鈣及維生素D補充對慢性呼吸道阻塞性疾病患者其骨質健康狀況之影響

Effects of calcium and vitamin D supplementation on bone health status in patients with chronic obstructive airway diseases

賴盈婷(Ying-Ting Lai)

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(2011年)

https://doi.org/10.6834/CSMU.2011.00083

摘要

骨質疏鬆是呼吸道阻塞性疾病患者常見合併症之一，隨著病程發展，腰椎或髖骨骨折發生率也隨之提高。研究發現使用糖皮質類固醇藥物之慢性阻塞性肺病患者會加重 (chronic obstructive pulmonary disease, COPD)其腰椎及股骨頸骨質流失情形；另有研究發現使用糖皮質固醇藥物的氣喘患者以鈣及維生素D補充可避免腰椎骨的骨質流失。本研究以使用吸入性糖皮質固醇藥物的慢性呼吸道阻塞性疾病患者為對象，探討鈣及維生素D介入對其骨質狀況之影響。
本研究於中山醫學大學附設醫院胸腔內科門診募集慢性呼吸道阻塞性疾病並使用糖皮質類固醇藥物之患者為受試者，隨機分派為每日補充550 mg鈣及200 IU維生素D之實驗組或安慰劑對照組，介入共十二個月，於基線收集患者的體位測量及醫療史，並於基線與介入後六個月及十二個月分別收集受試者血液樣本及肺功能和骨質檢測資料進行分析；血液分析項目包括25-羥基維生素D [25(OH)D]、副甲狀腺素 (parathyroid hormone)、蝕骨指標 (C-terminal telopeptide of type I collagen，第一型膠原蛋白羧基端胜肽)及成骨指標 (osteocalcin，骨鈣蛋白)。
結果顯示安慰劑組在介入後十二個月的股骨頸T-score較基線時低，而在實驗組則和基線沒有顯著差異。雖然兩組不論在全身平均、腰椎骨及股骨頸骨密度改變量百分比均未發現顯著差異，但可發現在腰椎骨含量及骨密度改變量百分比部分，實驗組在介入後六個月及十二個月均呈現正向增加趨勢，而安慰劑組則均呈現負向減少趨勢。
本研究結果顯示鈣及維生素D的介入或許可減少慢性呼吸道阻塞疾病患者腰椎骨骨質流失，但可能需較長的介入時間或較高的劑量。

關鍵字

鈣 ； 維生素D ； 慢性呼吸道阻塞性疾病 ； 骨密度 ； 糖皮質固醇

並列摘要

Osteoporosis is one of the most common complications in patients with chronic obstructive airway diseases. Incidence of fractures at lumbar spine and hip increased with disease progression. The results of earlier studies show that COPD patients using glucocorticoids had increased bone loss at lumbar spine and femoral neck, and other studies show that calcium and vitamin D supplementation might prevent bone loss at lumbar spine in asthmatic patients using glucocorticoids. The current study was carried out to investigate the effects of calcium and vitamin D supplementation on bone status in patients with chronic obstructive airway diseases using glucocorticoids.
Patients with chronic obstructive airway diseases using glucocorticoids were recruited from outpatient department of chest medicine in Chung Shan Medical University Hospital, Taichung. The subjects were randomly assigned to either experimental or placebo group. Daily dose of supplementation was calcium 550 mg plus 200 IU of vitamin D. The duration of intervention was 12 months. All patients were evaluated for anthropometric measurements and medical history at baseline. Collection of blood samples and measurements of bone and pulmonary functions were performed at baseline as well as 6 months and 12 months post-intervention, respectively. The serum levels of 25-hydroxyvitamin D, parathyroid, ICTP(C-terminal telopeptide of type I collagen, bone resorption marker) and OST (osteocalcin, bone formation marker) were analyzed.
The results showed that the mean bone mineral density T-score at femoral neck 12 months post-intervention was lower than at baseline in the placebo group but not in the experimental group. There were no significant differences between groups in the changes in bone mineral density at total body, lumbar spine, and femoral neck. Percentage changes of bone mineral density and bone mineral content at lumbar spine were increased in the experimental group, and were decreased in placebo group 6 months and 12 months post-intervention, respectively.
Supplementation of calcium and vitamin D may decrease bone loss at lumbar spine in patients with chronic obstructive airway diseases using glucocorticoids. Intervention for longer period or with higher dosages may be necessary for observing significant changes in bone measurements.

並列關鍵字

Calcium ； vitamin D ； chronic obstructive airway diseases ； bone mineral density ； glucocorticoids

參考文獻

行政院衛生署國民健康局

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