维生素D与2型糖尿病患者静力性平衡的相关性分析
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摘要
目的分析2型糖尿病患者不同维生素D水平组之间静力性平衡指标的差异,探讨维生素D对平衡功能的影响。方法对86名年龄32~78岁的2型糖尿病患者进行研究,测定体重指数、跟骨骨密度、25(OH)D3水平等指标,应用Foot Scan Balance7.7平板式足底压力测试系统评估静力性平衡功能,获得压力中心的移动轨迹总长度(TTW)及包绕95%压力中心移动轨迹在内的椭圆面积(EA)两项平衡参数,分析维生素D对平衡参数的影响。结果 86名受检者平均年龄(54.99±10.19)岁,男女比例40∶46,按照25(OH)D3水平分为3组:严重缺乏组(<10 ng/ml,n=32);缺乏组(≥10 ng/ml而<20 ng/ml,n=40);不足组(≥20 ng/ml而<30 ng/ml,n=14)。维生素D严重缺乏组压力中心移动轨迹总长度(TTW)及包绕95%压力中心移动轨迹在内的椭圆面积(EA)明显高于不足组,差异存在统计学意义[(10.66±4.42)mm对(97.0±20.1)mm;(11.55±8.78)mm2对(6.58±2.68)mm2,P<0.05]。多元逐步回归分析显示25(OH)D3水平与压力中心移动轨迹总长度(TTW)及包绕95%压力中心移动轨迹在内的椭圆面积(EA)成负相关,相关系数分别为-1.835和-0.247,P<0.05。且独立于年龄、性别、跟骨骨密度等因素。结论糖尿病患者中维生素D水平同静力性平衡之间存在独立负相关,对糖尿病患者进行维生素D的筛查及补充仍有待进一步研究。
Objective To analyze the difference of static equilibrium index among diverse vitamin D level groups in patients with type 2 diabetes mellitus,and to investigate the relationship between vitamin D and balance function. Methods Eight-six patients with type 2 diabetes were enrolled,aged from 32 to 78 years old. Body mass index(BMI),calcaneal bone mineral density(CBMD),and 25-hydroxy vitamin D(25(OH) D3) levels were measured. The static equilibrium abilities were assessed using flat foot pressure measurement system(Foot Scan Balance 7. 7). Static equilibrium index included total traveled way of pressure center(TTW) and 95% confidence ellipse area(EA). The effect of vitamin D on equilibrium index was analyzed. Results Forty-six females and 40 males were included in this study. The average age was(54. 99 ± 10. 19) years old. According to the level of 25(OH) D3,the patients were divided into 3 groups: serious deficiency group(< 10 ng/ml,n = 32),deficiency group(≥10 ng/ml,< 20 ng/ml,n = 40),insufficiency group(≥20 ng/ml, < 30 ng/ml,n = 14). The TTW of pressure center and 95% confidence EA in the severe deficiency group were significantly higher than those in the deficiency group. The difference was statistically significant(10. 66 ± 4. 42 mm vs 97. 0 ± 20. 1 mm,11. 55 ± 8. 78 mm2 vs 6. 58 ± 2. 68 mm2,both P < 0. 05). Multiple stepwise regression analysis showed that the level of 25(OH) D3 was negatively correlated with the TTW of pressure center(r =- 1. 835,P< 0. 05) and 95% confidence EA(r =- 0. 247,P < 0. 05),and was independent of age,gender,and CBMD. Conclusion There is independent negative correlation between the level of vitamin D and the static equilibrium. The screening and supplementing of vitamin D in patients with type 2 diabetes mellitus still needs further research.
Objective To analyze the difference of static equilibrium index among diverse vitamin D level groups in patients with type 2 diabetes mellitus,and to investigate the relationship between vitamin D and balance function. Methods Eight-six patients with type 2 diabetes were enrolled,aged from 32 to 78 years old. Body mass index(BMI),calcaneal bone mineral density(CBMD),and 25-hydroxy vitamin D(25(OH) D3) levels were measured. The static equilibrium abilities were assessed using flat foot pressure measurement system(Foot Scan Balance 7. 7). Static equilibrium index included total traveled way of pressure center(TTW) and 95% confidence ellipse area(EA). The effect of vitamin D on equilibrium index was analyzed. Results Forty-six females and 40 males were included in this study. The average age was(54. 99 ± 10. 19) years old. According to the level of 25(OH) D3,the patients were divided into 3 groups: serious deficiency group(< 10 ng/ml,n = 32),deficiency group(≥10 ng/ml,< 20 ng/ml,n = 40),insufficiency group(≥20 ng/ml, < 30 ng/ml,n = 14). The TTW of pressure center and 95% confidence EA in the severe deficiency group were significantly higher than those in the deficiency group. The difference was statistically significant(10. 66 ± 4. 42 mm vs 97. 0 ± 20. 1 mm,11. 55 ± 8. 78 mm2 vs 6. 58 ± 2. 68 mm2,both P < 0. 05). Multiple stepwise regression analysis showed that the level of 25(OH) D3 was negatively correlated with the TTW of pressure center(r =- 1. 835,P< 0. 05) and 95% confidence EA(r =- 0. 247,P < 0. 05),and was independent of age,gender,and CBMD. Conclusion There is independent negative correlation between the level of vitamin D and the static equilibrium. The screening and supplementing of vitamin D in patients with type 2 diabetes mellitus still needs further research.
引文
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[8]Annweiler C,Schott AM,Rolland Y,et al.Vitamin D deficiency and orthostatic hypotension in oldest-old woman:a multicentric population-based cross-sectional study.J Intern Med2014,276:285-295.
[9]Burke TN,Franca FJ,Meneses SE,et al.Postural control among elderly women with and without osteoporosis;is there a difference?.Sao Paulo Med J,2010,128:219-224.
[10]范璐,林华,陈新,等.老年人群骨密度与平衡功能的相关性.中华骨质疏松和骨矿岩疾病杂志,2014,12:298-307.Fan L,Lin H,Chen X,et al.Association between bone mineral density and balance control ability in elderly population.Chin J0steoporosis&Bone Miner Res,2014,12:298-307.(in Chinese)
[11]Sanders KM,Stuart AL,Williamson EJ,et al.Annual high-dose oral vitamin D and falls and fractures in older women.JAMA,2010,303(18):1815-1822.
[12]Dargent-Molina P,Favier F,Grandjean H,et al.Fall-related factors and risk of hip fracture:the EPIDOS prospective study.Lancet,1996,348:145-149.
[13]Annweiler C,Montero-Odasso M,Llewellyn DJ.Meta-analysis of memory and executive dysfunctions in relation to vitamin D.J Alzheimers Dis,2013,37:147-171.
[2]Hsu WL,Chen CY,Tsauo JY,et al.Balance control in elderly with osteoporosis.Formos Med Assoc,2014,113:334-339.
[3]徐军.多维运动对社区居住老人平衡、灵活性和跌倒危险的干预效果.国外医学:物理医学与康复分册,1998,18:23-25.Xu J.Results of multi-dimensional movement on balance,flexibility and fall risk in community-dwelling elderly people.Foreign medical science:Physical medical and rehabilitation,1998,18:23-25.(in Chinese)
[4]Holick MF.Vitamin D deficiency.N Engl J Med,2007,357(3):266-281.
[5]《人体测量与评价》编写组.人体测量与评价.北京:高教出版社,1990:232-238.The human body measurement and evaluation editorial committee.The human body measurement and evaluation.Beijing:Higher Education Press,1990:232-238.(in Chinese)
[6]Dhesi JK,Beame LM,Moniz C,et al.Neuromuscular and psychomotor function in elderly subjects who fall and the relationship with vitamin D status.J Bone Miner Res,2002,17(5):891-897.
[7]Pfeifer M,Begerow B,Minne HW.Effacts of a long time vitamin D and calcium supplementation on falls and parameters of muscle function incommunity-dwelling older individuals.Osteoporos Int,2009,20(2):315-22.
[8]Annweiler C,Schott AM,Rolland Y,et al.Vitamin D deficiency and orthostatic hypotension in oldest-old woman:a multicentric population-based cross-sectional study.J Intern Med2014,276:285-295.
[9]Burke TN,Franca FJ,Meneses SE,et al.Postural control among elderly women with and without osteoporosis;is there a difference?.Sao Paulo Med J,2010,128:219-224.
[10]范璐,林华,陈新,等.老年人群骨密度与平衡功能的相关性.中华骨质疏松和骨矿岩疾病杂志,2014,12:298-307.Fan L,Lin H,Chen X,et al.Association between bone mineral density and balance control ability in elderly population.Chin J0steoporosis&Bone Miner Res,2014,12:298-307.(in Chinese)
[11]Sanders KM,Stuart AL,Williamson EJ,et al.Annual high-dose oral vitamin D and falls and fractures in older women.JAMA,2010,303(18):1815-1822.
[12]Dargent-Molina P,Favier F,Grandjean H,et al.Fall-related factors and risk of hip fracture:the EPIDOS prospective study.Lancet,1996,348:145-149.
[13]Annweiler C,Montero-Odasso M,Llewellyn DJ.Meta-analysis of memory and executive dysfunctions in relation to vitamin D.J Alzheimers Dis,2013,37:147-171.