维生素D联合阻抗训练对老年肌少症患者骨骼肌质量、日常生活活动能力及血清学指标的影响

Effects of vitamin D combined with resistance training on skeletal muscle mass, activities of daily living and serological indices in elderly patients with sarcopenia

摘要:

目的 观察维生素D联合阻抗训练对老年肌少症患者的骨骼肌质量、日常生活活动能力(ADL)及血清单核细胞趋化蛋白-1(MCP-1)、白细胞介素-1β(IL-1β)、C反应蛋白(CRP)水平的影响。方法 选取2017年1月至2018年5月河北省人民医院老年病二科收治的112例老年肌少症合并维生素D缺乏患者,根据随机数表法分为对照组(T1组,30例)、阻抗训练组(T2组,41例)及阻抗训练+维生素D组(T3组,41例)。T1组给予肌少症健康宣教；T2组在健康宣教的基础上给予阻抗训练,每周2次,每次30min；T3组在T2组基础上加用骨化三醇治疗,每次0.25μg,2次/d。3组均持续干预24周,分别于干预前及干预24周后测定3组血清25(OH)D3、MCP-1、IL-1β、CRP水平,并评估握力、步速、ADL及四肢骨骼肌质量指数(SMI)；采用Pearson相关分析,分析血清25(OH)D3与SMI、ADL、MCP-1、IL-1β、CRP的关系。结果 干预24周后,T2组、T3组血清25(OH)D3、SMI、握力、步速、ADL均较干预前及同期T1组升高(均P＜0.05),MCP-1、IL-1β、CRP均较干预前及同期T1组降低(均P＜0.05),其中T3组上述指标的变化幅度较T2组更大(均P＜0.05)；Pearson相关分析结果显示,血清25(OH)D3与SMI、ADL呈正相关(r=0.537、0.439,均P＜0.05),与MCP-1、IL-1β、CRP呈负相关(r=-0.544、-0.618、-0.496,均P＜0.05)。结论 维生素D联合阻抗训练能够增加老年肌少症患者的肌肉质量,提升其ADL。两者联合治疗的效果较单一阻抗训练效果更好,其作用机制可能与维生素D能降低老年肌少症患者体内MCP-1、IL-1β、CRP炎症因子水平有关。

Abstract:

Objective To observe the effects of vitamin D combined with resistance training on skeletal muscle mass, activities of daily living (ADL), and serum monocyte chemotactic factor-1 (MCP-1), interleukin-1β (IL-1β) and C-reactive protein (CRP) in the elderly patients with sarcopenia. Methods From January 2017 to May 2018,112 elderly patients with sarcopenia complicated with vitamin D deficiency were enrolled in the study, who were treated in Second Division of Geriatrics Department, Hebei Gerneral Hospital. They were randomized into control group (T1 group, n=30), resistance training group (T2 group, n=41) and resistance training plus vitamin D group (T3 group, n=41). T1 group were provided with education on sarcopenia, T2 group were given resis-tance training (twice a week, 30min each time) in addition to education on sarcopenia, and calcitriol (0.25μg, twice daily) was added for T3 group on the basis of the treatment for the T2 group. All three groups were observed for 24 weeks. The serum 25(OH)D3, MCP-1,IL-1β, CRP, grip strength, pace, ADL, and skeletal muscle mass index (SMI) of the limbs were measured before intervention and after 24 weeks of intervention for all the participants, and the changes of the above indicators were compared at the 0 week and 24 weeks. Pearson correlation analysis was made for the relationship between serum 25(OH)D3 and MCP-1, IL-1β, CRP, SMI and ADL. Results After 24 weeks of intervention, T2 and T3 groups had higher levels of serum 25(OH)D3, SMI, grip strength, pace and ADL but lower levels of MCP-1, IL-1β and CRP than those before the intervention and those of the T1 group (all P<0.05). The changes of the above indices in the T3 group were greater than those in the T2 group (all P<0.05). Pearson correlation analysis showed that serum 25(OH)D3 was positively correlated with SMI and ADL (r=0.537,0.439, all P<0.05), and negatively correlated with MCP-1, IL-1β and CRP (r=-0.544, -0.618, -0.496, all P<0.05). Conclusion Vitamin D combined with resistance training can increase muscle mass and improve daily activities in the elderly patients with sarcopenia and is better than single resistance training. The mechanism may be related to the reduction of inflammatory factors MCP-1, IL-1β and CRP.