目的 探讨补充维生素D对老年慢性肌肉骨骼疼痛患者抑郁症状的影响。方法 选取2019-10至2020-10北京医院骨科和神经内科住院的慢性肌肉骨骼疼痛合并抑郁患者152例,年龄60~80岁,采用随机数字表法分为观察组和对照组,每组76例。两组除予以常规治疗,分别补充2000 U/d(观察组)或400 U/d(对照组)维生素D3胶丸,治疗时间均为12周。对两组进行老年抑郁量表(GDS-30)问卷和25-羟基-维生素D [25-hydroxyvitamin D,25(OH)D]分析。抑郁评分作为因变量进行多元回归分析,评估抑郁症状的影响因素。结果 共入组受试者148例,观察组75例,对照组73例,治疗前观察组25(OH)D基线浓度中位数与对照组基本一致(Z=0.232,P>0.05)。干预前两组抑郁评分也基本相同,差异无统计学意义。干预12周后,观察组25(OH)D明显高于对照组,差异有统计学意义(P<0.05)。且干预后,观察组的58例(90.7％)维生素D水平正常,明显高于对照组的17例(23.3％),差异有统计学意义(P<0.05)。多元回归分析显示,干预分组和干预前的抑郁评分是影响干预后抑郁评分的因素(R2=0.727,F=62.459,P<0.05)。结论 补充维生素D可以降低60岁及以上人群的抑郁评分,有助于老年慢性肌肉骨骼疼痛患者抑郁症状的缓解。
Abstract
Objective To investigate the effect of vitamin D supplementation on depressive symptoms in elderly patients with chronic musculoskeletal pain. Methods A total of 152 patients with chronic musculoskeletal pain and depression who were hospitalized between October 2019 and October 2020 in the Department of Orthopedics and Neurology of Beijing Hospital were selected, who were aged 60 to 80. The patients were divided into the intervention group (n=76) and the observation group (n=76) using the random number table method. In addition to conventional treatment, the two groups were supplemented with vitamin D. Both groups received vitamin D3 supplementation of 2000U (intervention group) or 400U (control group) daily for 12 weeks, respectively. The main outcome measures included the Geriatric Depression Scale (GDS-30) questionnaire and 25-hydroxyvitamin D [25(OH)D]. The chi-square test was used for the comparison of classified variables while the Mann Whitney U test and Wilcoxon signed rank sum test were used for the comparison of continuous variables. Multiple regression analysis was conducted with the depression score as the dependent variable to evaluate the influencing factors of depressive symptoms. Results A total of 148 subjects were enrolled, including 75 in the intervention group and 73 in the control group. There was no statistically significant difference in the shedding rate and elimination rate between the two groups. There was no significant difference in gender, age, levels of education, lifestyles or concomitant diseases between the two groups. The median baseline concentration of 25(OH)D was 12.4 ng/ml in the intervention group and 12.8 ng/ml in the control group. The depression scores of the two groups before intervention were 15 and 14 respectively (Z=1.714). After 12 weeks, 25(OH)D increased to 34.6 ng/ml in the intervention group (P<0.05) and to 19.5 ng/ml in the control group.Depression scores decreased from 15 points to 12 points in the intervention group (P<0.05), and from 14 points to 13 points in the control group.The increase of 25(OH)D levels and the improvement of depression in the intervention group were significantly better than in the control group. Multiple regression analysis showed that intervention grouping and pre-intervention depression scores were influencing factors of post-intervention depression scores (R2=0.727,F=62.459,P<0.05). Conclusions Vitamin D supplementation may reduce depression scores in people aged 60 or above and contribute to the improvement of depressive symptoms in elderly patients with chronic musculoskeletal pain.
关键词
维生素D /
老年 /
抑郁 /
严重程度
Key words
vitamin D /
aging /
depression /
severity
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