Otago运动训练结合阿法骨化醇对糖尿病伴骨质疏松患者骨代谢、腰背疼痛及躯体平衡的影响

Effects of Otago exercise training combined with alfacalcitol on bone metabolism,low back pain and body balance in patients with diabetes mellitus and osteoporosis

目的观察Otago运动训练结合阿法骨化醇对糖尿病伴骨质疏松患者骨代谢、腰背疼痛及躯体平衡的影响。方法前瞻性选取2020年2月至2022年8月四川大学华西医院收治的80例糖尿病伴骨质疏松患者作为研究对象。按照随机数字表法将其分为Otago运动训练组和对照组,每组各40例。对照组给予阿法骨化醇治疗,Otago运动训练组在对照组基础上给予Otago运动训练治疗。比较两组干预前和干预12个月后的骨代谢指标[Ⅰ型胶原羧基端肽β特殊系列(β-CTX)、I型胶原C端肽(CTX-I)、Ⅰ型前胶原氨基末端肽(PINP)、骨钙素]、骨密度、静态平衡功能(左-右和前-后运动速度、重心轨迹运动长度和面积)、简易躯体能力测试(SPPB)评分、跌倒功效量表(FES)、腰背视觉模拟评分法(VAS)评分差异。记录两组干预12个月内跌倒和骨折发生情况。结果Otago运动训练组干预12个月后β-CTX、CTX-I水平分别为(326.54±38.87)ng/L、(0.24±0.08)μg/L,均低于对照组[(363.45±51.02)ng/L、(0.39±0.12)μg/L],PINP、骨钙素水平分别为(36.58±4.77)ng/mL、(8.92±1.02)μg/L,均高于对照组[(30.85±4.05)ng/mL、(7.44±0.89)μg/L],差异均有统计学意义(P<0.05)。Otago运动训练组干预12个月后股骨颈和腰椎1-4骨密度分别为(0.83±0.15)、(0.96±0.17)g/cm 2,均高于对照组[(0.72±0.14)、(0.81±0.15)g/cm 2],差异均有统计学意义(P<0.05)。Otago运动训练组干预12个月后左-右和前-后运动速度、重心轨迹运动长度和面积分别为(11.14±2.03)mm/s、(11.23±2.33)mm/s、(451.02±97.33)mm、(612.32±120.51)mm^(2),均低于对照组[(13.35±2.41)mm/s、(14.04±2.42)mm/s、(502.12±116.69)mm、(698.86±159.47)mm^(2)],差异均有统计学意义(P<0.05)。Otago运动训练组干预12个月后SPPB评分、FES评分分别为(8.94±1.14)、(8.51±0.28)分,均高于对照组[(7.31±0.86)、(6.85±0.36)分],腰背VAS评分为(1.51±0.28)分,低于对照组[(2.45±0.36)分],差异均有统计学意义(P<0.05)。Otago运动训练组干预12个月内跌倒发生率为5.56%,低于对照组(17.78%),差异有统计学意义(P<0.05);两组骨折发生率比较,差异无统计学意义(P>0.05)。结论Otago运动训练结合阿法骨化醇治疗糖尿病伴骨质疏松可改善骨代谢和骨密度,提高躯体静态平衡功能,减轻腰背疼痛,降低跌倒发生率。

Objective To observe the effects of Otago exercise training combined with alfacalcitol on bone metabolism,low back pain and body balance in patients with diabetes mellitus and osteoporosis.Methods Eighty patients with diabetes and osteoporosis who were admitted to West China Hospital,Sichuan University from February 2020 to August 2022 were prospectively selected as the study subjects.According to the random number table method,they were divided into Otago exercise training group and control group,with 40 cases in each group.The control group was treated with alpha calcitriol,the Otago exercise training group received Otago exercise training treatment on the basis of the control group.The differences of bone metabolism indexes[type I collagen carboxyl terminal peptideβspecial series(β-CTX),procollagen I N-terminal propeptide(PINP),C-terminal peptide of type I collagen(CTX-I),osteocalcin],bone mineral density,static balance function(left right and front back movement speeds,center of gravity trajectory length and area),short physical performen battery(SPPB)score,fall efficacy scale(FES)and lumbar visual analog scale(VAS)score before and after 12 months of intervention were compared between the two groups.The occurrence of falls and fractures within 12 months of intervention was recorded in two groups.Results After 12 months of intervention,the levels ofβ-CTX-I,CTX in the Otago exercise training group were(326.54±38.87)ng/L and(0.24±0.08)μg/L,respectively,which were lower than those in the control group[(363.45±51.02)ng/L and(0.39±0.12)μg/L],the levels of PINP,osteocalcin in the Otago exercise training group were(36.58±4.77)ng/mL and(8.92±1.02)μg/L,respectively,which were higher than those in the control group[(30.85±4.05)ng/mL and(7.44±0.89)μg/L],and the differences were statistically significant(P<0.05).After 12 months of intervention,the 1-4 bone density of the femoral neck and lumbar spine in the Otago exercise training group were(0.83±0.15)and(0.96±0.17)g/cm 2,respectively,which were higher than those in the control group[(0.72±0.14)and(0.81±0.15)g/cm 2],and the differences were statistically significant(P<0.05).After 12 months of intervention,the left right and front back movement speeds,center of gravity trajectory length and area in the Otago exercise training group were(11.14±2.03)mm/s,(11.23±2.33)mm/s,(451.02±97.33)mm,and(612.32±120.51)mm^(2),respectively,which were lower than those in the control group[(13.35±2.41)mm/s,(14.04±2.42)mm/s,(502.12±116.69)mm,and(698.86±159.47)mm^(2)],and the differences were statistically significant(P<0.05).After 12 months of intervention,the SPPB scores,FES scores of the Otago exercise training group were(8.94±1.14)and(8.51±0.28)points,respectively,which were higher than those of the control group[(7.31±0.86)and(6.85±0.36)points],the VAS score for the waist and back was(1.51±0.28)points,which was lower than the control group[(2.45±0.36)points],and the differences were statistically significant(P<0.05).The incidence of falls within 12 months of intervention in the Otago exercise training group was 5.56%,which was lower than the control group(17.78%),and the difference was statistically significant(P<0.05);there was no statistically significant difference in the incidence of fractures between the two groups(P>0.05).Conclusion Otago exercise training combined with alfa calcitol in the treatment of diabetes mellitus with osteoporosis can improve bone metabolism and bone mineral density,improve body static balance function,reduce back pain,and reduce the incidence of falls.