不同剂量阿托伐他汀钙对中重度衰弱高龄患者肌少症的影响

Efficacy of different dosages of atrovastatin calcium in ≥80 years sarcopenia patients with moderate to severe frailty

摘要:

目的 观察不同剂量阿托伐他汀钙对中重度衰弱高龄患者肌少症的影响。方法 入选2016年4月至2018年4月就诊于江苏省钟山康复医院康疗科高龄伴中重度衰弱患者98例,随机数字表法分为20 mg组34例,10 mg组33例,未服药组31例,分别检测服药前、服药12和24个月的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)和高密度脂蛋白胆固醇(HDL-C)、握力、4.5 m步行时间、四肢骨骼肌质量指数(ASMI)和衰弱分级。采用SPSS 19.0软件对数据进行分析。组间比较采用t检验、方差分析或χ²检验。结果 服药24个月时,20 mg组患者相比未服药组患者TC[(3.84±0.96) vs(4.36±0.95)mmol/L]、LDL-C[(2.48±1.33) vs(3.19±1.30)mmol/L]、握力[(15.77±3.71) vs(18.58±3.43)kg]和 ASMI[(13.90±2.33) vs(15.27±3.16)kg/m²]降低,相比10 mg组患者TC[(3.84±0.96) vs(4.26±1.03)mmol/L]和LDL-C[(2.48±1.33 ) vs(3.47±1.41)mmol/L]降低,10 mg组患者相比未服药组患者握力[(15.31±4.71) vs(18.58±3.43)]降低,差异均具有统计学意义(P＜0.05)。服药24个月20 mg组患者衰弱分级增加一级的发生率为35.3%(12/34),10 mg组患者为18.2%(6/33),未服药组患者为9.7%(3/31),差异具有统计学意义(P=0.036)。结论 他汀类药物可能进一步加剧增龄相关的肌功能下降和衰弱。

Abstract:

Objective To investigate the efficacy of different dosages of atrovastatin calcium on very elderly sarcopenia patients with moderate to severe frailty. Methods Ninety-eight very elderly patients with moderate to severe frailty admitted to our Department of Rehabilitation Medicine from April 2016 to April 2018 were recruited in this study. They were randomly divided into 3 groups, taking 20 mg group (n=34), taking 10 mg group (n=33) and drug withdrawl group (n=31). The levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in the peripheral blood, grip strength, 4.5-meter walking time, appendicular skeletal muscle mass index (ASMI), and frailty levels were detected and measured before and after treatment. SPSS statistics 19.0 was used to perform the statistical analysis. Student′s t test, analysis of variance, or Chi-square test was employed for intergroup comparison on different data types. Results After 24 months of treatment, the patients from the 20 mg group had significantly lower TC [(3.84±0.96) vs (4.36±0.95)mmol/L] and LDL-C levels [(2.48±1.33) vs (3.19±1.30)mmol/L], decreased grip strength [(15.77±3.71) vs (18.58±3.43)kg] and ASMI [(13.90±2.33) vs (15.27±3.16)kg/m²] than those from the drug withdrawl group, and the levels of TC and LDL-C were still lower when compared with those of the 10 mg group [(4.26±1.03), (3.47±1.41)mmol/L, all P<0.05]. The grip strength was significantly lower in the 10 mg group than the drug withdrawal group [(15.31±4.71) vs (18.58±3.43)kg, P<0.05]. Moreover, the incidence of frailty level increasing by at least 1 level was 35.3%(12/34) in the 20 mg group, 18.2% (6/33) in the 10 mg group, and 9.7% (3/31) in the withdraw group (P=0.036). Conclusion Statins may further exacerbate age-related declines in muscle function and accelerate frailty.