台灣南部地區年輕族群氣喘及過敏疾病與代謝因子之關係

The association between asthma, atopic diseases and metabolic factors in a young population of southern Taiwan

袁子喻(Tsu-Yu Yuan)

指導教授 ： 王姿乃

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2011年)

摘要

研究背景：氣喘與過敏的盛行率近二十年來顯著的上升，同時肥胖及代謝症候群的盛行率，如同氣喘及過敏性疾病正持續的上升。過去研究已指出肥胖會導致氣喘的發生，因此氣喘、過敏性疾病與代謝因子間是否存在某種特殊關係，是值得探討的議題。
研究目的：本研究之主要目標為探究肥胖、高膽固醇、高血壓、高三酸甘油脂等代謝因子是否與氣喘及過敏性疾病有關，並利用統合分析來探討氣喘與代謝因子的方向性。
材料方法：本研究為橫斷型研究，對南部地區國小、國中及高中18歲以下的學生，以分層集束抽樣來選取研究對象，最後共有5754人納入分析。所有分析的對象皆完成問卷的調查、身高、體重等身體的量測，以及血液檢體的採集。氣喘及過敏性疾病以問卷詢問是否曾有醫師診斷為氣喘、過敏性鼻炎及過敏性皮膚炎。其餘相關變項包括腰圍、身體質量指數、血壓值、三酸甘油脂及總膽固醇等數值亦有測量。總膽固醇依據美國心臟學會標準分為正常(<170mg/dl)、邊際異常(170-199.9mg/dl)及異常(≥200mg/dl)三組。統合性分析中，根據嚴謹的納入及排除標準，包括本橫斷型研究，共納入13篇，分別探討氣喘與BMI及總膽固醇之間的關係。
研究結果：在校正可能潛在危險因子後，氣喘與中央型肥胖(aOR=4.34，p=0.009)及高濃度總膽固醇(aOR=1.93，p<0.001)有關，過敏性疾病亦與血中總膽固醇濃度邊際異常(aOR=1.31，p=0.039)及異常(aOR=1.47，p=0.007)有關，且氣喘及過敏性疾病與膽固醇濃度有正相關的趨勢(p=0.007，p=0.004)。在氣喘及過敏性疾病與代謝因子的相關性中，對照組有一項代謝因子異常其氣喘及過敏之aOR分別為1.66(p=0.022)與1.29(p=0.043)，若有兩項以上異常代謝因子的aOR升高至2.96(p=0.002)及1.67(p=0.027)倍，顯示氣喘及過敏患者相較於對照組之代謝因子異常有較多的趨勢(p=0.017；p=0.005)。其餘代謝因子包括：血壓、三酸甘油脂等經校正後則與氣喘及過敏性疾病沒有統計上顯著相關性。統合性分析結果也證實氣喘與BMI有顯著的正相關(p<0.001)，氣喘與總膽固醇則沒有統計上顯著相關(p=0.47)。
結論：肥胖者有較高比例有氣喘之情形，並發現氣喘與過敏性疾病相較於健康對照有總膽固醇濃度偏高的趨勢，且氣喘與過敏疾病患者也有較多超過標準值之代謝因子。雖然統合分析結果氣喘與總膽固醇濃度沒有明顯相關，但代謝因子仍可能為氣喘或過敏性疾病的危險因子，未來須經追蹤研究及更多生化路徑加以證實。

關鍵字

氣喘 ； 肥胖 ； 膽固醇 ； 代謝因子

並列摘要

Background：The prevalence of asthma and atopy has increased distinctly over the last two decades. Arising prevalence of obesity and metabolic syndrome has also been observed. Previous studies have proved that obesity cause subsequent development of asthma. But few studies have discussed the relation between metabolic factors and asthma.

Objective：This study aimed to assess whether there is an association with asthma, atopy and metabolic factors which include obesity, high serum cholesterol, hypertension and high triglyceride.

Materials and methods：The cross-sectional study randomly sampled 7583 subjects ≦ 18 years old from elementary, junior and senior high schools in southern Taiwan. There were 5754 eligible subjects in the ultimate analysis. All subjects completed a questionnaire interview, weight and height data measurements were recorded and blood samples collected. Allergic disorders were determined by the subjects who had ever been diagnosed by a doctor. Body mass index [BMI], blood pressure, the levels of triglyceride and total cholesterol were measured. Furthermore, we conducted a meta-analysis including 13 studies according to criteria to review the association with asthma, BMI and total cholesterol.

Results：We found a significant association between asthma and abdominal fat (aOR=4.34，p=0.009) and high concentrations of cholesterol (aOR=1.93，p<0.001) after adjusting for potential confounding factors. Atopy had a significant relationship with borderline level (aOR=1.31，p=0.039) and high level (aOR=1.47，p=0.007) of cholesterol. There was a trend effect between asthma, atopy (p=0.007，p=0.004) and cholesterol. The number of metabolic factors was significantly associated with increasing asthma and atopy risk (p=0.017；p=0.005). Other metabolic factors included blood pressure and triglyceride, but a significant relationship with asthma and atopy was not found after adjusting for confounding factors. We also found a positive relationship with asthma and BMI, but no significant association between asthma and cholesterol in meta-analysis.

Conclusion：Asthma patients are more obese, have higher concentrations of cholesterol and more metabolic factors. Although asthma is not related to cholesterol in meta-analysis, metabolic factors could be risk factors to asthma and atopy.

並列關鍵字

asthma ； obesity ； cholesterol ； metabolic factors

參考文獻

參考文獻

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