本文選題：肌肉衰減綜合征 + 25(OH)D��； 參考：《中國疾病預(yù)防控制中心》2016年碩士論文

【摘要】：研究目的隨著中國步入老齡化社會,增齡性疾病在老年人中明顯增多,現(xiàn)已成為降低老年人生活質(zhì)量的重要健康問題。人體骨骼肌質(zhì)量和功能隨年齡增加而不斷衰減,骨骼肌質(zhì)量、肌力及功能衰減到一定程度即可發(fā)生肌肉衰減綜合征(sarcopenia)。目前關(guān)于肌肉衰減綜合征的研究主要是營養(yǎng)、運動、激素、炎癥等方面。維生素D作為一種營養(yǎng)素在肌肉衰減綜合征中的作用越來越受關(guān)注,但研究結(jié)果并不一致。本文主要是分析血清維生素D水平與老年人肌肉衰減綜合征的關(guān)系,同時探討維生素D受體基因多態(tài)性與老年人肌肉衰減綜合征的關(guān)系。研究方法一、橫斷面調(diào)查選擇北京市石景山區(qū)兩社區(qū)醫(yī)院所轄范圍內(nèi)、年齡在60歲及以上、無嚴(yán)重導(dǎo)致活動受限的骨關(guān)節(jié)疾病及重大疾病的社區(qū)居民作為初篩對象。主要包括問卷調(diào)查、體格測量、肌肉量和功能測定及實驗室檢測。問卷調(diào)查主要收集研究對象的基本人口學(xué)信息、生活方式、行為方式和膳食調(diào)查(采用半定量食物頻率法)。體格測量包括身高、體重、上臂圍、小腿圍、腰圍等維度測量。肌肉量測定(采用Inbody720體成分儀)和功能(握力、4米常規(guī)步速)的測定。實驗室測定指標(biāo)包括血清25(OH)D水平、甲狀旁腺素(PTH)水平；提取血細(xì)胞基因組DNA,對VDR進(jìn)行基因型分析,同時測定受試對象的生化指標(biāo)(總膽固醇、甘油三酯、血糖、肌酐、白蛋白等)。二、病例對照研究對初篩對象按照肌衰征的判定流程(見圖3-1)將符合條件的肌衰者納入病例組：對照組按照性別、年齡進(jìn)行1：2匹配,對照組年齡與病例組相比控制在±2歲以內(nèi)；其他非研究因素應(yīng)盡可能保證一致。三、干預(yù)實驗將患有肌衰征且維生素D缺乏(血清25(OH)D20ng/ml)的老年人作為干預(yù)組,在同樣的人群中選擇年齡、性別等非研究因素相匹配的老年人作為對照組,兩組再分別按基因型分成兩個干預(yù)亞組(對入選干預(yù)對象采用雙能X線吸收譜(DXA)測定肌肉量,膳食調(diào)查采用3天24小時回歸法與稱重法相結(jié)合)。對干預(yù)組、對照組分別進(jìn)行12個月的口服維生素D膠囊(800IU/d)、維生素E膠囊(100mg/d)干預(yù)。四、統(tǒng)計分析本研究采用Epidata3.0進(jìn)行數(shù)據(jù)雙錄入和數(shù)據(jù)庫的建立；采用SAS9.4進(jìn)行統(tǒng)計學(xué)描述和分析。對于定量資料根據(jù)是否符合正態(tài)分布分別用均數(shù)和標(biāo)準(zhǔn)差(正態(tài)分布)、中位數(shù)和四分衛(wèi)間距(非正態(tài)分布)進(jìn)行描述；分類資料采用率或百分比進(jìn)行統(tǒng)計學(xué)描述。定量資料根據(jù)是否是正態(tài)分布、方差齊性分別用T檢驗或方差分析(符合)和wilcoxon秩和檢驗(不符合)進(jìn)行分析；分類資料采用R*C的卡方檢驗進(jìn)行差異性分析或多因素logistic回歸(二分類資料)進(jìn)行影響因素分析。對于兩因素重復(fù)測量定量資料采用兩因素重復(fù)資料方差分析(或擬合多水平模型)進(jìn)行分析：對于重復(fù)測量分類資料采用廣義估計方程模型。橫斷面調(diào)查分別分析血清25(OH)D水平與骨骼肌質(zhì)量、功能的關(guān)聯(lián)性；分析維生素D缺乏、不足、充足及維生素D受體不同基因型在人群中的分布情況,從而進(jìn)行維生素D缺乏與肌肉衰減綜合征(以下簡稱“肌衰征”)的關(guān)聯(lián)性分析及VDR基因多態(tài)性的關(guān)聯(lián)性分析。病例對照研究分析肌衰征的影響因素、膳食影響因素、維生素D缺乏與肌衰征的相關(guān)性及不同VDR基因型骨骼肌質(zhì)量與功能情況。干預(yù)實驗分析干預(yù)一年后血清25(OH)D水平改善情況、維生素D干預(yù)對肌肉質(zhì)量、力量和功能的改善效果情況以及干預(yù)效果的影響因素分析。研究結(jié)果：一、橫斷面調(diào)查本研究共調(diào)查研究對象875名,總肌衰檢出率為20.5%,其中男性17.4%,女性22.2%。肌衰征的影響因素有年齡、BMI、運動量、受教育程度、日曬時間、是否有在外就餐的經(jīng)歷(每周至少一次,不含早餐)(P0.05)。在控制性別、年齡、運動量、受教育程度、BMI、日曬時間后,握力隨血清25(OH)D的升高呈增加趨勢(P=0.02),但并未發(fā)現(xiàn)骨骼肌質(zhì)量、步速與維生素D水平的關(guān)聯(lián)性。多元線性回歸結(jié)果顯示老年男性握力與血清25(OH)D水平顯著相關(guān)(β=0.16, P=0.001),但在骨骼肌質(zhì)量及步速方面未發(fā)現(xiàn)類似結(jié)果。調(diào)查的老年人群中,VDR-rs 1544410 (Bsml)位點Bb基因型頻率為11.4%,bb基因型頻率為88.6%,BB基因型頻率為0;VDR-rs2228570(Fokl)位點FF基因型頻率為32.8%,Ff基因型頻率為45.1%,ff基因型頻率為22.1%,且兩種基因型頻率在性別上無統(tǒng)計學(xué)差異(P0.05)。對于Bsm1位點的兩個基因分型,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),差異具有統(tǒng)計學(xué)意義(P0.05),從數(shù)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基因型中分別為7.6kg/m2、7.6kg/m2和7.8kg/m2且差異有統(tǒng)計學(xué)意義(P0.05)；女性RSMI在數(shù)值上也是ff基因型人群高于另兩種基因型人群;同時男性肌衰率或四肢骨骼肌質(zhì)量下降率在FF,Ff,ff三種基因型中分別為17.6%、23.0%和8.5%且差異有統(tǒng)計學(xué)意義(P0.05)。二、病例對照研究按照1：2匹配性別、年齡后的病例對照研究發(fā)現(xiàn)：肌衰征的一般影響因素為運動量、BMI、受教育程度和是否有每周至少一次的在外就餐經(jīng)歷。多因素logistic回歸分析可知老年人肌衰征膳食影響因素是魚蝦等動物性食物,魚蝦類攝入量
[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

【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R685

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 宋笑凱;李淮玉;任明山;;25-羥基維生素D與腦梗死的關(guān)系及干預(yù)治療的臨床研究[J];中國卒中雜志;2015年03期

，

本文編號：1883887