中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2017, Vol. 39 ›› Issue (3): 345-351.doi: 10.3881/j.issn.1000-503X.2017.03.008

• 论著 • 上一篇    下一篇

强化运动、维生素D和钙剂补充对绝经后女性肌力及骨折的影响

薛瑜1, 胡莹莹2, 王鸥1, 王春艳3, 韩桂艳4, 沈蔷5, 邓红月5, 姜艳1, 李梅1, 夏维波1, 邢小平1(), 徐苓6   

  1. 中国医学科学院 北京协和医学院 北京协和医院 1内分泌科国家卫生和计划生育委员会内分泌重点实验室2检验科,北京 100730
    3航空总医院内分泌科,北京 100012
    4北京市东城区卫生服务管理中心,北京 100010
    5北京市东城区社区卫生服务管理中心,北京 100010
    6中国医学科学院 北京协和医学院 北京协和医院妇产科,北京100730
  • 收稿日期:2016-06-20 出版日期:2017-06-30 发布日期:2017-06-20
  • 作者简介:

    通信作者:邢小平 电话/传真:010-69155084,电子邮件:xingxp2006@126.com

  • 基金资助:
    基金项目:国家科技支撑计划(2006BAI02B03)、国家自然科学基金青年基金(81100559)、国家自然科学基金面上项目(81270873)和国家临床重点专科建设项目(WBYZ2011-873)

Effects of Enhanced Exercise and Combined Vitamin D and Calcium Supplementation on Muscle Strength and Fracture Risk in Postmenopausal Chinese Women

Yu XUE1, Yingying HU2, Ou WANG1, Chunyan WANG3, Guiyan HAN4, Qiang SHEN5, Hongyue DENG5, Yan JIANG1, Mei LI1, Weibo XIA1, Xiaoping XING1(), Ling XU6   

  1. 1Key Laboratory of Endocrinology of National Health and Family Planning Commission,Department of Endocrinology,2Department of Laboratory,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
    3Department of Endocrinology,Aviation General Hospital,Beijing 100012,China
    4Health Service Management Center in Dongcheng District,Beijing 100010,China
    5Community Health Service Management Center in Dongcheng District,Beijing 100010,China
    6Department of Gynecology and Obstetrics,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
  • Received:2016-06-20 Online:2017-06-30 Published:2017-06-20
  • Supported by:
    Supported by the National Key Technology R&D Program(2006BAI02B03),the National Natural Sciences Foundation-Youth Foundation(81100559),the National Natural Sciences Foundation-General Program(81270873),and the National Key Specialty Construction of Clinical Projects(WBYZ2011-873)

摘要:

目的 观察强化运动、不同维生素D制剂和钙剂补充对绝经后骨质疏松高危人群肌力及骨折的影响。方法 纳入北京市东城区绝经后女性614名,具有骨质疏松高危因素,随机分为4组:(1)A组(n=173):对照组;(2)B组(n=171):强化运动组;(3)C组(n=139):给予元素钙600 mg/d+普通维生素D 800 U/d;(4)D组(n=131):给予元素钙600 mg/d+25羟基维生素D(25OHD)0.25 μg/d。随访2年,测定基线、随访1年及2年肌力,测定基线及随访2年骨转换指标;记录跌倒及新发骨折次数。结果 92.6%的受试者基线血清25OHD<50 nmol/L。与基线水平比较,A组在随访2年时左手握力(t=-3.252,P=0.001)较基线显著降低,B组1年时右手握力明显下降(t=2.460,P=0.015),C组1年时左手握力显著升高(t=-2.051,P=0.043),D组2年随访中双手握力均无统计学变化(P>0.05)。随访2年时,A(t=-2.962,P=0.004)、B(t=-2.888,P=0.005)、C组(t=-2.441,P=0.016))血清Ⅰ型前胶原氨基末端前肽水平显著高于基线,B(t=2.285,P=0.024)、D组(t=2.596,P=0.011)Ⅰ型胶原交联羧基末端肽水平显著低于基线。结论 强化运动及补充钙和25OHD可能有利于维持改善绝经后女性肌力,补充钙和维生素D可能短期内改善绝经后女性肌力。

关键词: 维生素D, 绝经后女性, 强化运动, 肌力, 骨折

Abstract:

Objective To observe the effects of enhanced exercise and combined vitamin D and calcium supplementation on muscular strength and fracture occurrence in postmenopausal women with a high risk of osteoporosis.Methods Totally 614 postmenopausal women at high risk factors of osteoporosis were enrolled in Dongcheng district of Beijing and randomized into four groups:group A(control group,n=173),group B(regular Tai Chi exercise,n=171),group C(calcium 600 mg/d+VitD3 800 U/d,n=139),and group D[calcium 600 mg/d+25 hydroxyl vitamin D(25OHD) 0.25 μg/d,n=131].Muscular strength was measured at baseline and one and two years after intervention.Bone turnover markers were measured at baseline and during the two-year follow-up.Falls and fractures were recorded.Results The incidence of 25OHD<50 nmol/L was approximately 92.6%.During the follow-up,the left grip strength decreased significantly two years after intervention(t=-3.252,P=0.001)in group A.Right grip strength decreased significantly in group B(t=2.460,P=0.015)while left grip strength improved significantly in group C(t=-2.051,P=0.043)one year after intervention.In group D,muscular strength in both 12-month and 24-month did not change compared with baseline(both P>0.05).Furthermore,serum procollagen type I N-terminal propeptide elevated significantly in group A(t=-2.962,P=0.004),group B(t=-2.888,P=0.005),and group C(t=-2.441,P=0.016),whereas β-C-terminal telopeptide of type I collagen decreased significantly in group B(t=2.285,P=0.024)and group D(t=2.596,P=0.011)two years after intervention.Conclusion Enhanced exercise and combined calcium vitamin D supplementation may help sustain muscle strength in postmenopausal women,while calcium and vitamin D supplementation may improve muscular strength within a short period of time.

Key words: vitamin D, postmenopausal women, enhanced exercise, muscular strength, fracture

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