冠心病患者衰弱程度与身体运动功能指标的相关性分析

Correlation analysis of frailty and physical exercise function indicators in patients with coronary artery disease

目的探讨60~80岁冠心病患者的基本衰弱工具集(EFT)评分与5次坐站(FTSTS)、30 s坐站(30s-STS)、1 min坐站(1min-STS)、6 min步行试验(6MWT)的相关性,以确定可用于临床筛选合并衰弱冠心病患者的身体运动功能指标。方法回顾性选择2020年1月至2021年12月上海交通大学医学院附属新华医院心血管内科收治的78例冠心病患者,根据EFT评分分为衰弱组(EFT评分≥1分,n=28)与非衰弱组(EFT评分=0分,n=50)。收集患者的基本信息、FTSTS、30s-STS、1min-STS、6MWT、左心室射血分数(LVEF)和血液指标,统计分析上述指标与衰弱的相关性;采用ROC曲线评估上述指标对陈旧性心肌梗死与非心肌梗死患者衰弱的诊断能力,并确定最佳临界值。结果与非衰弱组相比,衰弱组冠心病患者的BMI较低[(23.14±3.03)kg/m^(2) vs(24.78±3.29)kg/m2,P=0.033],氨基末端脑钠肽前体水平较高[199.40(55.32,1012.65)mmol/Lvs99.75(41.36,217.75)mmol/L,P=0.016],LVEF及身体运动功能测试指标30s-STS、1min-STS、6MWT均较低[(56.99±10.20)%vs(62.15±6.45)%、(10.93±2.98)次vs(14.50±2.63)次、(21.32±5.45)次vs(27.30±5.62)次、(412.84±62.34)m vs(470.04±56.41)m,P均<0.01]。Spearman相关分析显示,30s-STS、1min-STS、6MWT与EFT评分呈中度或高度负相关(rs=-0.575、-0.493、-0.467)。ROC曲线分析结果显示,在非心肌梗死患者中,30s-STS判断衰弱的AUC值为0.85(灵敏度为66.7%,特异度为92.9%,最佳临界值为≤13次),1min-STS的AUC值为0.82(灵敏度为60.6%,特异度为92.9%,最佳临界值为≤27次),6MWT的AUC值为0.80(灵敏度为78.8%,特异度为78.6%,最佳临界值为≤446.55 m);在陈旧性心肌梗死患者中,30s-STS的AUC值为0.81(灵敏度为94.1%,特异度为71.4%,最佳临界值为≤10次),1min-STS的AUC值为0.72(灵敏度为94.1%,特异度为57.1%,最佳临界值为≤19次),6MWT的AUC值为0.68(灵敏度为94.1%,特异度为42.9%,最佳临界值为≤387.45 m)。结论30s-STS、1min-STS、6MWT与冠心病患者衰弱程度呈中度或高度负相关,是临床评价衰弱的有效工具。对于非心肌梗死和陈旧性心肌梗死冠心病患者,30s-STS均是临床评估衰弱与否的较佳身体运动功能指标。

Objective To investigate the correlations between the essential frailty toolset(EFT)score and five times sit-to-stand(FTSTS),30-second sit-to-stand(30s-STS),1-minute sit-to-stand(1min-STS),and 6-minute walk test(6MWT)in patients with coronary artery disease(CAD)aged 60-80 years old,so as to determine the physical exercise function indicators for clinical assessment of patients with CAD combined frailty.Methods A total of 78 CAD patients admitted to the Department of Cardiovasology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from Jan.2020 to Dec.2021 were retrospectively enrolled.They were assigned to 2 groups according to the EFT score:frailty group(EFT score≥1,n=28)or non-frailty group(EFT score=0,n=50).The basic information,FTSTS,30s-STS,1min-STS,6MWT,left ventricular ejection fraction(LVEF),and blood indexes were collected,and their correlations with frailty were statistically analyzed.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of the above indexes for frailty in patients with old myocardial infarction(MI)or without MI,and the optimal cutoff value was determined.Results Compared with the non-frailty group,the frailty group had lower body mass index([23.14±3.03]kg/m2 vs[24.78±3.29]kg/m2,P=0.033),higher N-terminal pro-brain natriuretic peptide level(199.40[55.32,1012.65]mmol/L vs 99.75[41.36,217.75]mmol/L,P=0.016),and lower LVEF,30s-STS,1min-STS and 6MWT([56.99±10.20]%vs[62.15±6.45]%,[10.93±2.98]repetitions vs[14.50±2.63]repetitions,[21.32±5.45]repetitions vs[27.30±5.62]repetitions,and[412.84±62.34]m vs[470.04±56.41]m,all P<0.01).Spearman correlation analysis showed that the 30s-STS,1min-STS,and 6MWT were moderately or highly negatively correlated with the EFT score(rs=-0.575,-0.493,and-0.467).ROC curve analysis showed that in the patients without MI the area under curve(AUC)value was 0.85 for 30s-STS diagnosing frailty(sensitivity 66.7%,specificity 92.9%,optimal cutoff value≤13 repetitions),0.82 for 1min-STS(sensitivity 60.6%,specificity 92.9%,optimal cutoff value≤27 repetitions),and 0.80 for 6MWT(sensitivity 78.8%,specificity 78.6%,optimal cutoff value≤446.55 m);in the patients with old MI the AUC value was 0.81 for 30s-STS(sensitivity 94.1%,specificity 71.4%,optimal cutoff value≤10 repetitions),0.72 for 1min-STS(sensitivity 94.1%,specificity 57.1%,optimal cutoff value≤19 repetitions),and 0.68 for 6MWT(sensitivity 94.1%,specificity 42.9%,optimal cutoff value≤387.45 m).Conclusion The 30s-STS,1min-STS,and 6MWT are moderately or highly negatively correlated with the degree of frailty in CAD patients,and they are effective tools for clinical assessment of frailty.The 30s-STS is a good physical exercise function indicator for clinical assessment of frailty in CAD patients with or without MI combined frailty.