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口服和肠外维生素 D 补充对老年人的影响:一项前瞻性、双盲、随机、安慰剂对照研究。

The effect of oral and parenteral vitamin D supplementation in the elderly: a prospective, double-blinded, randomized, placebo-controlled study.

机构信息

Internal Medicine, Adana Numune Training and Research Hospital, 01960 Adana, Turkey.

出版信息

Rheumatol Int. 2012 Aug;32(8):2279-83. doi: 10.1007/s00296-011-1943-6. Epub 2011 May 10.

Abstract

Hypovitaminosis D in the elderly causes falls and fractures as a result of impaired neuromuscular functions and also may be a reason for nonspecific musculosceletal pain. The aim of this study is to investigate the benefits of a single dose per os or parenterally administrated vitamin D on increasing the quality of life and functional mobility and decreasing the pain in the elderly. The community-dwelling elderly subjects over 65 years age were included in the study. The subjects were given 300.000 IU Vitamin D via per os and parenteral route and assessed after 4 weeks. The serum creatinine, calcium, phosphorous, ALT, ALP, 24-h urine calcium excretion, PTH, and vitamin D levels, as well as VAS (visual analog scale) for pain assessment, functional mobility with TUG (timed up and go test) and quality of life with SF-36 before and after the treatment were evaluated. The serum vitamin D levels were measured by the RIA method. The subjects were divided into four groups each consisting of 30 subjects. The 1st group took i.m. vitamin D, the 2nd group took i.m. placebo, the 3rd group took p.o. vitamin D, and the 4th group took p.o. placebo. The mean age of all the participants was 70.1 ± 4.3 years. There was no difference in the age and gender between the groups (P > 0.05). After treatment, the PTH level of first group was decreased (P = 0.0001) and the vitamin D level increased (P = 0.0001) significantly. In the third group, the PTH level of first group was decreased (P = 0.0001) and the vitamin D level increased (P = 0.004) and the 24-h calcium excretion in urine (P = 0.015) increased significantly. When the pain, the functional mobility, and the quality of life were evaluated, in the first group, the TUG (P = 0.0001) and the VAS (P = 0.0001) decreased significantly, whereas the SF-36 subtitles: physical functioning (P = 0.0001), role physical (0.006), bodily pain (P = 0.0001), general health (P = 0.007), social functioning (P = 0.05), and mental health (P = 0.048) increased significantly. In group two, the VAS (P = 0.001) decreased, the role physical (P = 0.009), and role emotional (P = 0.034) increased significantly; In group three, the TUG (P = 0.0001) and the VAS (P = 0.002) decreased, whereas the physical function (P = 0.0001) and role physical (0.001) increased significantly; In group four, the VAS (P = 0.007) decreased significantly. The megadose vitamin D administration increases quality of life, decreases pain, and improves functional mobility via po or im route in the elderly.

摘要

维生素 D 缺乏症会导致老年人的神经肌肉功能受损,从而引起跌倒和骨折,也可能是导致非特异性肌肉骨骼疼痛的原因。本研究旨在探讨口服或肌肉注射维生素 D 单次剂量对提高生活质量和改善功能活动能力、减轻老年人疼痛的益处。本研究纳入了年龄在 65 岁以上的社区居住的老年人。给予受试者 30 万国际单位的维生素 D 口服和肌肉注射,并在 4 周后进行评估。在治疗前后评估血清肌酐、钙、磷、ALT、ALP、24 小时尿钙排泄、PTH 和维生素 D 水平,以及疼痛评估的视觉模拟量表(VAS)、TUG(计时站立和行走测试)的功能活动能力和 SF-36(健康调查简表)的生活质量。血清维生素 D 水平采用放射免疫法测定。受试者分为四组,每组 30 人。第 1 组接受肌肉注射维生素 D,第 2 组接受肌肉注射安慰剂,第 3 组接受口服维生素 D,第 4 组接受口服安慰剂。所有参与者的平均年龄为 70.1 ± 4.3 岁。组间年龄和性别无差异(P > 0.05)。治疗后,第 1 组的 PTH 水平降低(P = 0.0001),维生素 D 水平升高(P = 0.0001)。第 3 组第 1 组的 PTH 水平降低(P = 0.0001),维生素 D 水平升高(P = 0.004),24 小时尿钙排泄量增加(P = 0.015)。评估疼痛、功能活动能力和生活质量时,第 1 组 TUG(P = 0.0001)和 VAS(P = 0.0001)显著降低,而 SF-36 子标题:身体机能(P = 0.0001)、角色身体(0.006)、身体疼痛(P = 0.0001)、一般健康(P = 0.007)、社会功能(P = 0.05)和心理健康(P = 0.048)显著升高。第 2 组 VAS(P = 0.001)降低,角色身体(P = 0.009)和角色情绪(P = 0.034)升高;第 3 组 TUG(P = 0.0001)和 VAS(P = 0.002)降低,身体功能(P = 0.0001)和角色身体(0.001)升高;第 4 组 VAS(P = 0.007)显著降低。大剂量维生素 D 给药可通过口服或肌肉注射途径提高老年人的生活质量,减轻疼痛,改善功能活动能力。

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