骨化三醇对原发性低骨量患者血甲状旁腺素水平骨转换及肌力的作用

Effect of 1, 25(OH)2D3 on serum parathyroid hormone levels, bone metabolic markers and muscle strength in the community elderly with low bone mass

目的探讨骨化三醇对原发性骨量减少或骨质疏松患者血甲状旁腺素(PTH)水平、骨转换指标及肌力的干预效果。方法收集132例诊断为骨量减少或骨质疏松且自愿参加本研究的社区居民为受试者,给予骨化三醇0.5μg/d治疗3个月,治疗前后采用罗氏公司的Cobas诊断体系对其血生化及骨转换指标进行检测,同时进行左、右手握力测定。结果132例受试者平均年龄(66.1±6.3)岁,4例女性提前终止用药,128例完成3个月的治疗。受试者血25(OH)D和PTH平均水平分别为(19.6±7.9)μg/L和41.0ng/L。根据干预前血PTH的中位数值将受试者分为两组,与低PTH组相比,高PTH组血25(OH)D及血钙水平更低[(17.1±7.0)μg/L比(22.1±8.2)μg/L;2.4mmol/L比2.5mmol/L,均P<0.05]。经骨化三醇治疗3个月后,血肌酐、尿钙水平及左手握力均较治疗前明显升高[(68.2±13.8)μmol/L比(65.2±13.4)μmol/L;(5.9±2.8)mmol/24h比(4.4±2.0)mmol/24h;23.8kg比21.0kg;均P<0.05],血PTH、估算肾小球滤过率(eGFR)、血磷水平均较治疗前明显降低(35.5ng/L比42.0ng/L;(87.0±17.0)ml/min比(93.1±17.9)ml/min;1.2mmol/L比1.3mmol/L;均P<0.05)。骨化三醇治疗前血清25(OH)D和PTH之间呈负相关(r=-0.312,P<0.05),但经骨化三醇治疗3个月后,二者之间的负相关关系不再显著(r=-0.042,P>0.05)。Logistic回归分析显示,经骨化三醇治疗3个月左手握力是否提高25%(OR=0.138,95%CI:-0.002~8.383)、血钙是否提高(OR=2.578,95%CI:1.0345~8.693)以及年龄(OR=0.103,95%CI:0.035~0.345)与血清PTH能否明显下降相关(均P<0.05)。结论维生素D减少或缺乏在社区居民中普遍存在,骨化三醇短期内治疗即可明显抑制PTH,减少骨吸收、提高肌力。骨化三醇对PTH的影响与促进钙吸收、提高握力密切相关。

Objective To investigate the intervention effect of 1, 25(OH)2D3 on serum level of parathyroid hormone, bone metabolic markers and muscle strength in the community elderly with low bone mass. Methods A total of 132 residents aged 60 years and over from Shanghai communities diagnosed as osteopenia or osteoporosis were enrolled and treated with 0.5 μg/d calcitriol for 3 months.Serum levels of parameters in blood biochemistry and bone metabolic markers were determined by Cobas Diagnosis System of Roche before and after treatment, and the handgrip strength of both left and right hands were measured at the same time. Results The average age of 132 patients was(66.1±6.3)years, 4 cases(all female)terminated their medication in advance, and 128 patients completed the treatment for three months.The baseline serum levels of 25(OH)D and PTH were 19.6±7.9 μg/L and 41.0 μg/L respectively.According to the median value of serum PTH before treatment, patients were divided into the two groups: the high PTH group and the low PTH group.Compared with the low PTH group, the serum levels of 25OHD and serum calcium were decreased in the high PTH group[(17.1±7.0)μg/L vs.(22.1±8.2)μg/L, 2.4 mmol/L vs.2.5 mmol/L, P<0.05]. After 3 months of intervention, serum levels of creatinine, urine calcium and left handgrip were significantly elevated[(68.2±13.8)μmol/L vs.(65.2±13.4)μmol/L,(5.9±2.8) mmol/24 h vs.(4.4±2.0) mmol/24 h, 23.8 kg vs.21.0 kg, all P<0.05], while serum levels of PTH, eGFR, phosphorus were significantly decreased[35.5 ng/L vs.42.0 ng/L,(87.0±17.0) ml/min vs.(93.1±17.9) ml/min, 1.2 mmol/L vs.1.3 mmol/L, all P<0.05). There was a significant negative correlation between serum 25(OH)D and PTH before treatment(r=-0.312, P<0.05), but the negative correlation between them was no longer significant after 3 months of treatment(r=-0.042, P>0.05). A multivariate logistic regression analysis revealed that the increment of left handgrip strength greater than 25%(OR=0.138, 95%CI:-0.002-8.383), the increment of serum calcium levels(OR=2.578, 95%CI: 1.0345-8.693)and age(OR=0.103, 95%CI: 0.035-0.345)were significantly correlated with the decrement of serum PTH levels greater than 30% after three months of treatment. Conclusions Vitamin D diminution or deficiency is common in the elderly.The short-term treatment of calcitriol can obviously reduce serum PTH, inhibit bone absorption and increase muscle strength.The effect of calcitriol on serum PTH is closely related to promoting calcium absorption and improving handgrip strength.