成年女性维生素D水平与握力、平衡能力的相关性分析

Association of Serum Vitamin D with Hand-grip Strength and Balance Ability:a Cross-sectional Study on Community-dwelling Women in Sichuan,China

目的探讨中国四川地区成年女性血清25(OH)D、1,25(OH)2D水平与握力、平衡能力的关系。方法采用横断面调查研究,2012年11月至2013年2月期间,以整群随机抽样法调查了四川地区成都、广元、泸州和西昌共1 095名29~95岁女性。采用手持式测力仪和简易躯体能力测试(简称SPPB测试)评估握力和平衡能力。根据血清25(OH)D水平分为4组:>75nmol/L为充足,51~75nmol/L为不足,25~50nmol/L为缺乏,<25nmol/L为严重缺乏。采用一般线性模型校正混杂因素,分析维生素D不同水平分组之间的握力、平衡能力是否有差异,采用logistic多元回归分析25(OH)D、1,25(OH)2D与握力、平衡能力的关系。结果该人群维生素D缺乏占70.9%,维生素D缺乏或不足的人群多生活在纬度较高的地区(P<0.001),平均户外活动时间少(P=0.013),且食物中未额外补充维生素D制剂(P<0.001)。≥65岁的女性血清25(OH)D水平低于<65岁者(P=0.001),≥65岁女性血清25(OH)D≤50nmol/L的比例高于<65岁者(74.6%vs.68.9%,P=0.046),但两个年龄组血清1,25(OH)2D浓度差异无统计学意义(P=0.610)。按照全年龄段或年龄段分层分析,各维生素D水平分组比较,握力、SPPB总分的差异均无统计学意义。Logistic回归分析提示,随着年龄增长,肌力、平衡能力下降[比值比(OR)=1.066,P<0.001;OR=1.111,P<0.001];体质量增加可保持正常善握力(OR=0.958,P<0.001);血清白蛋白升高(OR=0.896,P=0.001)和增加步行时间(OR=0.799,P=0.001)可保持正常平衡能力。结论四川地区成年女性血清25(OH)D、1,25(OH)2D水平与握力、平衡能力没有相关性。基于维生素D缺乏现状加强维生素D补充的建议能否改善肌力和平衡能力,还有待进一步研究。

Objective To determine the relationship between serum levels of 25（OH）D and 1,25（OH）2 D and the hand-grip strength and balance ability of women in Sichuan,China.Methods A cross-sectional study on a representative sample of 1 095 women aged 29-95 yr.in Sichuan Province was undertaken.Their hand-grip strength and balance ability were assessed using a hand-held dynamometer and the short physical performance battery（SPPB）,respectively.The participants were divided into four groups according to the level of serum 25（OH）D：sufficient（75 nmol/L）,insufficient（51-75 nmol/L）,deficiency（25-50 nmol/L）,and serious deficiency（25 nmol/L）.General liner models were established to compare the differences of the four groups in balance ability.Logistic regression models were established to examine the associations of serum 25（OH）D and 1,25（OH）2 D with hand-grip strength and physical performance.Results About 70.9% of the participants had vitamin D deficiency.Those with vitamin D insufficiency or deficiency were more likely to reside in a higher latitudinal area（P〈0.001）,spend less time in outdoor activities（P=0.013）,and take less vitamin D supplements（P〈0.001）.Older women（≥65 years）had lower serum 25（OH）D（P=0.001）and were more likely to have ≤50 nmol/L 25（OH）D than their younger counterparts（74.6% vs.68.9%,P=0.046）.However,no significant age differences were found in serum 1,25（OH）2 D.Serum levels of 25（OH）D and 1,25（OH）2 D were not found to be associated with hand-grip strength and balance ability after adjusting for confounding factors.Hand-grip strength and balance ability decreased with age（OR=1.066,P〈0.001;OR=1.111,P〈0.001）.Higher body mas was associated with higher hand-grip strength（OR=0.958,P〈0.001）.Higher serum albumin（OR=0.896,P=0.001）and longer walking time（OR=0.799,P=0.001）were associated with higher balance ability.Conclusion Serum levels of 25（OH）D and1,25（OH）2 Dare not associated with hand-grip strength and balance ability.