维生素D及其受体基因多态性与老年人肌肉衰减综合征关联性研究

发布时间：2018-05-13 16:08

本文选题：肌肉衰减综合征 + 25(OH)D　；参考：《中国疾病预防控制中心》2016年硕士论文

【摘要】：研究目的随着中国步入老龄化社会,增龄性疾病在老年人中明显增多,现已成为降低老年人生活质量的重要健康问题。人体骨骼肌质量和功能随年龄增加而不断衰减,骨骼肌质量、肌力及功能衰减到一定程度即可发生肌肉衰减综合征(sarcopenia)。目前关于肌肉衰减综合征的研究主要是营养、运动、激素、炎症等方面。维生素D作为一种营养素在肌肉衰减综合征中的作用越来越受关注,但研究结果并不一致。本文主要是分析血清维生素D水平与老年人肌肉衰减综合征的关系,同时探讨维生素D受体基因多态性与老年人肌肉衰减综合征的关系。研究方法一、横断面调查选择北京市石景山区两社区医院所辖范围内、年龄在60岁及以上、无严重导致活动受限的骨关节疾病及重大疾病的社区居民作为初筛对象。主要包括问卷调查、体格测量、肌肉量和功能测定及实验室检测。问卷调查主要收集研究对象的基本人口学信息、生活方式、行为方式和膳食调查(采用半定量食物频率法)。体格测量包括身高、体重、上臂围、小腿围、腰围等维度测量。肌肉量测定(采用Inbody720体成分仪)和功能(握力、4米常规步速)的测定。实验室测定指标包括血清25(OH)D水平、甲状旁腺素(PTH)水平；提取血细胞基因组DNA,对VDR进行基因型分析,同时测定受试对象的生化指标(总胆固醇、甘油三酯、血糖、肌酐、白蛋白等)。二、病例对照研究对初筛对象按照肌衰征的判定流程(见图3-1)将符合条件的肌衰者纳入病例组：对照组按照性别、年龄进行1：2匹配,对照组年龄与病例组相比控制在±2岁以内；其他非研究因素应尽可能保证一致。三、干预实验将患有肌衰征且维生素D缺乏(血清25(OH)D20ng/ml)的老年人作为干预组,在同样的人群中选择年龄、性别等非研究因素相匹配的老年人作为对照组,两组再分别按基因型分成两个干预亚组(对入选干预对象采用双能X线吸收谱(DXA)测定肌肉量,膳食调查采用3天24小时回归法与称重法相结合)。对干预组、对照组分别进行12个月的口服维生素D胶囊(800IU/d)、维生素E胶囊(100mg/d)干预。四、统计分析本研究采用Epidata3.0进行数据双录入和数据库的建立；采用SAS9.4进行统计学描述和分析。对于定量资料根据是否符合正态分布分别用均数和标准差(正态分布)、中位数和四分卫间距(非正态分布)进行描述；分类资料采用率或百分比进行统计学描述。定量资料根据是否是正态分布、方差齐性分别用T检验或方差分析(符合)和wilcoxon秩和检验(不符合)进行分析；分类资料采用R*C的卡方检验进行差异性分析或多因素logistic回归(二分类资料)进行影响因素分析。对于两因素重复测量定量资料采用两因素重复资料方差分析(或拟合多水平模型)进行分析：对于重复测量分类资料采用广义估计方程模型。横断面调查分别分析血清25(OH)D水平与骨骼肌质量、功能的关联性；分析维生素D缺乏、不足、充足及维生素D受体不同基因型在人群中的分布情况,从而进行维生素D缺乏与肌肉衰减综合征(以下简称“肌衰征”)的关联性分析及VDR基因多态性的关联性分析。病例对照研究分析肌衰征的影响因素、膳食影响因素、维生素D缺乏与肌衰征的相关性及不同VDR基因型骨骼肌质量与功能情况。干预实验分析干预一年后血清25(OH)D水平改善情况、维生素D干预对肌肉质量、力量和功能的改善效果情况以及干预效果的影响因素分析。研究结果：一、横断面调查本研究共调查研究对象875名,总肌衰检出率为20.5%,其中男性17.4%,女性22.2%。肌衰征的影响因素有年龄、BMI、运动量、受教育程度、日晒时间、是否有在外就餐的经历(每周至少一次,不含早餐)(P0.05)。在控制性别、年龄、运动量、受教育程度、BMI、日晒时间后,握力随血清25(OH)D的升高呈增加趋势(P=0.02),但并未发现骨骼肌质量、步速与维生素D水平的关联性。多元线性回归结果显示老年男性握力与血清25(OH)D水平显著相关(β=0.16, P=0.001),但在骨骼肌质量及步速方面未发现类似结果。调查的老年人群中,VDR-rs 1544410 (Bsml)位点Bb基因型频率为11.4%,bb基因型频率为88.6%,BB基因型频率为0;VDR-rs2228570(Fokl)位点FF基因型频率为32.8%,Ff基因型频率为45.1%,ff基因型频率为22.1%,且两种基因型频率在性别上无统计学差异(P0.05)。对于Bsm1位点的两个基因分型,bb基因型人群女性握力23.3kg(20.1kg-26.3kg)要大于Bb基因型女性握力21.5kg(19.7kg-24.3kg),差异具有统计学意义(P0.05),从数值上看握力下降率(男、女)和步速下降率(女)bb基因型人群也要低于Bb基因型人群。男性RSMI在FF, Ff, ff基因型中分别为7.6kg/m2、7.6kg/m2和7.8kg/m2且差异有统计学意义(P0.05)；女性RSMI在数值上也是ff基因型人群高于另两种基因型人群;同时男性肌衰率或四肢骨骼肌质量下降率在FF,Ff,ff三种基因型中分别为17.6%、23.0%和8.5%且差异有统计学意义(P0.05)。二、病例对照研究按照1：2匹配性别、年龄后的病例对照研究发现：肌衰征的一般影响因素为运动量、BMI、受教育程度和是否有每周至少一次的在外就餐经历。多因素logistic回归分析可知老年人肌衰征膳食影响因素是鱼虾等动物性食物,鱼虾类摄入量
[Abstract]:The purpose of this study is to improve the quality of life of the elderly. The quality and function of human skeletal muscle attenuates with age, the quality of skeletal muscle, muscle strength and function decline to a certain extent can occur muscle attenuation syndrome (SA Rcopenia). The current research on muscle attenuation syndrome is mainly about nutrition, exercise, hormone and inflammation. The role of vitamin D as a nutrient in muscle attenuation syndrome is becoming more and more concerned, but the results are not consistent. This article is mainly to analyze the relationship between the level of serum vitin D and the muscle attenuation syndrome in the elderly. At the same time, the relationship between vitamin D receptor gene polymorphism and seniors' muscle attenuation syndrome was investigated. First, a cross-sectional survey selected two community hospitals in Shijingshan District, Shijingshan District, Beijing, with age at the age of 60 years and above, and there was no serious cause of limited activity of bone and joint diseases and major diseases in community residents as the primary screening object. Questionnaire survey, physical measurement, muscle volume and function measurement and laboratory testing. Questionnaire survey mainly collected the basic demographic information, lifestyle, behavior and dietary survey (using semi quantitative food frequency method). Physical measurement included height, weight, arm circumference, leg circumference, waist circumference and other dimensions. The Inbody720 body composition instrument) and function (grip force, 4 meter regular pace) were measured. The laboratory indexes included serum level of 25 (OH) D, parathyroid hormone (PTH), genomic DNA of blood cells, genotype analysis of VDR, and simultaneous determination of biochemical indexes (total cholesterol, triglyceride, blood glucose, creatinine, albumin, etc.). Two, a case-control study was included in the initial screening object in accordance with the criteria of myocutaneous signs (see Figure 3-1) to incorporate the eligible muscle failure into the case group: the control group was matched by the sex, age and 1:2, and the control group was controlled within the 2 years of age compared with the case group; the other non research factors should be as consistent as possible. Three, intervention experiments will be suffering. The aged people with myocutaneous failure and vitamin D deficiency (serum 25 (OH) D20ng/ml) were used as the intervention group. In the same population, the elderly were selected for age, sex and other non research factors as the control group. The two groups were divided into two subgroups according to the genotype (DXA). The investigation was combined with 3 day 24 hour regression and weighing method. For the intervention group, the control group had 12 months oral vitamin D capsule (800IU/d), vitamin E capsule (100mg/d) intervention. Four. The statistical analysis was conducted by Epidata3.0 for data double entry and database establishment, and SAS9.4 was used for statistical description and analysis. The quantitative data are described with the average number and standard deviation (normal distribution), the median and the quarterback spacing (non normal distribution) according to whether the quantitative data are in accordance with the normal distribution. The classification data are statistically described by the rate or percentage. The quantitative data are based on whether the distribution is normal, and the homogeneity of variance is T test or variance analysis (coincidence) and wilc, respectively. The Oxon rank sum test (non conformity) was analyzed; the classification data were analyzed by the chi square test of R*C or the multiple factor Logistic regression (two classification data) for the influence factors analysis. The two factor repeated measurement quantitative data was analyzed by two factor repeated data ANOVA (or fitting multi level model): for repetition A generalized estimation equation model was used for the classification data. The cross-sectional survey was used to analyze the relationship between serum 25 (OH) D level and skeletal muscle mass and function. The distribution of vitamin D deficiency, insufficient, sufficient and different genotype of vitamin D receptor in the population was analyzed, and the vitamin D deficiency and muscle attenuation syndrome (hereinafter referred to as hereinafter referred to as the following abbreviation) Correlation analysis of "muscle failure") and association analysis of VDR gene polymorphism. Case control study analyzed the factors affecting muscle failure, dietary influence factors, correlation of vitamin D deficiency with muscle failure and different VDR genotypes of skeletal muscle mass and function. Intervention tests were conducted to analyze the improvement of serum 25 (OH) D level after one year of intervention. Analysis of the effect of vitamin D intervention on the improvement of muscle mass, strength and function and the influencing factors of intervention. First, a total of 875 subjects were investigated in this study. The total rate of total muscle failure was 20.5%, of which men were 17.4%, and the factors affecting 22.2%. muscle failure were age, BMI, exercise and education. The experience of daily exposure (at least once a week, without breakfast) (P0.05). In controlling sex, age, exercise, education, BMI, and exposure time, the grip strength increases with the increase of serum 25 (OH) D (P=0.02), but the association of skeletal muscle mass, step speed and vitamin D level is not found. Multiple linear regression junctions are not found. The results showed that the grip strength of old men was significantly correlated with the level of serum 25 (OH) D (beta =0.16, P=0.001), but no similar results were found in skeletal muscle mass and pace. In the elderly population, the VDR-rs 1544410 (Bsml) locus Bb genotype frequency was 11.4%, BB genotype frequency was 88.6%, BB genotype frequency was 0; VDR-rs2228570 (Fokl) loci of FF genes. The frequency of the type was 32.8%, the Ff genotype frequency was 45.1%, the FF genotype frequency was 22.1%, and the two genotypes had no statistical difference (P0.05). For the two genotyping of the Bsm1 locus, the 23.3kg (20.1kg-26.3kg) of the women in the BB genotype was larger than the Bb genotype female grip 21.5kg (19.7kg-24.3kg), and the difference was statistically significant. P0.05, from the numerical point of view, the decline rate of the grip force (male, female) and the rate of step down (female) BB genotype were also lower than that of the Bb genotype population. The male RSMI was 7.6kg/m2,7.6kg/m2 and 7.8kg/m2 in FF, Ff and FF genotypes, respectively, and the difference was statistically significant (P0.05), and the female RSMI was also higher than the other two genotypes in the number of FF genotypes. At the same time, the rate of male muscle failure or the decrease of skeletal muscle mass was 17.6%, 23% and 8.5% in FF, Ff, and FF, and the difference was statistically significant (P0.05). Two. The case control study matched the sex according to 1:2, and the case control study after age found that the general influence factors of muscle failure were exercise, BMI, and education. And whether there was at least one time to eat at least once a week. Multi factor Logistic regression analysis showed that the factors affecting the diet of elderly people were fish and shrimp and other animal food, fish and shrimp intake

【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R685

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