对维生素D缺乏中老年人群实施维生素D分层补充干预的效果评估

EFFECT OF STRATIFIED VITAMIN D SUPPLEMENTATION IN MIDDLE-AGED AND ELDERLY SUBJECTS WITH VITAMIN D DEFICIENCY

目的探讨维生素D(vitamin D,VD)缺乏中老年人群相关因素,探讨VD分层补充干预的应用效果。方法 (1)选取2015年2月~2017年8月我院800例中老年健康体检者,根据VD水平分组,分为VD充足者[25(OH)D≥75nmol/L,252例],VD缺乏者[25(OH)D<75nmol/L,548例],分析其相关影响因素。(2)将548例VD缺乏者按照随机数字表法分为观察组(274例)、对照组(274例),两组均给予常规干预措施,对照组给予常规剂量VD3补充治疗,观察组根据患者危险度进行分层计分,给予VD分层补充干预,对比探讨干预前、干预6月后两组血清25(OH)D、骨钙素水平、骨密度(BMD)、握力、简易躯体能力测试(SPPB)评分、跌倒风险评估试验结果、生活质量(SF-36)评分。结果经Logistic多因素回归分析显示,女性、年龄(升高)、合并高血压、糖尿病为VD缺乏患者危险因素,经常进食动物内脏、日照时间长为VD缺乏患者保护因素;两组年龄、性别、合并症、血清25(OH)D水平、VD分级等资料比较差异无统计学意义(P>0.05);干预6月后观察组血清25(OH)D、骨钙素水平高于对照组,观察组腰椎、髋部BMD大于对照组(P<0.05);干预6月后观察组握力、SPPB评分大于对照组,跌倒风险评估试验TST、TGUG、NGV、CRT异常率低于对照组,差异有统计学意义(P<0.05);干预6月后观察组社会功能(SF)、精神健康(MH)、情感职能(RE)、活力(VT)、生理功能(PF)、躯体疼痛(BP)、总体健康(GH)、生理职能(RP)等生活质量各维度评分大于对照组,差异有统计学意义(P<0.05)。结论性别、年龄、合并高血压、糖尿病、进食动物内脏、日照时间均与中老年人群VD缺乏明显相关,针对上述因素在常规干预基础上给予VD分层补充干预能进一步改善骨健康、骨密度,提高肢体功能,降低跌倒风险,提高患者生活质量。

Objective To explore the risk factors of vitamin D deficiency in middle-aged and elderly individuals,and the effect of stratified vitamin D supplemention.Methods(1)A total of 800 subjects of middle-aged and elderly were selected in health examination between February 2015 and August 2017,and divided into vitamin D sufficient group[25(OH)D≥75 nmol/L,252 cases],and vitamin D deficiency group[25(OH)D 75 nmol/L,548 cases].(2)548 cases of vitamin D deficiency were randomly divided into the observation group(274 cases)and the control group(274 cases).The control group was given the routine dose of vitamin D3 supplementation.The observation group was graded according to the risk degree of the deficiency,and was treated with the vitamin D stratified supplementation for six months.The serum 25(OH)D,osteocalcin,bone mineral density(BMD),grip strength,simple physical ability tests(SPPB)score,fall risk assessment tests[series gait test(TST),station starting line test(TGUG),daily pace test(NGV),stand up test(CRT)],and quality of life(SF-36)score were measured at the beginning and 6 months post intervention.Results Logistic regression analysis showed that female,age,hypertension,diabetes mellitus were risk factors for vitamin D deficiency,and frequent eating of animal viscera and sunshining were the protective factors of vitamin D deficiency.There was no difference in age,sex,complications,and the levels of serum 25(OH)D and vitamin D between the two groups(P>0.05).After 6 months of intervention,the serum levels of 25(OH)D and osteocalcin in the observation group were higher than those in the control group,and the BMD of lumbar spine and hip of the observation group was higher than that of the control group(P<0.05);the grip strength and SPPB score of the observation group were greater than those of the control group;the scores of SF,MH,RE,VT,PF,BP,GH and RP in the observation group were higher than those in the control group(P<0.05);the rates of TST,TGUG,NGV and CRT in the fall risk assessment test were lower than that of the control group(P<0.05).Conclusion Gender,age,hypertension,diabetes,eating animal viscera and sunshine time were significantly related to vitamin D deficiency in the middle age and elderly subjects.Vitamin D stratified supplementary intervention can improve bone health,bone mineral density,limb function,and reduce falls risk,increase the quality of life.