老年稳定型冠心病患者的衰弱评估与预后分析

Frailty assessment and prognostic analysis of stable coronary artery disease in the elderly

目的评估稳定型老年冠心病（CAD）患者衰弱的发生情况，分析与衰弱相关的指标，以及研究衰弱对稳定型CAD患者短期预后的影响。方法连续入选2014年12月1日至2015年4月30日期间在北京协和医院心内科及老年医学科门诊就诊的老年患者153例，进行老年综合评估及临床衰弱量表（CFS）评估，运用CAD特异性指数来量化共存基础疾病的影响。随访患者非常规就诊（URV）及全因死亡发生率。结果依据CFS评估结果，将153例患者分为两组：衰弱组（n=69，45．10％）和非衰弱组（n=84，54．90％）。其中，中-重度衰弱患者33例，占21．57％（33／153）。与非衰弱组相比，衰弱组患者的握力和步速显著降低，而炎症指标超敏C-反应蛋白（hs-CRP）和白细胞介素-6（IL-6）显著增高，差异均具有统计学意义（P〈0．05）。步速的衰弱诊断界值为：男性0．879m／s；女性0．870m／s。握力的衰弱诊断界值为：男性29．85kg；女性19．50kg。Cox回归分析显示，CFS评分是稳定型CAD患者URV（HR：3．312；95％CI：1．439～7．621；P=0．005）的独立风险预测因子。结论老年CAD患者衰弱的发生率较高，尤其中-重度衰弱患者需要得到关注。步速和握力均可作为衰弱评估的指标。CFS评分是老年冠心病患者URV的独立风险预测因子。

Objective To investigate the incidence of frailty in elderly patients with stable coronary artery disease （CAD）, analyze the related clinical indicators, and determine the effect of frailty on short-term outcomes of the patients. Methods Consecutive 153 outpatients aged ≥65 years in the Departments of Geriatrics and Cardiology from December 1, 2014 to April 30, 2015 were recruited in this study. Comprehensive geriatric assessment and clinical frailty scale （CFS） were employed to survey their conditions and frailty. The CAD-specific comorbidity index was used to quantify the effects of the comorbid conditions. Unscheduled return visits （URV） and all-cause mortality were observed during follow-up. Results For the 153 patients, 69 （45.10%） were assigned into the frail group, and 84 （54.90%） into the non-frail group according to the results of CFS. The former group also included 33 cases of moderately or severely frailty, accounting for 21.57% （33/153）. Grip strength and gait speed were significantly lower, while the serum levels of IL-6 and high-sensitivity C-reactive protein （hs-CRP） were obviously higher in the frail group than in the non-frail group （P 〈 0.05 ）. For frail diagnosis, the cutoff value for hand grip strength was 29. 85 kg for men and 19. 50 kg for women, and that for usual gait speed was 0. 879 m/s for men and 0. 870 m/s for women. Cox regression analysis showed that CFS scale was the independent predictive factor for URV risk for stable CAD patients （ HR = 3.312, 95 % CI ： 1. 439 - 7. 621, P = 0. 005 ）. Conclusion Elderly patients with stable CAD have higher incidence of frailty, and special attention should be paid to those with moderate-severe frailty. Gait speed and grip strength can be used as indicators for frailty assessment. CFS score is an independent predictor factor for URV risk of the elderly with stable CAD.