贵阳市城区中老年女性维生素D营养状况及其对骨密度的影响

Vitamin D status and its effect on bone mineral density of the middle and old aged women in the urban area of Guiyang

目的了解贵阳市城区中老年女性维生素D营养状况及其对骨密度的影响。方法采用整群抽样方法，调查贵阳市主城区所辖-社区中40—79岁女性511名，以放射免疫法检测血清25-羟维生素D[25（OH）D]及完整甲状旁腺素（iPTH）水平，应用双能x线骨密度仪检测髋部、腰椎前后位（LJ4）、左侧股骨颈骨密度。结果受试者总体血清25（OH）D浓度为（21．3±7．9）n∥ml，血清iPTH水平为（29．3±16．5）pg／ml；贵阳市城区中老年女性维生素D严重缺乏[25（OH）D〈10ng／m1]、缺乏[10≤25（OH）D〈20n/m1]、不足[20≤25（OH）D≤30ng／m1]、正常[25（OH）D〉30ng／m1]的比例依次为5．3％、42．3％、37．9％和14．5％：4．7％的受试者存在继发性甲状旁腺功能亢进。血清25（OH）D浓度与股骨颈、L1-4骨密度呈正相关（均P〈0．01）；血清iPTH水平与股骨颈、L1-4骨密度呈负相关（均P〈0．05）。结论贵阳市城区中老年女性维生素D不足及缺乏现象普遍，其血清25（OH）D水平与腰椎、股骨近端骨密度正相关；血清iPTH在血清25（OH）D浓度低于20ng／ml时表现出升高趋势，骨质疏松症患病风险增加。

Objective To evaluate vitamin D status of the middle and old aged women in the urban area of Guiyang, and to explore the impact of vitamin D status on the bone mineral density. Methods A total of 511 healthy women, aged 40 to 79 years old, living in one of the urban communities in Guiyang, were selected by means of stratified cluster sampling. The levels of serum 25-hydroxyvitamin D [ 25 （ OH ） D ] and intact parathyroid hormone （iPTH） were detected by radioimmunoassay. In addition, the bone mineral density （BMD） of hip, lumbar vertebrae 1-4 （L1-4） , and neck of left femur were detected by Dual energy X ray absorptiometry. Results The average serum level of 25 （OH） D in all subjects was （ 21.3 ± 7.9 ） ng/ml and that of iPTH was （ 29.3 ± 16.5 ） pg/ml. Severe deficiency [ 25 （ OH ） D 〈 10 ng/ml ], deficiency [ 10 〈 25 （ OH ） D 〈 20 ng/ml ], insufficiency [ 20 ≤25 （ OH ） D ≤ 30 ng/ml], and sufficiency 125 （OH） D〉 30 ng/mlI of vitamin D were ascertained in 5.3%, 42.3%, 37.9%, and 14.5 % of the total eases respectively. The morbidity of secondary hyperparathyroidism was 4.7%. The level of 25 （OH） D was positively correlated with the BMD of L1-4 and neck of left femur （ both P〈0.01 ）. The level of iPTH was negatively correlated with BMD of neck of left femur and L1-4 （ both P〈0.05 ）. Conclusion The majority of middle and old aged women in the urban area of Guiyang city were found to be of vitamin D deficiency and insufficiency. Vitamin D status is positively correlated with BMD at lumbar spine and proximal femur. Serum 25 （ OH ） level below 20 ng/ml is associated with raised parathyroid hormone, which increases the risk of osteoporosis.