强化运动、维生素D和钙剂补充对北京市东城区绝经后女性肌力、骨折及生活质量的影响

发布时间：2018-04-14 20:40

本文选题：维生素D + 强化运动　；参考：《山东大学》2015年硕士论文

【摘要】：背景和目的：骨质疏松症是骨强度下降导致骨折危险性升高的一种骨骼疾病。女性绝经后骨质疏松症的患病率明显高于一般人群。有研究表明,维生素D缺乏与绝经后女性肌力下降、跌倒及骨折发生、以及生活质量相关。然而,目前国外关于维生素D补充能否改善绝经后女性肌肉功能、生活质量及骨折发生的结论尚不完全一致；国内相关研究,尤其是大样本的前瞻性研究较少；且国内暂无以社区为基础的前瞻性干预研究。本研究对来自北京市东城区多个社区的绝经后骨质疏松高危人群进行为期2年的前瞻性随机对照研究,观察强化运动、不同种类维生素D联合钙剂补充对其肌力、生活质量及骨折发生的影响,以进一步探索经济有效的人群骨质疏松干预模式。方法：通过骨质疏松性骨折的危险因素简易调查表筛选出北京地区多个社区绝经后骨质疏松高危人群,最终纳入研究对象614名,年龄45～81岁。对研究对象的一般情况,生活方式,骨质疏松相关情况,既往史和疾病治疗史,月经生育史和家族史等以调查问卷的形式进行记录。将研究人群随机分为四组：A组为对照组,B组为强化运动(太极拳)组,C组予钙剂600mg/d+普通维生素D 800IU/d,D组予钙剂600mg/d+活性维生素D 0.25μg/d。分别测定研究对象基线水平及干预1年后、2年后站立试验时间及左、右手握力,采用SF-36评分评估生活质量,并记录随访、期间跌倒及新发骨折次数,测定基线及随访2年的血清骨转换指标和25羟基维生素D水平。采用SPSS 16.0软件进行统计分析。结果：1.基线指标：(1)本研究人群基线血清25OHD50nmol/1的比例为92.6%,75nmol/1的比例则高达99.3%。(2)相关性分析显示,校正混杂因素后血清250HD水平与肌力(站立试验时间、双手握力)、生活质量评分(SF-36)各项指标、既往骨折史均无相关性(P均0.05)。2.经过为期2年的干预：(1)对照组女性随年龄增长出现肌力下降及部分生活质量评分下降。2年后血清PINP较基线显著增加(51.5±19.7vs.56.1±20.2,P=0.004),β-CTX则较基线无显著变化。(2)强化运动组1年后右手握力较基线显著下降(25.04±5.15vs.24.40+5.09,P=0.015),2年后双手握力较基线均无显著变化；1年后活力较基线改善(76.9±14.5vs.79.9±14.7,P=0.041),2年后大部分SF-36指标较基线无显著改变；2年后血清PINP较基线水平明显升高(54.9±21.Ovs.61.0±20.4, P=0.005), β-CTX较基线显著下降(0.43±0.18vs.0.39±0.17,P=0.024)。(3)钙剂+普通维生素D组1年随访时左手握力较基线显著增加(22.18±4.34 vs.22.73±4.53,P=0.043),2年随访时双手肌力均较基线无显著变化；1年随访SF-36各项评分指标均较基线无显著差异,2年随访大部分SF-36指标可维持基线水平；血清PINP显著高于基线水平(52.2±19.0vs.57.3±21.4,P=0.016),而β-CTX则未见显著下降。(4)钙剂+活性维生素D组1年及2年随访中双手握力均较基线无显著变化；1年随访SF-36各项评分指标均较基线无显著差异,2年随访生活质量指标较基线均无显著改善,同时也出现了生理功能、社会功能、情感职能、精神健康的下降；2年后血清β-CTX显著低于基线水平(0.40±0.17vs.0.36±0.18,P=0.011),而PINP则较基线无显著差异。(5)各组2年后血清250HD浓度均显著高于基线水平(P均0.001),但C、D两组250HD增加较对照组更为显著,而B组增高程度与对照组无显著差异。结论：在本研究人群中：1.绝经后女性随年龄增长出现肌力下降及部分生活质量指标下降。2.强化运动(太极拳)不能显著改善绝经后女性的肌力及生活质量,但可能可维持其不显著下降；在骨转换方面,可能促进骨形成,抑制骨吸收。3.补充钙剂+普通维生素D可能短期内改善绝经后女性肌力,长期作用仍需进一步试验观察；不能显著改善生活质量,但可部分减缓生活质量相关指标的下降；可能促进骨形成,但对骨吸收标志物β-CTX水平无显著影响。4.补充钙剂+活性维生素D并未显著改善绝经后女性肌力和生活质量,但可维持肌力不显著下降；可能抑制骨吸收,但对骨形成标志物P1NP水平无显著影响。5.长期补充普通维生素D 800IU/d及活性维生素D0.251μg/d均可显著提高血清250HD水平,改善维生素D缺乏。
[Abstract]:Background and objective: osteoporosis is bone strength decrease resulting in fracture a bone disease. The increased risk of post menopausal osteoporosis prevalence rate was significantly higher than the general population. Studies have shown that vitamin D deficiency and decreased muscle strength in postmenopausal women, falls and fractures, and the quality of life. However, at present abroad about vitamin D supplementation can improve muscle function in postmenopausal women, quality of life and fracture conclusion is not completely consistent; the related research in China, especially in large prospective studies less; and domestic no community-based prospective intervention study. The study of menopause from Beijing Dongcheng District city after a number of communities high risk of osteoporosis for a prospective randomized study of 2 years of observation, strengthening exercise, different kinds of vitamin D combined with calcium supplementation on muscle strength, quality of life The amount and effect of fracture, in order to further explore the osteoporosis intervention effectively. Methods: selected in Beijing community of postmenopausal osteoporosis in high-risk groups by risk factors for osteoporotic fractures were simple, ultimately included 614 subjects, aged 45~81. In general, the study object of life the way, related to osteoporosis, history and disease history, reproductive history and family history were recorded in the form of a questionnaire. The subjects were randomly divided into four groups: A group, B group for intensive exercise (Taijiquan) group, C group, 600mg/d+ normal calcium vitamin D 800IU/d, D group, 600mg/d+ calcium activated vitamin D 0.25 g/d. respectively. The study objects were determined at baseline and after 1 year of intervention, 2 years after the standing test time and left, right hand grip, the SF-36 scores of quality of life assessment The amount, and record the follow-up, during the fall and new fracture times, serum bone turnover markers were measured at baseline and follow-up of 2 years and 25 hydroxyvitamin D levels. Statistical analysis was performed using SPSS 16 software. Results: 1. baseline indicators: (1) this study baseline serum 25OHD50nmol/1 ratio was 92.6%, while the proportion of 75nmol/1 up to 99.3%. (2) correlation analysis showed that serum 250HD levels and muscle strength after adjusting for confounding factors (stand the test of time, hand grip strength), quality of life score (SF-36) of the index, the history of fractures were not correlated (P 0.05).2. after 2 years of intervention: (1) the control group female muscle drop and quality of life score decreased after.2 years compared with baseline serum PINP increased significantly with age (51.5 + 19.7vs.56.1 + 20.2, P=0.004), beta -CTX compared to the baseline. No significant changes (2) to strengthen the sports group 1 years after the right hand grip strength compared to the baseline significantly Drop (25.04 + 5.15vs.24.40+5.09, P=0.015), after 2 years of hand grip strength compared to the baseline showed no significant change; improve the activity compared to the baseline after 1 years (76.9 + 14.5vs.79.9 + 14.7, P=0.041), after 2 years, most of the SF-36 index did not change significantly compared to the baseline; serum PINP was significantly elevated baseline levels after 2 years (54.9 + 21.Ovs.61.0 + 20.4, P=0.005), beta -CTX compared with baseline was significantly decreased (0.43 + 0.18vs.0.39 + 0.17, P=0.024). (3) calcium + vitamin D group ordinary left-handed strength increased significantly compared to the baseline at 1 years of follow-up (22.18 + 4.34 vs.22.73 + 4.53, P=0.043), 2 years of follow-up were compared with baseline muscle strength without hands significant changes; follow-up SF-36 scores were compared with baseline index 1 years there is no significant difference between the 2 year follow up most of the SF-36 index can be maintained at baseline; serum PINP was significantly higher than the baseline level (52.2 + 19.0vs.57.3 + 21.4, P=0.016), and beta -CTX no significant decline. (4) Ca + active dimension Vitamin D group of 1 years and 2 years of follow-up were compared with baseline hand grip strength did not change significantly; follow-up SF-36 scores were compared with baseline index 1 years there is no significant difference between the 2 years of follow-up compared with baseline quality of life index were not significantly improved, there has also been a physiological function, social function, emotional function, mental health decline after 2 years; serum -CTX was significantly lower than the baseline level (0.40 + 0.17vs.0.36 + 0.18, P=0.011), while PINP had no significant difference compared to the baseline. (5) were 2 years after the concentration of serum 250HD was significantly higher than the baseline level (P 0.001), but C, D two 250HD group increased compared with the control group was more while the B group increased significantly, and the degree of the control group had no significant difference. Conclusion: in the study population: 1. postmenopausal women with age decreased muscle strength and quality of life index decreased.2. intensive exercise (Taijiquan) can significantly improve the quality of life and muscle strength in postmenopausal women, But may maintain the significant decline in bone turnover;, may promote bone formation and inhibit bone resorption of.3. calcium supplement + normal vitamin D may improve in the short term muscle strength in postmenopausal women, the long-term effects still need further observation; do not significantly improve the quality of life, but the quality of life index decreased slow; may promote the bone formation and bone resorption markers but the beta -CTX level had no significant effect on.4. + calcium activated vitamin D did not significantly improve muscle strength in postmenopausal women and the quality of life, but can not maintain muscle strength significantly decreased; can inhibit bone resorption, but bone formation markers P1NP level had no significant effect of.5. supplementation common vitamin D 800IU/d and vitamin D0.251 g/d could significantly increase the level of serum 250HD, improve vitamin D deficiency.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R580

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