慢性阻塞性肺病患者之骨質狀況、活動能力及生活品質之相關因子研究

Study of factors associated with bone health status, physical capacity, and quality of life in patients with chronic obstructive pulmonary disease.

翁栯涔(Yu-Tsen weng)

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(2014年)

https://doi.org/10.6834/CSMU.2014.00029

摘要

慢性阻塞性肺病(chronic obstructive pulmonary disease, COPD)為全球重要的致病及致死原因。患者因呼吸困難等症狀而有活動能力較低的現象，且常見全身性發炎反應；發炎因子如C-反應蛋白(CRP)和interleukin-6(IL-6)會促進蝕骨細胞之活性與蝕骨作用(bone resorption)之速率，抑制成骨作用，因而增加患者發生骨質疏鬆與骨折之風險，並影響其生活品質。本研究的目的主要為觀察COPD患者在骨質健康、活動能力及生活品質指標、發炎反應指標、體組成和肺功能等方面與健康對照組之差異，並分析可能的相關因子。
本研究於中山醫學大學附設醫學中心胸腔內科門診及健檢中心召募30位中/重度之COPD患者與30位年齡相仿之健康對照組，皆為男性，安排進行問卷訪視、肺功能指標、血液及尿液樣本等資料之收集並進行活動能力測試(6分鐘步行測試)及骨質檢測。血液分析項目包括蝕骨作用指標(第一型膠原蛋白羧基端胜肽)、成骨作用指標(骨鈣蛋白)、發炎指標IL-6及高敏感性C反應蛋白(Hs-CRP)。
分析結果顯示患者之6分鐘步行距離及肺功能各項指標均顯著低於健康對照組，且患者之6分鐘步行距離與肺功能之間為顯著正相關。在骨質檢測方面，患者之全身平均骨礦物量顯著低於健康對照組；患者中骨質疏鬆者其IL-6顯著高於骨質正常或不足者，且患者之肺功能與股骨頸骨礦物量之間呈現顯著之正相關。此外，COPD患者之生活品質問卷(St. George Respiratory Questionnaire)分數顯著高於健康對照組。在飲食攝取方面，患者之奶類、蔬菜類及堅果類攝取低於每日飲食指南之建議量；患者之肉類攝取與股骨頸骨礦物量之間為顯著正相關。
本研究結果顯示COPD患者可能因病情影響其活動能力、骨質健康與生活品質，且有發炎反應的情形。在飲食攝取方面，本研究並未觀察到奶類攝取對COPD患者的骨質健康具有正向關聯性；肉類及油脂類則可能對COPD患者的骨質健康是有益的。

關鍵字

慢性阻塞性肺病 ； 發炎反應 ； 骨質 ； 6分鐘步行 ； 生活品質

並列摘要

Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality worldwide. Patients with COPD may have lower level of physical activity due to dyspnea. Systemic inflammation is a common complication in patients with COPD, and the elevation of inflammation markers such as C-reactive protein and interleukin-6 have been known to enhance osteoclastic activity and bone resorption, and to inhibit bone formation, and thus increase the risk for osteoporosis and fracture, and compromise the quality of life. The purposes of this study were to analyze the correlations between bone health measurements, physical capacity, quality of life, inflammation markers and lung function parameters, and to compare the abovementioned indicators in patients with COPD with healthy controls.
Thirty patients with moderate to severe COPD and thirty healthy controls were recruited form the outpatient clinic of chest medicine and the health center in Chung Shan Medical University Hospital.The subjects are all males. Data of medical history, quality of life and dietary intake was collected through interview. Parameters of lung function, bone health status and physical capacity were assessed and recorded, and venous blood samples were analyzed for serum levels of markers for 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 the measurement of physical capacity (6-minute walking distance, 6MWD) and lung functions in patients with COPD were significantly lower than the healthy controls, and the 6MWD was significantly positively correlated with lung functions in patients with COPD. The total body bone mineral contents (BMC) in patients was significantly lower than the controls, and the serum level of IL-6 in osteoporotic COPD patients was significantly higher than those normal or osteopenic COPD patients. There was a significantly positive correlation between the lung function parameter and BMC at femoral neck in patients with COPD. The scores of quality of life, as assessed by St. George Respiratory Questionnaire (SGRQ) in patients were significantly higher than controls. The intake of milk, vegetables and nuts in patients with COPD was lower than the recommended dietary guideline for adults. The intake of meats was significantly positively correlated with BMC at femoral neck in patients with COPD.
In conclusion, patients with COPD appeared to have lower physical capacity, and poorer bone health status and quality of life, and increased inflammation as well. In patients with COPD in the current study, there appeared to be positive correlations between the intake of meats and oils and bone measurements. However, no positive correlation between the intake of dairy products and bone measurements has been observed.

並列關鍵字

chronic obstructive pulmonary disease ； systemic inflammation ； bone mineral content ； 6-minute walking test ； quality of life

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