使用結構方程式探討成人氣喘之身體組成分析與氣喘控制、生活品質及嚴重程度之間的相關研究

The association between body composition and asthma control, quality of life and severity in adult asthma by using the structural equation modeling

陳彥儒(Yan-Ru Chen)

指導教授 ： 王姿乃

高雄醫學大學/健康科學院/公共衛生學系公共衛生學碩士班/碩士(2016年)

摘要

前言:氣喘是一個多因性的疾病也是目前最常見的慢性疾病之一，過去的研究有指出氣喘與肥胖是有相關的，並提出建議認為較高身體質量指數的氣喘病人，在氣喘控制與生活品質上都有較差的趨勢。而且，血清中促發炎激素濃度的上升與肥胖也有相關。因此我們這篇研究想透過身體組成分析及測量血清中的發炎與肥胖指標去探討成人氣喘病人的氣喘控制、氣喘生活品質與氣喘嚴重程度之間的相關。
材料方法:本研究係屬病人世代追蹤研究，研究對象來自南台灣醫學中心的胸腔科門診，本研究總共納入253位成人氣喘病人。研究個案會接受身體檢查、身體組成分析及血液檢查分析，基本人口學資料是採用結構式問卷。氣喘控制評估是使用具有高信效度的評估問卷(Asthma Control Test TM , ACT)，而生活品質是使用台灣版本的氣喘生活品質評估問卷(Taiwanese version asthma quality-of-life, TAQLQ)。本研究使用結構方程式(Structural equation modeling, SEM)分析身體組成分析的因子及血清中的生物指標與氣喘控制、生活品質及氣喘嚴重程度之間的相關。
結果:本研究以結構方程式去建構一個預測模型，透過路徑分析探討不同預測因子間的關係，並計算每條路徑的標準化迴歸係數。透過結構方程式所建構出的預測模型中WHR、leptin、CRP、軀幹脂肪率、體脂肪率與BMI會顯著的直接或間接影響氣喘控制、生活品質與氣喘嚴重程度，本研究的預測模型在配適度檢驗中，有良好的配適度，(Chi-square= 234.1, p-value<0.001, degree of freedom=3.90, CFI=0.982, TLI=0.934, GFI=0.928, RMSEA=0.073)。
結論:本研究發現可以透過身體組成分析與血清中leptin與CRP的濃度及腰臀比與軀幹脂肪率去預測氣喘病人的氣喘控制、生活品質與氣喘嚴重程度，並發現體脂肪與BMI較高的氣喘病人有較差的氣喘控制進而影響生活品質與氣喘嚴重程度，而血清中的leptin與CRP的濃度及腰臀比與軀幹脂肪率會透過間接的方式去影響氣喘控制、生活品質與氣喘嚴重程度。本研究建議，氣喘病人可以透過控制體重與體脂肪，漸少肥胖對於氣喘控制、生活品質與氣喘嚴重程度的影響，達到良好的生活品質。

關鍵字:身體組成分析、氣喘、結構方程式、肥胖

關鍵字

身體組成分析 ； 氣喘 ； 結構方程式 ； 肥胖

並列摘要

Background: Asthma is the most common chronic disease with many variations. Previous studies have linked asthma and obesity, suggesting that higher BMI presents poor asthma control and life quality. The increased markers of inflammation in adipose tissue and serum are associated with obesity. In this study, we examined body composition and serum biomarkers to explore relationships between obesity, Asthma Control Test TM (ACT) scores, quality of life (QoL) and severity of asthma in adult asthma patients.
Methods: This was a patient cohort study that included 253 asthmatic patients from a medical center in southern Taiwan. The study subjects accepted a series of physical examinations, questionnaire and the body composition analysis (BCA). We using ACT scores to determine the level of asthma control, and collected Taiwanese version asthma quality-of-life (TAQLQ) questionnaires, and the severity of asthma was determined by patient medication history. We used structural equation modeling (SEM) to test the association between each body composition indicator and ACT, TAQLQ and severity of asthma.
Result: In this study, 253 patients were available after four years of follow-up, which had a rate of 87.8%. We used structural equation modeling (SEM) to construct the predicted model to examine the relationship between risk factors and outcome variables, and estimate standardized coefficients (β) for each pathway. The final predicted model of asthma patient’s ACT, AQLQ, severe asthma in SEM had a great model fit (Chi-square=262.348, p-value<0.001, degree of freedom=111, CFI=0.945, TLI=0.932, GFI=0.897, RMSEA=0.074). The WHR, torso body fat%, leptin, CRP, body fat% and BMI had significant direct and/or indirect association with asthma control, quality of life and severity of asthma in adult asthma patients.
Conclusion: In this study, we used BCA to discover the risk factor of obesity indicators and demonstrated that higher body fat percentage and BMI may reveal an under-controlled influence on asthma, poor quality of life and more severity of asthma, and the serum biomarker (leptin, CRP) had indirect effects on outcome variables. Our findings suggested that asthma patients should have more awareness of their fat and weight control in order to get better control of asthma and a higher quality of life.
Keywords: body composition, asthma, SEM, obesity

並列關鍵字

body composition ； asthma ； SEM ； obesity

參考文獻

References

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