衰弱与老年人冠状动脉粥样硬化性心脏病的相关性研究

Correlation between frailty and coronary heart disease in the elderly

目的前瞻性分析衰弱对冠心病患者短期预后及相关因素的影响。方法连续人选年龄≥65岁且在我院心内科及老年科就诊的冠心病患者505例，运用老年人综合评估全面评估老年冠心病患者的并存疾病及综合征；衰弱的诊断采用临床衰弱评分（CFS），用冠心病特异性指数来量化共存基础疾病的影响。采取门诊随诊和电话的方法进行随访，随访内容包括全因死亡、再发心脑血管事件、非常规就诊情况等；采用Cox生存分析探讨衰弱对预后的影响。结果所有入组老年冠心病患者中，评估为衰弱患者221例（43．8％），其中中度和重度衰弱者126例（25．0％）。衰弱老年患者的老年综合征如尿失禁、跌倒、视力障碍、听力障碍、便秘、疼痛、睡眠障碍、口腔问题、焦虑抑郁、谵妄患病率分别为51．1％（113／221）、31．2％（69／221）、43．9％（97／221）、49．3％（109／221）、60．2％（133／221）、62．o％（137／221）、49．3oA（109／221）、79．2％（175／221）、1I．3％（25／22i）、2．7％（6／221），明显高于非衰弱老年患者30．6％（87／284）、19．0oA（54／284）、29．9％（85／284）、29．6％（84／284）、33．8％（96／284）、46．8％（133／284）、37．7％（107／284）、55．6％（158／284）、6．0％（17／284）、0（o／284）（Y2—21．831，10．053，i0．510，20．519，34．894，11．481，6．886，30．695，4．624，7．803，均P〈0．05）。校正性别、年龄，共存疾病严重程度等因素后，Cox生存分析结果显示，CFS衰弱评分是冠心病患者全因死亡（HR=2．881，95oACI：1．591～5．215）和发生非常规就诊（HR=1．835，95％CI：1．458～2．311）的独立风险预测因子。结论运用老年人综合评估及衰弱评估可以更全面地评估老年冠心病患者的特点，衰弱是老年冠心病患者死亡及非常规就诊等短期预后的独立风险预测因子。

Objective To prospectively analyze the impact of frailty on the short-term outcomes of coronary heart disease （CHD） and its related factors. Methods A total of 505 patients aged ≥65 years, with diagnosis of CHD in Cardiology Department and Geriatrics Department in our hospital were selected. Clinical data including geriatrics syndromes were collected by using Comprehensive Geriatrics Assessment （CGA）. Frailty was defined according to the Clinical Frailty Scale （CFS）. The impact of the comorbid conditions on the risk was quantified by the coronary artery disease-specific index. Patients were followed up by clinic visit or telephone consultation. Following-up items included recurrence of all-cause mortality, recurrence of cardiovascular events, and unscheduled returned visit. The impact of frailty on the prognosis of coronary heart disease was analyzed by Cox regression. Results Of the 505 patients, 221 patients （43.76%） were considered to be frail elderly, in whom 126 patients （24.95%） were assessed as moderately to severely frail elderly. The incidences of comorbidities and geriatrics syndrome including incontinence, fall history, visual impairment, hearing impairment, constipation, chronic pain, sleeping disorder, dental problems, anxiety or depression, and delirium were higher in frail patients than in non-flail patients[51.1% （113/221）vs. 30.6% （87/ 284）, 31.2% （69/221） vs. 19.0% （54/284）, 43.9% （97/221） vs. 29.9% （85/284）, 49.3% （109/ 221） vs. 29.6% （84/284）, 60.2%（133/221） vs. 33.8% （96/284）, 62.0% （137/221） vs. 46.8% （133/284）, 49.3% （109/221） vs. 37.7% （107/284）, 79.2% （175/221）vs. 55.6%（158/284）, 11.3% （25/221） vs. 6.0% （17/284）, 2.7% （6/221） vs. 0 （0/284）, χ^2=21.831, 10.053, 10. 510, 20. 519, 34.894, 11.481, 6.886, 30. 695, 4. 624,7. 803, respectively, all P〈0.05]. After adjusting for sex, age, severity of illness and other coexist factors, the Cox survival analysis showed that frailty was the independent risk predictor for the all-cause mortality and unscheduled return visit in CHD patients （HR= 2. 881 and 1. 835, 95% CI： 1. 591-5. 215 and 1. 458-2. 311, both P〈0. 001）. Conclusions Comprehensive Geriatrics Assessment and Clinical Frail Scale are useful to evaluate the clinical features in elderly CHD patients. Frailty is the independent risk predictor for the short term prognosis including all-cause mortality and unscheduled return visit in elderly CHD patients.