病(chronic obstructive pulmonary disease, COPD)為全球第三大死因，患者不僅肺功能退化且常見全身性發炎反應(systemic inflammation)之現象及併發症；骨質疏鬆症(osteoporosis)即為COPD患者常見的合併症之一。過去研究顯示n-3多元不飽和脂肪酸的補充可抑制COPD患者之全身性發炎作用及延緩疾病之惡化，並可能具有降低蝕骨作用(bone resorption)以減緩骨質流失的效果。本研究為給予COPD患者魚油補充介入，以瞭解魚油對於肺功能、骨質健康狀況、發炎指標、活動能力及生活品質之影響，並比較魚油介入與安慰劑之差異。
本研究於中山醫學大學附設醫院胸腔內科門診召募符合GOLD (Global Initiative for Chronic Obstructive Lung Disease)中度至極重度之COPD男性患者共30位為研究對象，每日以魚油補充劑(約含957mgEPA+638mgDHA)介入6個月後接著轉換為安慰劑6個月，並於基線和每3個月時收集受試者之體位測量、肺功能檢測、活動力評估、聖喬治呼吸問卷(St. George's respiratory questionnaire)等資料並抽取靜脈血液樣本分析包括蝕骨指標(ICTP，第一型膠原蛋白羧基端胜肽)、成骨指標(OST，骨鈣蛋白)及發炎指標(IL-6，介白素-6和Hs-CRP，高敏感性C反應蛋白)；骨密度檢測則於基線和每6個月時進行。
結果顯示魚油介入6個月後COPD患者之肺功能、活動能力及生活品質與基線時相比皆顯著提升。而患者各部位之骨礦物量和骨密度以及體內發炎指標相較於介入前皆無顯著差異，骨代謝指標OST及ICTP則分別有上升及下降之趨勢；另外，在轉換為安慰劑6個月後肺功能、活動能力及生活品質相較於基線時仍有改善的趨勢，但其幅度皆小於魚油介入期。
本研究結果顯示魚油介入後可顯著改善COPD患者之肺功能、活動能力及生活品質，骨代謝指標亦有改善的趨勢；然而魚油補充對患者之效益在轉換為安慰劑後便呈現趨於緩和。

關鍵字

慢性阻塞性肺病 ； Omega-3多元不飽和脂肪酸 ； 骨密度 ； 體能活動 ； 生活品質

並列摘要

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. In addition to significant deterioration of the lung function, systemic inflammation and co-morbidities, such as osteoporosis, are also common in patients with COPD. The results of earlier studies show that supplementation with omega-3 polyunsaturated fatty acids may decrease systemic inflammation, ameliorate the disease, and prevent bone loss by inhibiting bone resorption. The current study is to investigate whether intervention with omega-3 polyunsaturated fatty acids by fish oil may have effects on the lung function, skeletal health, inflammatory response, activity capacity, and quality of life in patients with COPD.
Thirty male subjects with COPD of GOLD moderate to severe degrees were recruited from the outpatient clinic of chest medicine in Chung Shan Medical University Hospital. The subjects were first supplied with fish oil supplementation of 957 mg of EPA plus 638 mg of DHA daily for 6 months, and were switched to placebo for another 6 months. Data including medical history, anthropometric measurements, lung function measurements, assessment of activity capacity, St. George's respiratory questionnaire (SGRQ), and blood samples were collected at baseline and every 3 months post-intervention. Bone mass were measured by dual-energy X-ray absorptiometry at baseline and every 6 months post-intervention. Venous blood samples were analyzed for serum levels of markers of 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 improvement in lung function parameters, activity capacity (6-minute walking distance) and the scores of quality of life, as assessed by SGRQ were observed after 6-month of fish oil supplementation. However, the mean bone mineral density at lumbar spine and femoral neck as well as the levels of inflammation markers did not significantly differ from baseline, yet there were trends observed for an increase in the serum level of OST and a decrease in the level of ICTP after six months of fish oil intervention. There also appeared to be trends toward improvement in the results of lung function, activity capacity, and quality of life at the end of six months of the placebo phase. The changes during the placebo phase, however, appeared to be lesser than those observed during the fish oil phase.
In conclusion, we observed some improvement in lung function, activity capacity, and quality of life in patients with moderate to severe COPD after 6 months of fish oil supplementation. There were also trends observed for the improvement in bone turnover markers but not bone mass measurements. The effects of fish oil supplementation seemed to somewhat diminish after the supplementation were replaced by placebo.

並列關鍵字

chronic obstructive pulmonary disease ； omega-3 polyunsaturated fatty acids ； bone mineral density ； activity capacity ； quality of life

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