活性维生素D3干预高原老年人骨骼肌减少症的相关因素

摘要

Objective To observe the correlation between active vitamin D3 level and sarcopenia development in elderly patients in plateau regions and the changes in the correlation factors for sarcopenia under the invention of active vitamin D3 (Calcitriol,Cal),and to observe whether Cal could improve the muscle function.Methods 90 patients were assigned to the normal control (Con) arm,and 120 patients with sarcopenia were assigned to the sarcopenia (Sar) arm to receive different oral doses of Cal as intervention (0.25 ug/d for low dose group including 60 patients and 0.25ug bid for high dose group including 60 patients) Before and after the intervention,levels of 1,25-(OH)2D3 and the inflammatory factors TNF-α,IL-6,IL-10,and hs-CRP were detected using ELISA;HOMA-IR,BMI,and ASMI were calculated;and walking speed and grip strength were measured to observe the correlation between 1,25-(OH) 2D3 level and sarcopenia,the changes in these indicators from before to after intervention,and the efficacy and safety of oral Cal for sarcopenia.Results Prior to intervention,compared with the Con arm,1,25-(OH)2D3 level,IL-10 level,ASMI,walking speed and grip strength were significantly reduced (P＜0.01),and HOMA-IR,IL-6,TNF-α and hs-CRP were significantly elevated (P＜0.01) in both dose groups;intervention with Cal produced significant increases in 1,25-(OH)2D3 and IL-10 levels,significantly improved walking speed and grip strength (P ＜0.05),significant decreases in HOMA-IR,IL-6,TNF-α,and hs-CRP (P＜0.05),which were more marked with higher dose,but no significant changes in ASMI.From before to after intervention,there were no significant changes in BMI or hepatic/renal function,blood calcium,or blood phosphorus in either group.Conclusions The development of sarcopenia is associated with reduced 1,25-(OH)2D3 level.Cal can lower the inflammatory factors IL-6,TNF-α,and hs-CRP,and elevate IL-10,providing anti-inflammatory and immunoregulatory actions;improve muscle function and strength;and improve insulin resistance.BMI is irrelevant to the management of sarcopenia.Cal is safe at the oral dose up to 0.5 tμg/d.%目的 观察高原地区老年人群维生素D3水平与骨骼肌减少症(肌少症Sarcopenia)发病的相关性及活性维生素D3(骨化三醇Calcitriol,Cal)干预下肌少症相关因素的变化,并观察Cal是否能够改善肌肉功能.方法 收集肌少症病例120例,正常对照组(Con) 90例;肌少症组(Sar)给予Cal不同剂量口服干预治疗24周(低剂量组60例,0.25 μg/d;高剂量组60例,0.25 μg/次,2次/d).干预前后采用ELISA法检测1,25-二羟活性维生素D3(1,25-(OH)2D3)及炎性因子TNF-α、IL-6、IL-10、hs-CRP水平,计算HOMA-IR指数、BMI、ASMI,测量步速、握力,观察1,25-(OH)2D3水平与肌少症的相关性,Cal干预前后以上指标的变化,口服Cal是否对肌少症有益及安全性.结果 干预前各组与Con组比较1,25-(OH)2D3水平、IL-10、ASMI、步速、握力均明显降低(P＜0.01);HOMA-IR、IL-6、TNF-α、hs-CRP明显升高(P＜0.01);给予Cal干预治疗后1,25-(OH)2D3水平、IL-10升高,步速及握力明显改善(P＜0.05);HOMA-IR、IL-6、TNF-α、hs-CRP明显下降(P＜0.05),且随剂量增加效果更加明显,但ASMI无明显变化.BMI各组均无明显变化.Cal干预前后肝肾功能、血钙、血磷无明显变化.结论 肌少症的发病与1,25-(OH)2D3水平降低有关;Cal可以降低炎性因子IL-6、TNF-α、hs-CRP,升高IL-10,有抗炎、调节免疫的作用;Cal可改善肌肉功能及肌力;Cal可改善胰岛素抵抗;体重指数对肌少症的诊治无意义;Cal口服0.5 μg/d是安全的.