社区老年人维生素D水平调查及其与健康相关生命质量的相关性研究

Association of Vitamin D Level with Health-related Quality of Life in Community-dwelling Elderly Population

背景维生素D水平随着年龄的增长而下降,与老年人常见的骨质疏松症、骨折、跌倒和肌无力等相关。此外,其与老年人生命质量的关联性也逐渐被关注。目的探讨北京市社区老年人群维生素D水平及其与健康相关生命质量的相关性,为提高该人群的全生命周期生活质量提供决策参考。方法本研究数据来源于2017年11月至2018年7月在北京市朝阳区和丰台区开展的BEYOND研究数据库,纳入≥60岁的1066例老年人进行分析。收集患者资料,包括人口和社会经济学特征、骨代谢生化指标、骨密度、左右手握力、坐立试验、随访2年的跌倒史和骨折史。依据25-羟基维生素D〔25(OH)D〕水平将受试者分为维生素D缺乏组、维生素D不足组和维生素D充足组,并采用欧洲五维健康量表(EQ-5D)对受试者健康相关生命质量进行评价。结果1066例受试者中,维生素D缺乏组729例(68.39%),维生素D不足组291例(27.30%),维生素D充足组46例(4.32%)。三组受试者血清Ⅰ型原胶原N-端前肽(P1NP)、碱性磷酸酶(ALP)、甲状旁腺激素(PTH)、骨钙素(OST)、Ⅰ型胶原羧基端肽交联(β-CTX)、左髋整体T值、右髋整体T值、左手握力比较,差异均有统计学意义(P<0.05)。三组疼痛不适维度和EQ-5D效用值比较,差异均有统计学意义(P<0.05);其中维生素D充足组EQ-5D效用值均高于维生素D缺乏组和维生素D不足组(P<0.05)。多元线性回归分析结果显示,25(OH)D水平是老年人EQ-5D效用值的影响因素(P<0.05)。结论北京市社区老年人维生素D缺乏率和不足率分别为68.39%和27.30%,维生素D水平与老年人骨密度、握力与EQ-5D总效用值相关。尽早筛查老年人群维生素D水平并及时补充足够摄入量对维持并提高该人群健康相关生命质量具有重要意义。

Background Vitamin D levels decrease with age and are associated with the occurrence of osteoporosis,fractures,falls and muscle weakness that are common in older adults.In addition,its association with quality of life in the elderly has also been increasingly paid attention.Objective To investigate the vitamin D level and its correlation with health-related quality of life in the elderly population dwelling in community in Beijing,and to provide decision-making reference for improving the full life-cycle quality of life of this population.Methods The data of this study were obtained from the BEYOND research database carried out in Chaoyang District and Fengtai District of Beijing from November 2017 to July 2018.A total of 1 066 elderly people aged ≥ 60 were included for analysis.Clinical information including demographic and socioeconomic characteristics,biochemical markers of bone metabolism,bone mineral density,left and right hand grip strength,sitting test,and history of falls and fractures during 2-year follow-up was collected.According to the level of 25-hydroxyvitamin D〔25(OH)D〕,the subjects were divided into vitamin D deficient group,vitamin D insufficient group and vitamin D sufficient group,and the EuroQol Five-dimensional Questionnaire(EQ-5D) was used to evaluate the quality of life of the subjects.Results Among the 1 066 subjects,729(68.39%) were in the vitamin D deficient group,291(27.30%) were in the vitamin D insufficient group,and 46(4.32%) were in the vitamin D sufficient group.Serum levels of procollagen type 1 N-terminal propeptide(P1NP),alkaline phosphatase(ALP),parathyroid hormone(PTH),osteocalcin(OST),and cross-linked type I collagen carboxyl-terminal peptide(β-CTX),left hip overall T value,right hip overall T value,and left hand grip strength were statistically significant among three groups(P<0.05).There were significant differences in pain discomfort dimension and EQ-5D utility value among the three groups(P<0.05).The EQ-5D utility value of vitamin D sufficient group was higher than that in both vitamin D deficient group and vitamin D insufficient group(P<0.05).The results of multiple linear regression analysis showed that 25(OH)D level was an influence factor of EQ-5D utility value in the elderly(P<0.05).Conclusion The prevalence of vitamin D deficiency and insufficiency in the elderly in the community in Beijing was 68.39% and 27.30%,respectively.The level of vitamin D is positively correlated with bone mineral density,grip strength and EQ-5D total utility value in the elderly.Early screening of vitamin D levels in the elderly population and timely supplementation with adequate intakes are of great significance to maintain and improve the health-related quality of life in the population.