维生素D补充结合膳食调整对老年男性糖尿病合并肌少-骨质疏松症患者血糖水平和骨密度的影响  

Effects of vitamin D supplementation combined with dietary adjustment on blood glucose level and bone mineral density in elderly male patients with diabetes combined with osteosarcopenia

作　　者：董娟[1] 李悦芃 张任飞[1] 赵籥陶[1] 邱蕾[1] Dong Juan;Li Yuepeng;Zhang Renfei;Zhao Yuetao;Qiu Lei(Department of Health Care,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院保健医疗部,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》2024年第6期681-686,共6页Chinese Journal of Geriatrics

基　　金：中央保健科研课题(2020YB07)。

摘　　要：目的:探究维生素D联合膳食调整对老年男性糖尿病合并肌少-骨质疏松症患者的治疗效果。方法:选取自2021年1月至2023年5月北京医院收治的老年男性糖尿病合并肌少-骨质疏松症的患者108例作为研究对象。采用随机数字表法将其分为对照组(54例)和试验组(54例)。对照组采用常规膳食调整法进行治疗,试验组在此基础上补充普通维生素D。观察两组患者治疗前后25-羟维生素D 3[25-(OH)-VitD 3]、血糖水平、四肢骨骼肌质量指数(ASMI)、骨密度及骨代谢指标。结果:与治疗前比较,两组患者25-(OH)-VitD 3、握力、6 m步速、ASMI均有升高,空腹血糖、餐后2 h血糖均有降低(均P<0.05);试验组治疗后25-(OH)-VitD 3水平、握力、6 m步速、ASMI高于对照组,空腹血糖、餐后2 h血糖均低于对照组(均P<0.05)。与治疗前(对照组骨密度腰椎:0.41±0.09、髋部:0.42±0.12;试验组骨密度腰椎:0.43±0.07、髋部:0.44±0.09)比较,两组患者治疗后腰椎、髋部的骨密度值均升高(对照组骨密度腰椎:0.76±0.12、髋部:0.78±0.12;试验组骨密度腰椎:0.95±0.22、髋部:0.97±0.28)(均P<0.05);试验组治疗后腰椎、髋部的骨密度值均高于对照组(均P<0.05)。两组患者血清甲状旁腺激素(PTH)和破骨细胞分化因子(RANKL)浓度显著降低,血清骨钙素(OCN)显著升高(均P<0.05);试验组治疗后血清PTH和RANKL浓度显著低于对照组,血清OCN显著高于对照组(均P<0.05)。结论:膳食调整期间补充维生素D能够显著改善糖尿病合并肌少-骨质疏松症患者的血糖水平,减少骨丢失,提高骨密度,增加肌肉质量。Objective To investigate the therapeutic impact of combining vitamin D supplementation with dietary adjustments on elderly male patients with diabetes and osteosarcopenia.Methods From January 2021 to May 2023,a total of 108 male patients diagnosed with diabetes and osteosarcopenia were admitted to Beijing hospital for research purposes.The patients were randomly assigned to either a control group(n=54)or a trial group(n=54).The control group received conventional dietary adjustments,while the trial group received vitamin D supplementation in addition to dietary adjustments.Various parameters including 25-(OH)-VitD3 levels,blood glucose levels,appendicular skeletal muscle mass index(ASMI),bone mineral density,and bone metabolism indexes were measured before and after the treatment in both groups.Results Compared to the pre-treatment period,the levels of 25-(OH)-VitD3,grip strength,6 m step speed,and ASMI increased in both groups,while fasting blood glucose and 2 h postprandial blood glucose decreased significantly(all P<0.05).Additionally,the experimental group showed higher levels of 25-(OH)-VitD3,grip strength,6 m step speed,and ASMI compared to the control group post-treatment,with lower levels of fasting blood glucose and 2 h postprandial blood glucose(all P<0.05).Compared with the pre-treatment period(bone density values in the lumbar spine:0.41±0.09,the hip:0.42±0.12 in the control group;bone density values in the lumbar spine:0.43±0.07,the hip:0.44±0.09 in the experimental group),the bone density values of the lumbar spine and the hip were higher in both groups after treatment(bone density values in the lumbar spine:0.76±0.12,the hip:0.78±0.12 in the control group;bone density values in the lumbar spine:0.95±0.22,the hip:0.97±0.28 in the experimental group).The bone density values of the lumbar spine and the hip in the experimental group were higher than those of the control group after treatment(all P<0.05).Furthermore,serum concentrations of parathyroid hormone(PTH)and osteoclast differentiation f

关 键 词：维生素D 糖尿病 肌少症 骨质疏松 骨密度 

分 类 号：R587.2[医药卫生—内分泌] R580[医药卫生—内科学]