不同剂量阿托伐他汀钙对中重度衰弱高龄患者肌少症的影响
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摘要
目的观察不同剂量阿托伐他汀钙对中重度衰弱高龄患者肌少症的影响。方法入选2016年4月至2018年4月就诊于江苏省钟山康复医院康疗科高龄伴中重度衰弱患者98例,随机数字表法分为20 mg组34例,10 mg组33例,未服药组31例,分别检测服药前、服药12和24个月的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)和高密度脂蛋白胆固醇(HDL-C)、握力、4.5 m步行时间、四肢骨骼肌质量指数(ASMI)和衰弱分级。采用SPSS 19.0软件对数据进行分析。组间比较采用t检验、方差分析或χ~2检验。结果服药24个月时,20 mg组患者相比未服药组患者TC[(3.84±0.96)vs(4.36±0.95)mmol/L]、LDL-C[(2.48±1.33)vs(3.19±1.30)mmol/L]、握力[(15.77±3.71)vs(18.58±3.43)kg]和ASMI[(13.90±2.33)vs(15.27±3.16)kg/m~2]降低,相比10 mg组患者TC[(3.84±0.96)vs(4.26±1.03)mmol/L]和LDL-C[(2.48±1.33)vs(3.47±1.41)mmol/L]降低,10 mg组患者相比未服药组患者握力[(15.31±4.71)vs(18.58±3.43)]降低,差异均具有统计学意义(P<0.05)。服药24个月20 mg组患者衰弱分级增加一级的发生率为35.3%(12/34),10 mg组患者为18.2%(6/33),未服药组患者为9.7%(3/31),差异具有统计学意义(P=0.036)。结论他汀类药物可能进一步加剧增龄相关的肌功能下降和衰弱。
Objective To investigate the efficacy of different dosages of atrovastatin calcium on very elderly sarcopenia patients with moderate to severe frailty. Methods Ninety-eight very elderly patients with moderate to severe frailty admitted to our Department of Rehabilitation Medicine from April 2016 to April 2018 were recruited in this study. They were randomly divided into 3 groups, taking 20 mg group(n=34), taking 10 mg group(n=33) and drug withdrawl group(n=31). The levels of triglycerides(TG), total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), and high-density lipoprotein cholesterol(HDL-C) in the peripheral blood, grip strength, 4.5-meter walking time, appendicular skeletal muscle mass index(ASMI), and frailty levels were detected and measured before and after treatment. SPSS statistics 19.0 was used to perform the statistical analysis. Student′s t test, analysis of variance, or Chi-square test was employed for intergroup comparison on different data types. Results After 24 months of treatment, the patients from the 20 mg group had significantly lower TC [(3.84±0.96) vs(4.36±0.95)mmol/L] and LDL-C levels [(2.48±1.33) vs(3.19±1.30)mmol/L], decreased grip strength [(15.77±3.71) vs(18.58±3.43)kg] and ASMI [(13.90±2.33) vs(15.27±3.16)kg/m~2] than those from the drug withdrawl group, and the levels of TC and LDL-C were still lower when compared with those of the 10 mg group [(4.26±1.03),(3.47±1.41)mmol/L, all P<0.05]. The grip strength was significantly lower in the 10 mg group than the drug withdrawal group [(15.31±4.71) vs(18.58±3.43)kg, P<0.05]. Moreover, the incidence of frailty level increasing by at least 1 level was 35.3%(12/34) in the 20 mg group, 18.2%(6/33) in the 10 mg group, and 9.7%(3/31) in the withdraw group(P=0.036). Conclusion Statins may further exacerbate age-related declines in muscle function and accelerate frailty.
Objective To investigate the efficacy of different dosages of atrovastatin calcium on very elderly sarcopenia patients with moderate to severe frailty. Methods Ninety-eight very elderly patients with moderate to severe frailty admitted to our Department of Rehabilitation Medicine from April 2016 to April 2018 were recruited in this study. They were randomly divided into 3 groups, taking 20 mg group(n=34), taking 10 mg group(n=33) and drug withdrawl group(n=31). The levels of triglycerides(TG), total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), and high-density lipoprotein cholesterol(HDL-C) in the peripheral blood, grip strength, 4.5-meter walking time, appendicular skeletal muscle mass index(ASMI), and frailty levels were detected and measured before and after treatment. SPSS statistics 19.0 was used to perform the statistical analysis. Student′s t test, analysis of variance, or Chi-square test was employed for intergroup comparison on different data types. Results After 24 months of treatment, the patients from the 20 mg group had significantly lower TC [(3.84±0.96) vs(4.36±0.95)mmol/L] and LDL-C levels [(2.48±1.33) vs(3.19±1.30)mmol/L], decreased grip strength [(15.77±3.71) vs(18.58±3.43)kg] and ASMI [(13.90±2.33) vs(15.27±3.16)kg/m~2] than those from the drug withdrawl group, and the levels of TC and LDL-C were still lower when compared with those of the 10 mg group [(4.26±1.03),(3.47±1.41)mmol/L, all P<0.05]. The grip strength was significantly lower in the 10 mg group than the drug withdrawal group [(15.31±4.71) vs(18.58±3.43)kg, P<0.05]. Moreover, the incidence of frailty level increasing by at least 1 level was 35.3%(12/34) in the 20 mg group, 18.2%(6/33) in the 10 mg group, and 9.7%(3/31) in the withdraw group(P=0.036). Conclusion Statins may further exacerbate age-related declines in muscle function and accelerate frailty.
引文
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[12] Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J]. Circulation, 2014, 129(25 Suppl 2): S1-S45. DOI: 10.1161/01.cir.0000437738.63853.7a.
[13] Jacobson TA, Ito MK, Maki KC, et al. National lipid association recommendations for patient-centered management of dyslipidemia: part 1 — full report[J]. J Clin Lipidol, 2015, 9(2): 129-169. DOI: 10.1016/j.jacl.2015.02.003.
[14] Aronow WS. Lipid-lowering therapy in older persons[J]. Arch Med Sci, 2015, 11(1): 43-56. DOI: 10.5114/aoms.2015.48148.
[15] Szadkowska I, Stanczyk A, Aronow WS, et al. Statin therapy in the elderly: a review[J]. Arch Gerontol Geriatr, 2010, 50(1): 114-118. DOI: 10.1016/j.archger.2008.12.012.
[16] Petersen LK, Christensen K, Kragstrup J. Lipid-lowering treatment to the end? A review of observational studies and RCTs on cholesterol and mortality in 80+ -year olds[J]. Age Ageing, 2010, 39(6): 674-680. DOI: 10.1093/ageing/afq129.
[17] Lee DS, Markwardt S, Goeres L, et al. Statins and physical activity in older men: the osteoporotic fractures in men study[J]. JAMA Intern Med, 2014, 174(8): 1263-1270. DOI: 10.1001/jamainternmed.2014.2266.
[18] Marcoff L, Thompson PD. The role of coenzyme Ql0 in statin-associated myopathy: a systemic review[J]. J Am Coll Cardiol, 2007, 49(23): 2231-2237. DOI: 10.1016/j.jacc.2007.02.049.
[19] Nishimoto T, Tozawa R, Amano Y, et al. Comparing myotoxic effects of squalene synthase inhibitor,T-91485,and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors in human myocytes[J].Biochem Pharmacol, 2003, 66(11): 2133-2139.
[20] Frishman WH, Aronow WS, Cheng-Lai A. Cardiovascular Drug Therapy in the Elderly[M]. 5th ed. Boca Raton: CRC Press, 2013, 67-103.
[2] Masanes F, Culla A, Navarro-Gonzalez M, et al. Prevalence of sarcopenia in healthy community dwelling elderly in an urban area of Barcelona(Spain)[J]. J Nutr Health Aging, 2012, 16(2): 184-187.
[3] Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype[J]. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-M156.
[4] Rockwood K, Song X, Macknight C, et al. A global clinical measure of fitness and frailty in elderly people[J]. CMAJ, 2005, 173(5): 489-495. DOI: 10.1503/cmaj.050051.
[5] Scott D, Hayes A, Sanders KM, et al. Operational definitions of sarcopenia and their associations with 5-year changes in falls risk in community-dwelling middle-aged and older adults[J]. Osteoporos Int, 2015, 25(1): 187-193. DOI: 10.1007/s00198-013-2431-5.
[6] Landi F, Liperoti R, Russo A, et al. Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study[J]. Clin Nutr, 2012, 31(5): 652-658. DOI: 10.1016/j.clnu. 2012.02.007.
[7] 于普林, 王建业. 加强老年人衰弱综合征的防治研究[J]. 中华老年医学杂志, 2015, 34(12): 1281. DOI: 10.3760/cma.j.issn.0254-9026.2015.12.001. Yu PL, Wang JY. Emphasis on prevention and treatment of frailty syndrome in the elderly[J]. Chin J Geriatr, 2015, 34(12): 1281. DOI: 10. 3760/cma.j.issn.0254-9026.2015.12.001.
[8] Hwang AC, Liu LK, Lee WJ, et al. Association of frailty and cardiometabolic risk among community-dwelling middle-aged and older people: results from the I-Lan Longitudinal Aging Study[J]. Rejuvenation Res, 2015, 18(6): 564-572. DOI: 10.1089/rej.2015.1699.
[9] Pilotto A, Gallina P, Panza F, et al. Relation of statin use and mortality in community-dwelling frail older patients with coronary artery disease[J]. Am J Cardiol, 2016, 118(11): 1624-1630. DOI: 10.1016/j.amjcard.2016.08.042.
[10] Yang G, Wang Y, Zeng Y, et al. Rapid health transition in China,1990-2010: findings from the Global Burden of Disease Study 2010[J]. Lancet, 2013, 381(9882): 1987-2015. DOI: 10.1016/S0140-6736(13)61097-1.
[11] European Association for Cardiovascular Prevention & Rehabilitation, Reiner Z, Catapano AL, et al. ESC/EAS guidelines for the management of dyslipidaemias: the task force for the management of dyslipidaemias of the European Society of Cardiology(ESC)and the European Atherosclerosis Society(EAS)[J]. Eur Heart J, 2011, 32(14): 1769-1818. DOI: 10.1093/eurheartj/ehr158.
[12] Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J]. Circulation, 2014, 129(25 Suppl 2): S1-S45. DOI: 10.1161/01.cir.0000437738.63853.7a.
[13] Jacobson TA, Ito MK, Maki KC, et al. National lipid association recommendations for patient-centered management of dyslipidemia: part 1 — full report[J]. J Clin Lipidol, 2015, 9(2): 129-169. DOI: 10.1016/j.jacl.2015.02.003.
[14] Aronow WS. Lipid-lowering therapy in older persons[J]. Arch Med Sci, 2015, 11(1): 43-56. DOI: 10.5114/aoms.2015.48148.
[15] Szadkowska I, Stanczyk A, Aronow WS, et al. Statin therapy in the elderly: a review[J]. Arch Gerontol Geriatr, 2010, 50(1): 114-118. DOI: 10.1016/j.archger.2008.12.012.
[16] Petersen LK, Christensen K, Kragstrup J. Lipid-lowering treatment to the end? A review of observational studies and RCTs on cholesterol and mortality in 80+ -year olds[J]. Age Ageing, 2010, 39(6): 674-680. DOI: 10.1093/ageing/afq129.
[17] Lee DS, Markwardt S, Goeres L, et al. Statins and physical activity in older men: the osteoporotic fractures in men study[J]. JAMA Intern Med, 2014, 174(8): 1263-1270. DOI: 10.1001/jamainternmed.2014.2266.
[18] Marcoff L, Thompson PD. The role of coenzyme Ql0 in statin-associated myopathy: a systemic review[J]. J Am Coll Cardiol, 2007, 49(23): 2231-2237. DOI: 10.1016/j.jacc.2007.02.049.
[19] Nishimoto T, Tozawa R, Amano Y, et al. Comparing myotoxic effects of squalene synthase inhibitor,T-91485,and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors in human myocytes[J].Biochem Pharmacol, 2003, 66(11): 2133-2139.
[20] Frishman WH, Aronow WS, Cheng-Lai A. Cardiovascular Drug Therapy in the Elderly[M]. 5th ed. Boca Raton: CRC Press, 2013, 67-103.