老年骨质疏松人群维生素D缺乏与跌倒风险关系的研究

摘要

目的 收集老年骨质疏松人群血清25-羟基维生素D[25(OH)D]、跌倒风险以及肌力等数据,分析维生素D缺乏与跌倒风险之间的关系.方法 共纳入2015年8月至2016年8月骨科门诊老年骨质疏松患者101例,收集患者信息,记录社区老人跌倒风险量表(FROP)、修订版跌倒能效量表(MFES)问卷结果.记录患者手握式测力仪(HHD)的握力数据,记录受试者简易躯体能力测试(SPPB)结果并记录患者骨密度情况.测定患者血钙值(Ca)、1型前胶原氨基末端肽(P1NP)、Ⅰ型胶原羧基末端肽(β-CTx)、25(OH)D.对25(OH)D不同水平组间的跌倒评分、骨密度等差异进行完全随机设计资料的单因素方差分析;25(OH)D和跌倒评分的相关性采用简单线性回归分析.结果 101例患者中,最近一年发生跌倒53例,占总数的52.5%,跌倒组25(OH)D 19.59 ng/ml,非跌倒组25(OH)D 23.91 ng/ml,跌倒组的25(OH)D水平明显低于非跌倒组,差异有统计学意义(t=2.951,P0.05).与维生素D缺乏组相比,不论是维生素D充足组还是维生素D不足组的FROP评分均较低、HHD均较高.结论 骨科老年骨质疏松患者中,维生素D缺乏者其跌倒风险较高.应从补充维生素D、平衡训练等多方面进行综合干预.%Objective To collect the serum level of vitamin D[25 (OH)D]and risk of fall in elderly patients with osteoporosis,and to analyze their relationship. Methods A total of 101 patients with osteoporosis treated in this hospital during August 2015 to August 2016 were in-volved in this study,their average age was 68. 55 ± 5. 92 years old. Their basic informations and assessment of fall risk were evaluated by Fall Risk for Old Persons (FROP)and modified Fall Efficiency Scale (MFES). Their muscular strength was examined by hand-held dynamometer (HHD),and records of Simplified Physical Performance Battle (SPPB)were collected. The results of bone mineral density,serum levels of calci-um,type 1 procollagen amino terminal peptide (P1NP),parathyroid hormone,25(OH)D and type I collagen carboxyl terminal peptide (β-CTx)were examined,and records of history of falls were analyzed. Single factor analysis of variance had been performed to get the difference in 25 (OH)D levels among groups. Simple linear regression analysis was used to analyze the relationship between 25(OH)D level and fall risk. All data were inspected with two-sided test,α = 0. 05 and P < 0. 05. Results Over the past year,101 patients (52. 5%)had fallen history. The level of 25(OH)D in fall group (19. 59 ng/ ml)was significantly lower than that (23. 91 ng/ ml)of non-fall group (t = 2. 951,P < 0. 05). The average of FROP scores were 10. 01 ± 8. 46,and the average MFES scores were 9. 14 ± 0. 94. There was no significant difference in factors of age,height,weight,bone density,serum calcium,P1NP,β-CTx and other factors among different 25(OH)D level groups. In comparison with vitamin D deficiency group,both vitamin D insufficiency group and vitamin D sufficiency group had lower HHD and higher FROP scores. Conclu-sion In elderly patients with osteoporosis,patients with vitamin D deficiency have a higher risk of fall. The comprehensive intervention should be carried out from the aspects of vitamin D supplementation,balanced training and so on.