阿托伐他汀对老年高胆固醇血症合并低骨量患者骨量和肌力的作用效果研究

背景　既往研究发现他汀类药物具有激活成骨细胞、促进骨合成代谢的作用，为临床治疗老年骨质疏松症提供了新的思路。但在社区老年人中，他汀类药物是否有治疗骨质疏松症的作用，目前尚不清楚。对低骨量者，他汀类药物是否可延缓骨量丢失速度，国内较少文献报道。目的　研究阿托伐他汀对老年高胆固醇血症合并低骨量患者骨量和肌力的作用效果。方法　2014年7—9月将上海市周家桥社区管理的401例老年高胆固醇血症〔总胆固醇（TC）>6.99 mmol/L〕合并低骨量〔-2.50.05），骨转换指标、除TC外的生化指标、肌力比较，差异有统计学意义（P<0.05）。干预2年后，试验组BMDL1~4、BMD股骨颈及BMD髋部的变化量分别为（0.029±0.002）、0.024（0.012，0.040）、（0.026±0.017）g/cm2，均大于对照组的（0.007±0.001）、0.009（0.003,0.015）、（0.007±0.006）g/cm2（P<0.001）；试验组β-CTX、PINP变化量分别为（-0.151±0.087）、（-17.57±16.89）μg/L，均小于对照组的（-0.020±0.017）、（-3.48±6.29）μg/L（P<0.001）；试验组CK变化量为0.17（0.11，0.18）U/L，大于对照组的-0.01（-0.02，0.01）U/L（P<0.001）；试验组AST变化量为（1.20±0.31）U/L，大于对照组的（1.07±0.31）U/L（P<0.001）；试验组TC变化量为（-2.68±0.10） mmol/L，大于对照组的（-0.25±0.00）mmol/L（P<0.001）；试验组左、右握力变化量分别为（-1.99±1.34）、（-2.28±1.26）kg，大于对照组的（1.18±1.77）、（1.10±1.80）kg（P<0.001）。他汀类药物干预后，试验组左、右手握力与CK之间无直线相关性（r=0.050，P=0.480；r=-0.105，P=0.141）；左、右手握力与TC之间呈正相关（r=0.302，P<0.001；r=0.462，P<0.001）。结论　阿托伐他汀能够减缓增龄性骨丢失，提高BMD，抑制骨转换；但使上肢肌力明显降低。建议服用阿托伐他汀的老年人应加强肌力训练。

Effects of Atorvastatin on Bone Mass and Muscle Strength in Elderly Patients with Hypercholesterolemia Combined with Low Bone Mass

Background Previous studies found that statins can activate osteoblasts and promote bone anabolic effect,thus providing a new perspective for clinical treatment of osteoporosis in the elderly.But it is not clear whether statins can treat osteoporosis in the elderly in the local community.There is also no literature in China about whether statins can retardbone mass loss rate of those with low bone mass.Objective To study the effects of atorvastatin on bone mass and muscle strength in elderly patients with hypercholesterolemia combined with low bone mass.Methods 401 elderly patients with hypercholesterolemia〔total cholesterol(TC)>6.99 mmol/L〕and low bone mass(-2.50.05),the bone turnover markers,biochemical markers(except TC),and hand grip strength showed significant differences between the groups(P<0.05).After two years'intervention,compared with the control group,the experimental group showed greater mean BMD variation of the lumbar vertebrae of 1-4〔(0.029±0.002)g/cm2 vs(0.007±0.001)g/cm2〕,of femoral neck〔0.024(0.012,0.040)g/cm2 vs 0.009(0.003,0.015)g/cm2〕,and of hip〔(0.026±0.017)g/cm2 vs(0.007±0.006)g/cm2〕(P<0.001).The experimental group showed lower mean variation of beta-CTX〔(-0.151±0.087)μg/L vs(-0.020±0.017)μg/L〕,and of PINP〔(-17.57±16.89)μg/L vs(-3.48±6.29)μg/L〕(P<0.001).The mean variation of CK of the experimental group was higher than that of the control group〔0.17(0.11,0.18)U/L vs-0.01(-0.02,0.01)U/L〕(P<0.05),the mean variation of AST of the experimental group was higher than that of the control group〔(1.20±0.31)U/L vs(1.07±0.31)U/L〕(P<0.001),the mean variation of TC of the experimental group was higher than that of the control group〔(-2.68±0.10)mmol/L vs(-0.25±0.00)mmol/L〕(P<0.001).Moreover,the experimental group also demonstrated higher left-hand grip strength〔(-1.99±1.34)kg vs(1.18±1.77)kg〕and higher right-hand grip strength〔(-2.28±1.26)kg vs(1.10±1.80)kg〕(P<0.001).After the intervention of statins,there was no linear correlation of CK with the left-or right-hand grip strength within the intervention group(r=0.050,P=0.480;r=-0.105,P=0.141).But both left-and right-hand grip strength and TC were positively correlated(r=0.302,P<0.001;r=0.462,P<0.001).Conclusion Atorvastatin could slow the increase of age-related bone loss,increase BMD,and inhibit bone turnover,but might decrease the muscle strength of the upper limb significantly.Thus,the elderly taking atorvastatin should strengthen muscle strength training.