探討呼吸道阻塞性疾病患者其生活型態相關因子與骨質健康狀況之相關性

Correlation between life-style factors and bone health status in patients with obstructive airway diseases

蕭惠倫(Huei-Lun Siao)

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(2010年)

https://doi.org/10.6834/CSMU.2010.00148

摘要

近年來研究發現呼吸道阻塞性疾病患者其骨質疏鬆的盛行率有上升的情形。本研究是以呼吸道阻塞性疾病患者包括慢性阻塞性肺病與氣喘為研究對象，並以健康者為對照，目的是要探討生活型態相關因子與呼吸道阻塞性疾病患者其骨質健康狀況之相關性。研究以橫斷方式進行。受試者是在中山醫學大學附設醫學中心胸腔內科門診及健檢部募集102位病人與39位健康者。病人依據醫師診斷分為慢性阻塞性疾病組57位及氣喘組45位。資料收集包括紀錄基本體位測量、體組成及骨質狀況、肺功能、活動情形、吸菸、飲酒、工作、日光曝曬、飲食攝取、睡眠、藥物與補充劑使用；檢測血清所得之生化指標包括、副甲狀腺素、維生素D營養狀況、成骨指標、蝕骨指標、高敏感C反應蛋白。研究結果顯示慢性阻塞性肺病組在年齡、瘦體組織百分比、6公尺步行測試時間、維生素D營養狀況指標以及蝕骨指標皆顯著高於健康對照組，而身體質量指數、脂肪百分比、全身骨密度 t-score、股骨頸骨礦物密度及t-score則顯著低於健康對照組 (p值皆<0.05)；氣喘組僅在身高顯著低於健康對照組 (p<0.05)，其餘皆與健康對照組無顯著差異。相較於健康對照組，肺功能在兩疾病組皆顯著較低 (p值皆<0.05)，且聖喬治呼吸問卷 (SGRQ) 得分顯著較高 (p值皆<0.05)。性別、吸菸、飲酒、工作、日光曝曬、藥物使用、骨質疏鬆比例在三組間皆有顯著差異。回歸分析結果顯示呼吸道阻塞性疾病患者目前仍工作者與全身 (β=0.055) 及股骨頸 (β=0.090) 之骨礦物密度呈顯著正相關 (p值皆<0.05)；吸菸則與腰椎骨礦物密度呈顯著負相關 (β=-0.090, p<0.05)。SGRQ問卷得分與肺功能、疾病、身高、體重、休閒活動、腰椎及股骨頸骨密度t-score多呈現顯著的負相關 (p<0.05)，而與高敏感C反應蛋白、6公尺步行測試時間多數呈顯著的正相關 (p<0.05)。本研究結果顯示，日常活動量較多的呼吸道阻塞性疾病患者其骨質狀況、肺功能、生活品質較佳。

關鍵字

慢性阻塞性疾病 ； 氣喘 ； 骨礦物密度 ； 生活型態相關因子

並列摘要

It has been observed that patients with obstructive airway diseases have higher risk for osteoporosis. We therefore conducted a cross-sectional study to assess the relation of life-style factors to bone health status in patients with obstructive airway diseases. One hundred and two patients with obstructive airway diseases and thirty nine healthy controls were all recruited from Chung Shan Medical University Hospital, and were classified to the chronic obstructive pulmonary disease (COPD, n=57), the asthma (n=45), and the control (n=39) groups. Data collected included the measurements of anthropometrics and lung functions. The status of usual daily activity, smoking and alcohol consumption habits, sun exposure, selected food intakes, sleeping time, and use of medication and supplements were assessed by a questionnaire interview. Bone health status and body composition were examined by a dual-energy X-ray absorptiometry. Venous blood samples were obtained for analyzing the serum levels of parathyroid hormone, vitamin D (25[OH]D), osteocalcin, cross-linked C-telopeptide type 1 collagen (ICTP), and high sensitivity C-reactive protein (hs-CRP) in all subjects. The results showed that the patients in the COPD group were significantly older and were higher in lean mass percentage, slower in the 6-m walking test, and lower in body mass index, fat percentage, total body bone mineral density (BMD) t-score, femoral neck BMD and t-score (p<0.05 for all of the above variables) compared to the controls. The COPD patients were also higher in the serum concentrations of 25(OH)D and ICTP (p <0.05 for both indices). The patients in the asthma group had significantly shorter height than the control group. All the parameters of lung function in the patient groups were lower than that in the controls, and the St George’s Respiratory Questionnaire (SGRQ) scores were higher in the patients than in the controls. The gender distribution, status of smoking, alcohol consumption, working, sun exposure, use of steroidal medication, and the prevalence of osteoporosis among the three groups were significantly different. In patients, there were positive relationships between current working status and BMD at total body (β=0.055) and femoral neck (β=0.090) ( p <0.05 for both sites), and a negative relationship was observed between smoking experience and lumbar spine BMD (β=-0.090, p <0.05). SGRQ scores were strongly inversely associated with lung functions, disease, height, weight, leisure physical activity, and BMD t-scores at lumbar spine and femoral neck (p <0.05 for all of the above variables). SGRQ scores were also strongly positively associated with the serum level of hs-CRP and the result of walking test (p <0.05 for both). In conclusion, patients with obstructive airway diseases with higher daily activity levels appeared to have better lung function, quality of life and bone mineral density.

並列關鍵字

chronic obstructive pulmonary disease ； asthma ； bone mineral density ； life-style factors

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