呼吸道阻塞性疾病患者骨質健康與其相關危險因子之探討

骨質疏鬆是呼吸道阻塞性疾病患者常見的合併症之一，而骨質健康不佳也使得呼吸道阻塞性疾病患者具有骨折的高危險性。本研究以呼吸道阻塞性疾病患者及健康者對照作為研究模式，探討骨質健康狀況與肺功能、骨代謝相關血液生化指標、活動力及類固醇藥物使用狀況之間的關係。研究以橫斷法進行，研究對象是由中山醫學大學附設醫學中心於胸腔內科門診及健檢中心募集經醫師確診為呼吸道阻塞性疾病之患者及健康對照者 (男性21人、女性18人)。呼吸道阻塞性疾病受試者依據病情診斷分為慢性阻塞性肺病 (COPD) 組 (男性51人、女性5人) 及氣喘 (Asthma) 組 (男性18人、女性26人) 。所有受試者接受體位測量、肺功能測量、骨密度檢測及活動力評估，並抽取靜脈血液樣本以分析血清中25-羥基維生素D (25(OH)D) 、副甲狀腺素 (PTH) 、蝕骨作用指標 (第一型膠原蛋白羧基端胜肽, ICTP) 及成骨作用指標 (骨鈣蛋白, OST) 。結果顯示COPD組股骨頸骨礦物密度 (bone mineral density, BMD) 顯著低於健康對照 (Control) 組 (0.7 ± 0.0 vs. 0.8 ± 0.0 g/cm2, p < 0.05) ，但在全身及腰椎BMD並未觀察到COPD組或Asthma組與健康對照組具顯著差異。COPD組之腰椎BMD與一秒最大呼氣量 (FEV1) 及用力肺活量 (FVC) 呈顯著正相關 (FEV1: β = 0.003, p < 0.05; FVC: β = 0.003, p < 0.05) ，而Asthma組之全身及股骨頸BMD皆與FEV1、FVC及用力呼氣一秒率 (FEV1/FVC) 呈顯著正相關 (全身：β = 0.003、0.003及0.004, p < 0.05; 股骨頸：β = 0.004、0.004及0.006, p < 0.05) 。呼吸道阻塞情形加重則其發生腰椎及任一處骨質疏鬆的風險也有增加的趨勢，中度呼吸道阻塞受試者發生任一處骨質疏鬆的勝算比 (OR) 為正常肺功能者的1.95倍，重度呼吸道阻塞受試者發生腰椎及任一處骨質疏鬆的勝算比為正常肺功能者的2.36倍及2.04倍，極重度呼吸道阻塞受試者發生腰椎骨質疏鬆的勝算比為正常肺功能者的2.22倍。本研究結果顯示，呼吸道阻塞性疾病受試者之股骨頸BMD較健康對照組低，且與肺功能間有顯著正相關性。

關鍵字

骨礦物密度；慢性阻塞性肺病；氣喘；骨代謝指標

並列摘要

Osteoporosis is one of the most common complications in patients with obstructive airway diseases, which will increase the risk of fracture. This study aims to investigate the relationships between bone health status, lung function, bone turnover markers, physical activity, and the use of steroidal medication in patients with obstructive airway diseases. Subjects with obstructive airway diseases or healthy controls were recruited from Chung Shan Medical University Hospital, Taichung. The patients were further classified into COPD (chronic obstructive pulmonary disease) or asthma groups. All participants were evaluated for anthropometric measurements, pulmonary functions, and bone health status. The venous blood samples were drawn to be analyzed for the serum levels of 25(OH)D, PTH, ICTP (bone resorption marker), and osteocalcin (bone formation marker). The results showed that the femoral neck (FN) BMD in COPD group was significantly lower than that in the healthy control group (0.7 ± 0.0 vs. 0.8 ± 0.0 g/cm2, p < 0.05), and there were no differences in BMD at total body (TB) and lumbar spine (LS) between the COPD or the asthma and the control groups. FEV1 (forced expiratory volume in one second) and FVC (forced vital capacity) in COPD group were significantly positively correlated to LS BMD (FEV1: β = 0.003, p < 0.05; FVC: β = 0.003, p < 0.05), and FEV1, FVC and FEV1/FVC in the asthma group were significantly positively correlated to TB BMD (β = 0.003, 0.003, and 0.004, respectively; p < 0.05) and FN BMD (β = 0.004, 0.004, and 0.006, respectively; p < 0.05). There was a trend for the prevalence of osteoporosis at FN or either site increased with the severity of obstruction of airflow. The odds ratios of osteoporosis in patients with severe airflow obstruction was 2.36 at LS and 2.04 at either site. In summary, FN BMD in patients with obstructive airway diseases was lower than in the healthy control group, and was significantly correlated with pulmonary function.

並列關鍵字

bone mineral density ； chronic obstructive pulmonary disease ； asthma ； bone turnover marker

參考文獻

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行政院衛生署中央健保局。

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Arya, V., R. Bhambri, et al. (2004). "Vitamin D status and its relationship with bone mineral density in healthy Asian Indians." Osteoporos Int 15(1): 56-61.

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呼吸道阻塞性疾病患者骨質健康與其相關危險因子之探討

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