阿托伐他汀对老年高胆固醇血症合并低骨量患者骨量和肌力的作用效果研究  

Effects of Atorvastatin on Bone Mass and Muscle Strength in Elderly Patients with Hypercholesterolemia Combined with Low Bone Mass

作　　者：王小冬 杜艳萍 肖峰 张敏 于爱华 乌日娜 陈宇 陈华 程群 WANG Xiaodong;DU Yanping;XIAO Feng;ZHANG Min;YU Aihua;WU Rina;CHEN Yu;CHEN Hua;CHENG Qun(Department of General Practice,Changning District Zhoujiaqiao Subdistrict Community Health Center,Shanghai 200051,China;Department of Osteoporosis and Bone Disease,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]上海市长宁区周家桥街道社区卫生服务中心全科,200051 [2]复旦大学附属华东医院骨质疏松科,上海市200040

出　　处：《中国全科医学》2020年第21期2669-2672,共4页Chinese General Practice

基　　金：上海市长宁区科学技术委员会课题(CNKW2014S02);长宁区首届社区特色专病项目(20175002);上海申康医院发展中心临床科技创新项目(SHDC12016201);上海市科学技术委员会课题(16411954600)。

摘　　要：背景既往研究发现他汀类药物具有激活成骨细胞、促进骨合成代谢的作用,为临床治疗老年骨质疏松症提供了新的思路。但在社区老年人中,他汀类药物是否有治疗骨质疏松症的作用,目前尚不清楚。对低骨量者,他汀类药物是否可延缓骨量丢失速度,国内较少文献报道。目的研究阿托伐他汀对老年高胆固醇血症合并低骨量患者骨量和肌力的作用效果。方法2014年7—9月将上海市周家桥社区管理的401例老年高胆固醇血症〔总胆固醇(TC)>6.99 mmol/L〕合并低骨量〔-2.5<骨密度(BMD)T值<-1.0〕患者分为两组,其中试验组199例自愿选择服用阿托伐他汀20 mg/d,对照组202例不选用阿托伐他汀治疗;两组患者均服用碳酸钙D3600 mg/d、阿法骨化醇0.5 g/d。比较干预前和干预2年后BMD、骨转换指标〔β胶原降解产物(β-CTX)、Ⅰ型胶原羧基端前肽(PINP)〕、生化指标〔肌酸激酶(CK)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆固醇(TC)〕、肌力〔左握力、右握力〕的变化。结果两组基线资料、BMD、TC比较,差异无统计学意义(P>0.05),骨转换指标、除TC外的生化指标、肌力比较,差异有统计学意义(P<0.05)。干预2年后,试验组BMDL1~4、BMD股骨颈及BMD髋部的变化量分别为(0.029±0.002)、0.024(0.012,0.040)、(0.026±0.017)g/cm2,均大于对照组的(0.007±0.001)、0.009(0.003,0.015)、(0.007±0.006)g/cm2(P<0.001);试验组β-CTX、PINP变化量分别为(-0.151±0.087)、(-17.57±16.89)μg/L,均小于对照组的(-0.020±0.017)、(-3.48±6.29)μg/L(P<0.001);试验组CK变化量为0.17(0.11,0.18)U/L,大于对照组的-0.01(-0.02,0.01)U/L(P<0.001);试验组AST变化量为(1.20±0.31)U/L,大于对照组的(1.07±0.31)U/L(P<0.001);试验组TC变化量为(-2.68±0.10)mmol/L,大于对照组的(-0.25±0.00)mmol/L(P<0.001);试验组左、右握力变化量分别为(-1.99±1.34)、(-2.28±1.26)kg,大于对照组的(1.18±1.77)、(1.10±1.80)kg(P<0.001)�Background Previous studies found that statins can activate osteoblasts and promote bone anabolic effect,thus providing a new perspective for clinical treatment of osteoporosis in the elderly.But it is not clear whether statins can treat osteoporosis in the elderly in the local community.There is also no literature in China about whether statins can retardbone mass loss rate of those with low bone mass.Objective To study the effects of atorvastatin on bone mass and muscle strength in elderly patients with hypercholesterolemia combined with low bone mass.Methods 401 elderly patients with hypercholesterolemia〔total cholesterol(TC)>6.99 mmol/L〕and low bone mass(-2.5<T<-1.0)who received management from Shanghai Zhoujiaqiao Community were enrolled from July to September 2014,and were divided into two groups according to patient subjective choice of regimen:experimental group(n=199,voluntary taking atorvastatin 20 mg/d,plus calcium carbonate D3600 mg/d and alfacalcidol 0.5 g/d),control group(n=202,taking calcium carbonate D3600 mg/d,alfacalcidol 0.5 g/d).Bone density index,change of bone turnover markers〔beta collagen degradation products(beta-CTX),propeptide of typeⅠcollagen carboxyl end(PINP)〕,biochemical indicators〔creatine kinase(CK),ALT,AST,TC〕,and change of hand grip strength(both left-and right-hand grip strength)before intervention and after two years'intervention were compared.Results The baseline data,including demographic factors,BMD,TC showed no significant differences between the groups(P>0.05),the bone turnover markers,biochemical markers(except TC),and hand grip strength showed significant differences between the groups(P<0.05).After two years'intervention,compared with the control group,the experimental group showed greater mean BMD variation of the lumbar vertebrae of 1-4〔(0.029±0.002)g/cm2 vs(0.007±0.001)g/cm2〕,of femoral neck〔0.024(0.012,0.040)g/cm2 vs 0.009(0.003,0.015)g/cm2〕,and of hip〔(0.026±0.017)g/cm2 vs(0.007±0.006)g/cm2〕(P<0.001).The experimental group showed lowe

关 键 词：老年人 高胆固醇血症 骨密度 低骨量 肌力 胆固醇 肌酸激酶 握力 

分 类 号：R589.2[医药卫生—内分泌] R336[医药卫生—内科学]