成年男性吸菸習慣與超音波骨密度測量值之相關性

Relationship between Smoking Habit and Bone Mineral Density Measured by Quantitative Ultrasound in Male Adults

陳依瀅(Yi-Ying Chen) ； 張翠珍(Tusi-Chen Chang) ； 吳至行(Chih-Hsing Wu) ； 王如雪(Ru-Hsueh Wang) ； 楊宜青(Yi-Ching Yang) ； 盧豐華(Feng-Hwa Lu) ； 張智仁(Chih-Jen Chang)

《臺灣家庭醫學研究》 1卷1期 (2003/10) Pp. 41-51

https://doi.org/10.29475/TFMR.200310.0005

摘要

研究發現吸菸可能對白人或停經後婦女的骨質密度有負面影響，但有關中國男性的相關研究報告並不多。為了探討吸菸習慣與男性骨質密度的相關性，本研究選取自1998年至2000年所進行台南市居民慢性病追蹤流行病學世代研究的個案中年齡大於50歲的男性共219名進行統計分析。每一位受檢者均接受超音波骨質儀測量左腳足跟骨骨質密度，結果以寬頻超音波衰減值(BUA)、聲音速度值(VOS)及骨骼強度指標(SI)來表示。同時以結構式問卷詢問身體活動量，有無使用酒類、咖啡、乳類製品、鈣片的習慣等。結果發現將受檢者依吸菸習慣不同分為持續吸菸(32.4%)、已戒菸(25.1%)及未吸菸(42.5%)三組，經共變數分析(ANCOVA)後，無論是比較BUA、VOS或SI值，未吸菸者的骨質密度均為最高，已戒菸者次之，持續吸菸者最低；持續吸菸組比其他二組在BUA及SI值的比較達到統計上的顯著差異。若依吸菸總量（包－年）的多寡將研究對象區分為未吸菸、輕度吸菸（總量小於20）及中重度吸菸（總量大於等於20）三組，結果顯示中重度吸菸者的骨質密度最低；而輕度吸菸者的骨質密度比中重度吸菸者高，但與未吸菸者相比則無統計上的顯著差異。經由線性逐步複迴歸分析，我們亦發現吸菸的總量（包－年）與身體質量指數均為影響骨質密度的獨立相關因子。
總之，本研究發現吸菸習慣是影響男性足跟骨超音波骨質密度的獨立性負相關因子，並具有劑量反應效應。

並列摘要

Smoking has been reported to be negatively associated with bone mineral density (BMD) in Caucasians or postmenopausal women, but only a few papers have been focused on male Chinese. To evaluate the relationship between smoking habit and BMD, a total of 219 male Chinese aged 50 or more were recruited from the cohort of Tainan epidemiological survey during 1998 to 2000. Left calcaneal BMD which reflected by broadband ultrasound attenuation (BUA), velocity of sound (VOS) and stiffness index (SI) was measured by quantitative ultrasound (QUS) densitometry for each subject. The structural questionnaires including total physical activity and lifestyle characteristics (alcohol, coffee, milk and calcium use) were also inquired. According to the smoking habit, subjects were classified as current smokers (32.4%), exsmokers (25.1%) and nonsmokers (42.5%). Through the statistical method of multiple analysis of covariance (ANCOVA), we found that BMDs (BUA, VOS and SI) were highest in the nonsmokers, median in the exsmokers but significantly lowest in the current smokers. Furthermore, according to the smoking amount in pack-year, subjects were trichotomized into never (pack-year=0), the lighter (less than 20 pack-years) and the moderate to heavy smokers (≧20 pack-years) groups. As compared with the never and the lighter smokers, the moderate to heavy smokers had significantly lower BMD. Lighter smokers had higher BMD than the moderate to heavy smokers, but similar to the never smokers. Using multiple stepwise linear regression model, we found that total pack-years of smoking and body mass index (BMI) were the independent factors of BMD. In conclusion, smoking habit is an independent factor of low BMD assessed by QUS in male Chinese. A dose response effect was also demonstrated between smoking amount and BMD.

並列關鍵字

smoking ； bone mineral density ； quantitative ultrasound