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錄 4948
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NC092FJU00255009
態
助
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學
校 輔仁大學
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所 食品營養學系
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舊
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學
490446111
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研
究 林芸甄
生
(中)
研
究 Yun-Chen Lin
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(英)
論
文
群居老人骨質代謝指標及身體活動情形與腰椎骨密度之探討
名
稱
(中)
論
文 The Relationship among Bone Turnover Markers, Physical Activity and Lumbar
名
Spine Bone Mineral Density in Group-Living Elderly
稱
(英)
其
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指
導
駱菲莉
教
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(中)
指
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Feili Lo
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位 碩士
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92
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文 中文
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骨質疏鬆症 群居老人 骨質密度 骨源性鹼性磷酸酶 骨鈣素 第一型原膠原蛋
鍵
白之碳端胜肽 pyridinoline 身體活動量
字
(中)
關
鍵 osteoporosis group-living elderly bone mineral density BAP OC CICP Pyd physical
字 activity
(英)
隨著社會環境變遷、家庭功能逐漸轉變，老人居住於安養機構之情形日漸
增加，又鑑於國外對於骨質疏鬆症之相關研究發展迅速，而國內目前針對
65 歲以上老人之骨質健康狀況相關研究資料卻仍有限，因此，本研究以北
區頤苑和翠柏安養機構中之 125 位群居老人為研究對象，使用雙能量 X 光
吸收儀（dual- energy X-ray absorptiometry, DEXA）測量腰椎骨密度以瞭解老
人骨質疏鬆症之盛行率，並利用身體活動量調查問卷輔助探討，及分析四
項血清中之骨質代謝指標，其中骨源性鹼性磷酸酶（bone-specific alkaline
phosphatase, BAP）、骨鈣素（osteocalcin, OC）和第一型原膠原蛋白之碳端
胜肽（type I C-terminal propeptide, CICP）為骨合成指標，pyridinoline（Pyd）
為骨分解指標，再以 bone turnover index 評估老人整體骨質重塑情形之變異
幅度。結果顯示，參與研究老人之平均年齡為 79.1 ± 5.6 歲，男女性老人平
摘
均腰椎骨密度分別為 1.004 ± 0.191 和 0.833 ± 0.153 g/cm2，其中男性骨質疏
鬆症之盛行率為 17.5％，女性為 43.6％，且有 44.4％的男性和 43.6％的女
性是屬於骨質密度低下的狀況。整體而言，男女性骨質不佳的比例分別有
要 61.9 及 87.1％。女性之夏季 BAP 和 Pyd 平均值分別較成人平均值高 28.1 和
(中) 23.9％，大部份男性該二項指標之分析結果與成人相當，且男女性之夏季
OC 平均值分別較成人高 83.1 及 92.5％，CICP 平均值分別較成人低 40.6 與
25.4％。男女性之冬季 bone turnover index 平均值分別較夏季平均值高 2.4 及
1.3 倍，顯示冬季時老人骨質重塑情形較夏季旺盛。又老人平均日常單位體
重之熱量消耗為 26.8 ± 2.2 METs/day，平均日常身體活動強度為 1.39 ±
0.13。將日常身體活動量扣除整日睡眠活動後，所得之清醒時間之活動量
(awaken physical activity, APA)與腰椎骨密度之正相關程度有增強情形。皮爾
森相關係數統計分析指出男性老人日常單位體重之熱量消耗值越高，其血
中 CICP 濃度、b-quotient 值越高和血中 Pyd 濃度越低。頤苑及翠柏安養機
構之老人多屬於骨質不足或骨質疏鬆，男性骨質異化代謝狀況可能傾向於
膠原蛋白合成不足，女性則可能傾向於骨分解作用旺盛，進而影響骨骼健
康，適度增加身體活動量可能有助於刺激第一型膠原蛋白合成和削弱蝕骨
作用。 關鍵詞：骨質疏鬆症、群居老人、骨質密度、骨源性鹼性磷酸酶、
骨鈣 素、第一型原膠原蛋白之碳端胜肽、pyridinoline、身體活動量
With the change in social environment and the function of the household, the elderly
population residing in elderly accommodation institutions or elderly residential
settings has risen progressively. International research in development of
摘
osteoporosis has expanded rapidly. However there is limited information regarding
要 the evaluation of bone health for the elderly above 65 years old in Taiwan.
(英) Therefore, the study recruited 125 group-living elderly from Yi-Yuan and Tsui-Po
elderly accommodation institutions. A Hologic QDR-1500 dual-energy X-ray
absorptometry was used to measure the bone mineral density (BMD) of the lumbar
spine (LS) of subjects. Total daily physical activity (TDPA) was assessed by a
nutrition screening questionnaire. Serum bone turnover markers, including bonespecific alkaline phosphatase (BAP), osteocalcin (OC), type I C-terminal propeptide
(CICP) and pyridinoline (Pyd) were measured to assess the variable status of bone
turnover in subjects. The average age of surveyed subjects was 79.1 ± 5.6 years. The
average BMD at the LS of male and female elderly were 1.004 ± 0.191 g/cm2 and
0.833 ± 0.153 g/cm2, respectively. The prevalence of osteoporosis and osteopenia
were 17.5％ and 44.4％ among male elderly and were 43.6％ and 43.6％ among
female elderly respectively. The state of poor bone health was 61.9％ in male elderly
and 87.1％ in female elderly. The mean concentrations of the BAP and Pyd in
summer of the female elderly were 28.1％ and 23.9％ higher compared with adult
reference values. The values of the BAP and Pyd of the male elderly were distributed
within adult reference range. The mean concentration of OC in summer was
increased in 83.1％ of the male and 92.5％ of the female elderly compared with
reference values for adults. The mean concentration of CICP in summer was lower in
40.6％ of the male and 25.4％ of the female elderly, as compared with adult
reference values. The mean value of bone turnover index for male and female elderly
in winter was 2.4 times and 1.3 times than of the values in summer, respectively. The
result indicated that bone turnover, as assessed by specific bone markers, was
accelerated during winter in both sexes. The average TDPA of subjects was 26.8 ±
2.2 METs/day. The physical activity level ratio (TDPA/basal energy expenditure) of
subjects was 1.39 ± 0.13. The degree of the positively correlation between BMD of
the LS and awaken physical activity (APA) was enhanced after METs or kcal for the
sleep was subtracted from TDPA. Moreover, we found that CICP and b-quotient
increased with increasing TDPA (METs/day) in male elderly. We found decreased
level of Pyd with increasing TDPA (METs/day) in male elderly. The state of bone
health of most elderly was classified as osteopenia or osteoporosis. Our findings with
respect to the differences in bone turnover markers between male and female elderly
indicated that bone loss probably is a result of insufficient type I collagen synthesis
in male elderly, whereas of excessive bone resorption in female elderly. Increase in
physical activity may be positively correlated with type I collagen synthesis and
negatively correlated with bone resorption. Key words: osteoporosis, group-living
elderly, bone mineral density, BAP, OC, CICP, Pyd, physical activity
論
文
目
次
中文摘要……………………………………………………………………I 英
文摘要……………………………………………………………………II 誌
謝…………………………………………………………………………IV 目
錄…………………………………………………………………………V 表目
錄……………………………………………………………………VIII 圖目
錄………………………………………………………………………IX 縮寫
表………………………………………………………………………X 第一章
緒論………………………………………………………………1 第二章 文獻
回顧…………………………………………………………2 第一節 骨質疏鬆
症簡介…………………………………………………2 一、骨質疏鬆
症……………………………………………………………2 二、骨質疏鬆症
之盛行與影響……………………………………………2 三、骨質疏鬆症之
臨床篩檢與診斷標準…………………………………4 （一）骨質疏鬆症之
臨床篩檢……………………………………………4 （二）骨質疏鬆症之診
斷標準……………………………………………5 四、骨質疏鬆症之治療方
法與措施………………………………………5 （一）骨質疏鬆症高危險群
者之飲食改善………………………………6 （二）骨質疏鬆症之藥物治
療……………………………………………7 第二節 骨質健康狀況評估指
標…………………………………………9 一、骨質密度（bone mineral
density, BMD）之測定.………………9 二、骨質代謝指標（bone turnover
markers）.………………………11 （一）骨合成指標（bone formation
markers）………………………14 （二）骨分解指標（bone resorption
markers）.……………………17 第三節 影響老人骨質健康狀況相關因子之
探討………………………21 一、個人特
質………………………………………………………………21 （一）種
族…………………………………………………………………21 （二）性
別…………………………………………………………………21 （三）遺
傳…………………………………………………………………21 （四）年
齡…………………………………………………………………22 （五）體組
成………………………………………………………………22 （六）內分泌
系統…………………………………………………………22 二、飲食營養因
子…………………………………………………………24 （一）
鈣……………………………………………………………………24 （二）維
生素 D……………………………………………………………25 （三）蛋白
質………………………………………………………………26 （四）
鈉……………………………………………………………………26 （五）異
黃酮素 (isoflavones) .………………………………………27 三、生活型
態………………………………………………………………27 （一）活動
量………………………………………………………………27 （二）抽菸、
咖啡和酒精攝取……………………………………………32 四、醫療紀
錄………………………………………………………………32 （一）疾
病…………………………………………………………………32 （二）用
藥…………………………………………………………………32 第四節 研
究問題與目的.…………………………………………………33 一、研究問
題………………………………………………………………33 二、研究目
的………………………………………………………………33 第三章 材料
與方法………………………………………………………34 第一節 研究設
計及架構…………………………………………………34 第二節 研究流
程…………………………………………………………35 第三節 研究對
象…………………………………………………………37 第四節 研究工具
與測量方法……………………………………………37 一、社區居民營養狀
況評估問卷之內容…………………………………37 二、體位測
量………………………………………………………………39 三、飲食紀
錄………………………………………………………………39 四、骨質密度
之測量………………………………………………………40 五、血樣檢體之
收集與檢驗………………………………………………40 （一）臨床血液生
化檢驗…………………………………………………40 （二）骨質代謝指標
之測定………………………………………………40 第五節 資料彙整與統
計分析方法………………………………………44 一、資料處理及分
析………………………………………………………44 二、統計分析方
法…………………………………………………………45 第四章 研究結
果…………………………………………………………47 第一節 研究對象
之基本資料……………………………………………47 一、研究對象之腰椎
骨密度及各項體位測量值…………………………47 二、研究對象之「社區
居民營養狀況評估問卷」訪視答題分佈情形…47 三、研究對象之飲食攝取
情形……………………………………………48 四、研究對象之骨質代謝指
標測定值及各項臨床血液生化值分佈情形 49 第二節 研究對象腰椎骨密度
與骨質代謝指標之測量…………………49 一、腰椎骨密度測量結
果…………………………………………………49 二、骨質代謝指標分析結
果………………………………………………50 （一）研究對象之骨質代謝
指標生化值分佈情形………………………50 （二）整體骨質代謝狀況之評
估…………………………………………52 （三）各骨質代謝指標間之相關
情形……………………………………53 （四）老人骨質代謝狀況之季節性
變異情形……………………………53 第三節 身體活動情形與腰椎骨密
度、骨質代謝狀況之探討…………53 一、老人身體活動情
形……………………………………………………53 二、老人身體活動情形
與腰椎骨密度、骨質代謝狀況之探討…………54 第五章 討
論………………………………………………………………84 第一節 安養
中心老人特性………………………………………………84 第二節 研究對
象之腰椎骨密度…………………………………………84 第三節 研究對象
之骨質代謝狀況………………………………………87 一、整體骨質代謝狀
況之評估……………………………………………87 二、老人骨質代謝狀況
之季節性變異情形………………………………90 第四節 身體活動情形與
腰椎骨密度、骨質代謝狀況之探討…………91 一、老人身體活動情
形……………………………………………………91 二、老人身體活動情形
與腰椎骨密度、骨質代謝狀況之探討…………92 第五節 研究限
制…………………………………………………………94 一、研究設計與取
樣………………………………………………………94 二、研究工具受
限…………………………………………………………95 第六章 結論與建
議………………………………………………………96 第一節 結
論………………………………………………………………96 第二節 建
議………………………………………………………………97 參考文
獻……………………………………………………………………99 附錄一、
社區居民營養狀況評估問卷……………………………………119 附錄二、
成人骨質代謝指標之參考範圍…………………………………127 附錄三、
研究對象血清骨質代謝指標之平均值、中位數及第 25 與第 75 百分位
值………………………………………………………………………128 表 目
錄 表一、世界衛生組織 (WHO) 制訂之骨質疏鬆症診斷標準.……………5
表二、一日身體活動總量計算方式………………………………………38 表
三、研究對象之個案人數………………………………………………55 表
四、老人之各項體位平均測量值及腰椎骨密度測量值………………56 表
五、老人腰椎骨骨質屬正常、骨質密度低下及骨質疏鬆之分佈情形 57 表
六、老人骨折病史及行動力之描述性分析……………………………58 表
七、女性老人生育史之描述性分析……………………………………59 表
八、老人生活型態之描述性分析………………………………………60 表
九、老人之每日營養素攝取情形………………………………………61 表
十、老人夏冬兩季之血清骨質代謝指標生化值………………………63 表十
一、老人之血液生化值………………………………………………64 表十
二、男性及女性老人夏季骨質代謝指標 Z-score、b-quotient 和 bone turnover
index 之比較.……………………………………………71 表十三、依腰椎骨
質狀況分組男性及女性老人夏季骨質代謝指標生化值、Z-score 和 bone
turnover index 之比較……………………………73 表十四、老人之骨質代謝
指標與年齡之相關情形………………………75 表十五、老人之骨質代謝指
標與腰椎骨密度之相關情形………………75 表十六、老人各夏季骨質代謝
指標間之相關情形………………………76 表十七、老人夏冬兩季骨質代謝
指標之比較……………………………77 表十八、老人各活動指標與腰椎骨
密度之相關情形……………………80 表十九、老人之活動量與夏季骨質代
謝指標之相關情形………………83 表二十、比較本研究、國內和國外老人
腰椎骨密度調查結果…………86 圖 目 錄 圖一、第 I 型膠原蛋白之合成過
程.………………………………………12 圖二、骨質合成與異化代謝之生化
指標概觀……………………………13 圖三、源自膠原蛋白分解產物之蝕骨
指標………………………………17 圖四、研究架
構……………………………………………………………34 圖五、研究流
程……………………………………………………………36 圖六、老人每日
鈣質總攝取情形…………………………………………62 圖七、老人腰椎骨
密度之分佈狀況………………………………………65 圖八、老人腰椎骨密
度與年齡之相關情形………………………………66 圖九、老人骨合成指標
骨源性鹼性磷酸酶之夏冬兩季分佈情形………67 圖十、老人骨合成指標骨
鈣素之夏冬兩季分佈情形……………………68 圖十一、老人骨合成代謝指
標第一型原膠原蛋白之碳端胜肽夏冬兩季分佈情
形………………………………………………………………………69 圖十
二、老人骨分解指標 pyridinoline 之夏冬兩季分佈情形…………70 圖十三、
男性及女性老人夏季各骨質代謝指標 Z-score 之比較.………72 圖十四、依
腰椎骨質狀況分組男性及女性老人夏季 bone turnover index 之分佈情
形…………………………………………………………………74 圖十五、老
人日常單位體重之熱量消耗與年齡之相關情形……………78 圖十六、老人
日常身體活動總熱量消耗與年齡之相關情形……………79 圖十七、老人腰
椎骨密度與日常單位體重熱量消耗之相關情形………81 圖十八、老人腰椎
骨密度與日常身體活動總熱量消耗之相關情形……82
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