老年共病患者轻度贫血与体位性低血压的相关性研究

Relation between mild anemia and orthostatic hypotension in elderly multimorbidity patients

目的了解体位性低血压在老年共病及多重用药患者中的发生情况,探讨该人群轻度贫血与体位性低血压的关系。方法选择老年共病及多重用药患者102例,根据年龄分为老年组56例(60~79岁),高龄组46例(≥80岁)。测量并记录患者卧位及直立位血压,并对各组体位性低血压发生情况、一般临床资料及血液生化指标进行统计分析。结果高龄组男性(69.6%vs 32.1%,P=0.000)、年龄[(85.26±3.42)岁vs(68.91±5.85)岁,P=0.000]、体位性低血压(28.3%vs 10.7%,P=0.022)、轻度贫血(32.6%vs 7.1%,P=0.001)、冠心病(82.6%vs33.9%,P=0.000)、脑卒中(37.0%vs 19.6%,P=0.042)、肌酐[(82.05±18.95)μmol/Lvs(68.91±5.85)μmol/L,P=0.000]、胱抑素C[(1.50±0.26)μmol/L vs(1.10±0.17)μmol/L,P=0.000]水平显著高于老年组,体质量指数、血红蛋白、红细胞比容、空腹血糖、白蛋白和估算肾小球滤过率显著低于老年组(P<0.05,P<0.01)。校正混杂变量前,老年患者轻度贫血与体位性低血压呈正相关(OR=4.760,95%CI:1.569~14.444,P=0.006),且在校正年龄、体质量指数、白蛋白、前白蛋白、TG、TC、HDL-C、胱抑素C等对血红蛋白指标及贫血状态有影响的因素后,该相关性仍然独立存在(OR=4.977,95%CI:1.111~22.309,P=0.036)。结论体位性低血压及轻度贫血发病率与年龄密切相关,高龄老年人更为多见。在老年共病及多重用药患者中,轻度贫血状态是体位性低血压发生的独立危险因素,应加强贫血的筛查与干预。

Objective To study the relation between mild anemia and OH by investigating the incidence of OH in elderly patients with multimorbidity and polypharmacy.Methods One hundred and two patients with multimorbidity and polypharmacy were divided into 60-79 years old group（n=56）and≥80years old group（n=46）.Their supine and orthostatic blood pressures were measured.The incidence of OH,blood biochemical parameters and general clinical data were analyzed.Results The percentage of males was higher,the age was older,the incidence of OH,mild anemia,CHD,stroke,the serum Cr and Cys-C levels were significantly higher while the BMI,Hb,HCT,FPG,albumin and eGFR were significantly lower in ≥80years old group than in 60-79 years old group（P〈0.05,P〈0.01）.Mild anemia was positively related with OH in elderly patients（OR=4.760,95%CI：1.569-14.444,P=0.006）even after adjustment for age,BMI,albumin,prealbumin,TG,TC,HDL-C,Cys-C（OR=4.977,95%CI：1.111-22.309,P=0.036）.Conclusion The incidence of OH and mild anemia is closely related with age,especially in advance-aged patients.Mild anemia is an independent risk factor for OH in elderly patients with multimorbidity and polypharmacy,anemia screening and intervention should thus be strengthened.