小腿围降低和维生素D缺乏对社区老年人全因死亡风险的联合作用  

Combined effects of low calf circumference and vitamin D deficiency on all-cause mortality among community-dwelling older adults

作　　者：张驰[1] 韩怡文[1] 沈姞[2] 李瑞奇 杨苏瑞 曾平[1] Zhang Chi;Han Yiwen;Shen Ji;Li Ruiqi;Yang Surui;Zeng Ping(The Key Laboratory of Geriatrics,Beijing Institute of Geriatrics,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing Hospital,National Center of Gerontology of National Health Commission,Beijing 100730,China;Department of Geriatrics,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院国家老年医学中心、国家卫生健康委北京老年医学研究所、国家卫生健康委老年医学重点实验室、中国医学科学院老年医学研究院,北京100730 [2]北京医院老年科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2023年第7期848-853,共6页Chinese Journal of Geriatrics

基　　金：中央高水平医院临床科研业务费项目(BJ-2022-133);国家重点研发计划(2022YFC2010100)。

摘　　要：目的基于中国老年健康追踪调查,探讨小腿围和维生素D水平对社区老年人全因死亡风险的独立和联合作用。方法在2012年和2014年的基线调查中测量小腿围,男性<34 cm或女性<33 cm为小腿围降低;血浆25-羟基维生素D[25(OH)D]低于50 nmol/L为维生素D缺乏。调查对象被随访至2018年,在追踪调查中收集死亡结局和生存时间,使用Cox比例风险回归模型分析小腿围和25(OH)D对全因死亡风险的影响。结果共有3052名老年人被纳入分析,其中1960名(64.22%)存在小腿围降低,2245名(73.56%)存在维生素D缺乏。经过10559.9人年的随访后,1312名老年人死亡。在校正社会人口学特征、活动能力、认知功能和多种慢性疾病后,小腿围和25(OH)D水平均与全因死亡风险呈负相关(趋势性均P<0.05)。在联合分析中,与正常组老年人比较,合并出现小腿围降低和维生素D缺乏时死亡风险最高,高于单独小腿围降低和单独维生素D缺乏,风险比(HR)(95%CI)分别为2.51(1.81~3.45)、1.71(1.22~2.42)和1.53(1.09~2.15),二者存在相加交互作用[相对超危险度比(RERI)>0]。结论小腿围降低和维生素D缺乏均与较高的死亡率有关,且合并出现时老年人的死亡风险更高,应重视联合筛查和综合干预。Objective To investigate the individual and combined effects of calf circumference and vitamin D levels on all-cause mortality risk in community-dwelling older adults based on the Chinese Longitudinal Healthy Longevity Survey.MethodsThe calf circumference was measured in the baseline survey in 2012 and 2014.Low calf circumference was defined as<34 cm for men or 33 cm for women at screening.Vitamin D deficiency was defined as plasma 25-hydroxyvitamin D[25(OH)D]levels<50 nmol/L.All participants were followed up until 2018,when death outcomes and survival time were collected.Cox proportional hazard regression models were used to analyze the effects of calf circumference and 25(OH)D levels on the risk of all-cause mortality.ResultsA total of 3052 older adults were included in the analysis,of which 1960(64.22%)had low calf circumference and 2245(73.56%)had vitamin D deficiency.After 10559.9 person-years of follow-up period,1312 death events were recorded.After adjusting for sociodemographic characteristics,physical activities,cognitive function,and multiple chronic diseases,calf circumference and 25(OH)D levels were negatively associated with the risk of all-cause mortality(both P<0.05).In the combined analysis,compared with the normal group,the risk of death was highest in the participants with both low calf circumference and vitamin D deficiency,which was higher than those with low calf circumference or vitamin D deficiency alone,with a hazard ratios(HR)(95%CI)of 2.51(1.81-3.45),1.71(1.22-2.42)and 1.53(1.09-2.15),respectively.There was a significant additive interaction between low calf circumference and vitamin D deficiency on mortality(RERI>0).ConclusionsLow calf circumference and vitamin D deficiency are associated with higher mortality.Older adults with combined conditions had a even higher risk of death.Attention should be paid to joint screening and comprehensive intervention for older adults with both low calf circumference and vitamin D deficiency.

关 键 词：维生素D 死亡率 小腿围 

分 类 号：R592[医药卫生—老年医学]