老人維生素D 受體基因多型性與骨質狀況及相關代謝指標之相關性

Associations of polymorphisms in the vitamin D receptor gene with broadband ultrasound attenuation and bone turnover markers in elderly Taiwanese

蔡依婷(Yi-Ting Tsai)

指導教授 ： 林以勤

中山醫學大學/健康管理學院/營養學系碩士班/碩士(2010年)

https://doi.org/10.6834/CSMU.2010.00036

摘要

活化態維生素D與維生素D受體結合後可能對蝕骨作用及鈣的吸收等機制進行調控，而影響骨骼健康。有關維生素D受體基因多型性與骨質疏鬆、骨密度、骨質指標BUA及骨相關代謝指標的相關性目前尚未有一致的結論。本研究目的是探討台灣老年族群維生素D受體基因多型性 (BsmΙ、ApaΙ、TaqΙ) 與超音波寬頻衰減 (broadband ultrasound attenuation, BUA) 及骨質相關代謝指標之相關性。研究對象乃自「竹東朴子地區心臟血管疾病長期追蹤研究 (Cardiovascular Disease Risk Factor Two-township Study, CVDFACTS)」之世代中曾參與1999-2002 年間進行之第五次普查 (第五循環) ，由當時完成問卷訪視及預計進行本研究體檢時滿65歲以上之個案中抽樣。共計收集196位受試者 (男性107位、女性89位) 之資料及檢體採集，分析基因多型性 (維生素D受體) 、維生素D營養狀況生化指標 (25-(OH)D) 、副甲狀腺素濃度、骨代謝狀況指標分析 (蝕骨作用指標ICTP、成骨作用指標osteocalcin) 、同半胱胺酸濃度。結果顯示，維生素D受體基因多型性分布狀況 (ApaΙ帶有AA基因者：7.1%、Aa基因者：47.9%、aa基因者：44.8%；BsmΙ帶有BB基因者：0.5%、Bb基因者：7.6%、bb

基因者：91.8%；TaqΙ帶有TT基因者：92.8%、Tt基因者：6.6%、tt基因者：0.5%) ；蝕骨指標ICTP在男性帶有aa基因者顯著高於AA+Aa組 (2.8±1.6 VS. 1.7±1.3 ng/mL ) ; 維生素D、副甲狀腺素濃度、成骨作用指標、BUA、BUA改變量在各組間則無顯著差異。蝕骨指標ICTP、維生素D、副甲狀腺素濃度、成骨作用指標、BUA、BUA change%在女性各組間則無顯著差異。

關鍵字

維生素D受體基因 ； broadband ultrasound attenuation ； 蝕骨作用指標 ； 成骨作用指標 ； 老人

並列摘要

The vitamin D endocrine system is center to the regulation of bone and calcium homeostasis. The active form of vitamin D acts through a specific receptor to mediate its genomic actions on almost every aspect of calcium homeostasis. The alterations of the vitamine D receptor gene could result in variation in the gene activation, and thus affecting calcium and bone metabolism. Recent studies reported that the use of vitamin D receptor gene polymorphisms as a predictor for bone turnover rate or bone mass remains controversial. In the current study, we examined in elderly Taiwanese the interrelationships between VDR polymorphisms, BUA, and bone turnover markers including carboxyterminal cross-linked telopeptide of type I collagen (ICTP), serum osteocalcin (OC). This study was carried out among the Cardiovascular Disease Risk Factor Two-township Study (between 1999 and 2002), CVDFACTS, a prospective study for the determinants of risk factors of cardiovascular disease. Data collected from 196 healthy elderly subjects were analyzed, including the polymorphisms in the vitamin D receptor (ApaI, TaqI and BsmI), BUA, and bone turnover markers. The distributions of ApaI, TaqI and BsmI restriction site of VDR genotypes are similar to that reported in other Asian populations (55%A, 3.5%B and 4.5% t). The mean bone

resorption marker ICTP in males was significantly higher (p=0.0008) in the aa genotype group than in the AA+Aa subgroup, whereas the serum concentrations of 25-hydroxyvitamin D3, parathyroid hormone, osteocalcin as well as BUA and BUA change% in 5 years did not differ by the genotypes. The serum levels of ICTP, but not 25-hydroxyvitamin D3, parathyroid hormone, osteocalcin, BUA, nor BUA change% correlated significantly with the homozygous aa genotype in males.

並列關鍵字

vitamin D receptor gene polymorphism ； broadband ultrasound attenuation ； bone turnover marker ； elderly Taiwanese

參考文獻

Alvarez-Hernandez D, Naves M, Diaz-Lopez JB, Gomez C, Santamaria I, Cannata-Andia JB. Influence of polymorphisms in VDR and COLIA1 genes on the risk of osteoporotic fractures in aged men. Kidney Int 2003; 63 (suppl): 14-18.

Anonymous. Consensus development conference V. Diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 1993; 94: 646-650.

Arabi A, Mahfoud Z, Zahed L, El-Onsi L, El-Hajj Fuleihan G. Effect of age, gender and calciotropic hormones on the relationship between vitamin D receptor gene polymorphisms and bone mineral density. Eur J of Clin Nutr 2010; 1-9.

Arden NK, Baker J, Hogg C, Baan K, Spector TD. The heritability of bone mineral density, ultrasound of the calcaneus and hip axis length: a study of postmenopausal twins. J Bone Miner Res 1996; 11: 530-534.

Arden NK, Spector TD. Genetic influences on muscle strength, lean body mass, and bone mineral density:a twin study. J Bone Miner Res 1997; 12: 2076-2081.