维生素D_(3)对阿尔茨海默病患者认知功能及外周炎性因子的干预研究

An intervention study on the effects of vitamin D3 on cognitive function and blood inflammatory cytokines in patients with Alzheimer's disease

目的评估维生素D_(3)干预12个月后对阿尔茨海默病(AD)患者认知功能和外周血炎性因子标志物的影响.方法将210例AD患者随机分为干预组和对照组,每组各105例患者,干预组给予维生素D_(3)(800 U/d)补充12个月,对照组给予安慰剂;采用重复测量方差分析对两组患者基线、6个月和12个月时的认知功能评分以及外周炎性因子水平进行干预效果评估.结果随访期间,干预组血清25-羟基维生素D_(3)[25(OH)D_(3))]水平和1,25-二羟维生素D_(3)[1,25(OH)_(2)D_(3)]水平与对照组相比具有显著上升趋势(F=712.086、372.038,均P<0.001);干预组全智商、言语智商以及操作智商评分的变化在组别、时间以及两者的交互作用中的差异均具有统计学意义(均P<0.001);与对照组比较,干预组白细胞介素-6(IL-6)水平(F=341.344,P<0.001)和肿瘤坏死因子-α(TNF-α)(F=9.580,P<0.001)水平呈明显下降趋势,Aβ40/Aβ42比值显著上升(F=4.617,P=0.010),组别和时间具有交互效应;除干预效应外,25(OH)D_(3)的基线浓度与全智商(β=0.016,P=0.031)和言语智商(β=0.017,P=0.031)得分有显著的相关性.结论补充维生素D_(3)(800 U/d)12个月可改善AD患者的认知功能,并降低外周血炎性因子的水平.

Objective To assess the effects of a 12-month vitamin D_(3)intervention on cognitive function and blood inflammatory cytokines in subjects with Alzheimer's disease(AD).Methods Two hundred and ten AD patients were randomly divided into the intervention and control groups,with 105 patients in each group.The intervention group received vitamin D_(3)800 U/day and the control group received a placebo for 12 months.Repeated-measures analysis of variance was used to evaluate the effects of vitamin D and placebo on cognitive performance and blood inflammatory cytokines at baseline,month 6 and month 12.Results During the follow-up,serum 25(OH)D_(3)(F=712.086,P V0.001)and 1,25(OH)_(2)D_(3)(F=372.038,P<C0.001)concentrations in the intervention group were significantly higher than those in the control group.Changes in FSIQ,VIQ and PIQ between the groups,between different time points and with interaction between the variables taken into account were statistically significant(all P<0.001).Compared with the control group,in terleukin-6(IL-6)(F=341.344,P<0.001)and tumor necrosis factor-a(TNF-a)(F=9.580,P<0.001)levels in the intervention group were significantly decreased,and the ratio of AJ34O to A042 was increased(F=4.617.P=0.010).There were interaction effects between group and time.Except for intervention effects.the baseline concentration of 25(OH)D_(3)was positively correlated with scores of FSIQ(0=0.016,P=0.031)and VIQ(0=0.017,P=0.031).Conclusions Daily oral vitamin D_(3)supplementation(800 U/day)for 12 mon ths may improve cognitive function and cha nge in flammatory cytokines in elderly patients with AD.