上海市社区老年人群全血硫胺素水平及其影响因素分析

Analysis of the whole blood thiamine level and its contributing factors among elderly people in a Shanghai community

目的分析上海市社区老年人群全血硫胺素及其主要磷酸酯衍生物水平,并探讨可能的影响因素。方法招募2012年4月至2014年12月上海市徐汇区某社区参加体检的2330名老年人。采用问卷调查收集老年人群年龄、受教育年限、身高、体质量、体质量指数(body mass index,BMI)等信息;采用简易精神状态检查(Mini-Mental State Examination,MMSE)量表评估认知功能;检测血常规、肝肾功能、空腹血糖、血脂等血液学指标;利用高效液相色谱法(high performance liquid chromatography,HPLC)检测全血二磷酸硫胺素(thiamine diphosphate,TDP)、单磷酸硫胺素(thiamine monophosphate,TMP)和游离硫胺素水平。构建多因素线性回归模型分析全血TDP、TMP和游离硫胺素水平的相关因素。结果最终纳入1685名社区老年人,平均年龄(72.78±5.94)岁。其中男性747名,女性938名;全血TDP(115.22±25.30)nmol/L,TMP(7.93±5.80)nmol/L,游离硫胺素(3.53±3.31)nmol/L。多因素线性回归模型结果显示:男性(β=3.304,95%CI 0.099~6.509,P=0.043)、受教育年限(β=0.367,95%CI 0.079~0.665,P=0.013)、BMI(β=0.520,95%CI 0.123~0.916,P=0.010)、血红蛋白(β=0.435,95%CI 0.330~0.540,P<0.001)、肌酐(β=﹣0.093,95%CI﹣0.176~﹣0.010,P=0.028)与TDP水平显著相关;男性(β=1.818,95%CI 1.067~2.569,P<0.001)、受教育年限(β=0.137,95%CI 0.069~0.204,P<0.001)、血红蛋白(β=0.082,95%CI 0.058~0.107,P<0.001)、空腹血糖(β=﹣0.416,95%CI﹣0.624~﹣0.208,P<0.001)、三酰甘油(β=﹣0.417,95%CI﹣0.743~﹣0.092,P=0.012)与TMP水平显著相关;男性(β=0.944,95%CI 0.513~1.375,P<0.001)、血红蛋白(β=﹣0.018,95%CI﹣0.032~﹣0.004,P=0.014)、三酰甘油(β=﹣0.228,95%CI﹣0.414~﹣0.042,P=0.016)、谷丙转氨酶(β=0.019,95%CI 0.003~0.035,P=0.018)与游离硫胺素水平显著相关。结论多种因素可能影响全血硫胺素及其主要磷酸酯衍生物水平,其中男性、受教育年限、血红蛋白、BMI与TDP水平显著正相关。女性、低血红蛋白和BMI异常的社区老年人群应该预防硫胺素缺乏及相关疾病发生风险。

Objective To analyze the level of thiamine and its main phosphate derivatives in whole blood among the elderly population in a Shanghai community,and explore its contributing factors.Methods A total of 2330 elderly people were recruited from a community in Xuhui District,Shanghai from April 2012 to December 2014.The information of age,education,height,weight,body mass index(BMI)and medical history was collected through questionnaires.The cognitive function was evaluated by Mini-Mental Status Examination(MMSE),and the blood routine,liver and kidney function,fasting blood glucose,triglyceride levels were measured.The whole blood thiamine diphosphate(TDP),thiamine monophosphate(TMP),and free thiamine levels were detected by high performance liquid chromatography(HPLC).A multivariate linear regression model was used to analyze the contributing factors of whole blood TDP,TMP and free thiamine levels.Results A total of 1685 elderly people were included,with an average age of(72.78±5.94)years.There were 747 male and 938 female.The levels of TDP,TMP and free thiamine were(115.22±25.30)nmol/L,(7.93±5.80)nmol/L and(3.53±3.31)nmol/L,respectively.Multivariate linear regression model showed a significant correlation between TDP level and male(β=3.304,95%CI 0.099-6.509,P=0.043),years of education(β=0.367,95%CI 0.079-0.665,P=0.013),BMI(β=0.520,95%CI 0.123-0.916,P=0.010),hemoglobin(β=0.435,95%CI 0.330-0.540,P<0.001),creatinine(β=﹣0.093,95%CI﹣0.176-﹣0.010,P=0.028).There was a significant correlation between TMP level and male(β=1.818,95%CI 1.067-2.569,P<0.00),years of education(β=0.137,95%CI 0.069-0.204,P<0.001),hemoglobin(β=0.082,95%CI 0.058-0.107,P<0.001),fasting plasma glucose(β=﹣0.416,95%CI﹣0.624-﹣0.208,P<0.001),triglyceride(β=﹣0.417,95%CI﹣0.743-﹣0.092,P=0.012).There was a significant correlation between free thiamine level and male(β=0.944,95%CI 0.513-1.375,P<0.001),hemoglobin(β=﹣0.018,95%CI﹣0.032-﹣0.004,P=0.014),triglyceride(β=﹣0.228,95%CI﹣0.414-﹣0.042,P=0.016),alanine aminotransferase(β=0.019,95%CI 0.003-0.035,P=0.018).Conclusions Multiple factors may affect thiamine and its main phosphate derivatives in whole blood,among which male,advanced education,hemoglobin level and BMI are positively correlated with TDP.It is suggested that women,elderly people with low level of hemoglobin and abnormal BMI in the community should prevent the risk of thiamine deficiency and related diseases.