运动认知风险综合征对跌倒和反复跌倒及跌倒后骨折影响的前瞻性队列研究

Prospective cohort study of the effects of motor cognitive risk syndrome on fractures after falls

目的 探讨老年人运动认知风险综合征跌倒、反复跌倒和跌倒后骨折的风险因素。方法 招募2015年4月至2016年4月于中国医科大学附属第一医院神经内科门诊接受研究共3552人。记录每个入选个体的人口统计学,入选个体均通过简易智力状态检查(MMSE)评估是否存在主观认知主诉(SCC),通过测步速评估是否存在慢速度行走及是否有运动认知风险综合征(MCR)。根据评估结果将所有个体分成MCR组和非MCR组,非MCR组内再分为SCC亚组、慢速度行走亚组和健康亚组。比较2组基线变量,并比较亚组之间、亚组与MCR组的人口统计学。之后每4个月进行随访,共随访2年。记录随访期间跌倒、反复跌倒、并发骨折的人数。以所有人口统计学及SCC、慢速度行走、MCR为自变量,以随访期间出现跌倒、反复跌倒及跌倒后骨折做为因变量,做自变量与因变量的COX比例风险回归模型。结果 MCR组受高等教育比例、抑郁情绪比例、使用拐杖比例、体质量指数、用药数量分别为10.2%(36/352)、22.4%(79/352)、44.9%(158/352)、(27.0±4.3)kg/m^2、(6.8±3.2)种,非MCR组分别为22.9%(732/3200)、12.8%(409/3200)、22.8%(729/3200)、(24.8±3.8)kg/m^2、(5.2±3.1)种,2组比较差异有统计学意义(χ^2值为29.93、24.98、82.71,t值为12.34、3.45,P<0.05)。SCC亚组受高等教育水平的比例、抑郁情绪比例、使用拐杖的比例分别为18.9%(289/1531)、13.2%(202/1531)、22.5%(344/1531),MCR组与SCC亚组比较差异有统计学意义(χ^2值为14.99、19.28、73.56,P<0.05)。慢速度行走亚组的高等教育水平比例为16.6%(34/205),与MCR组比较差异有统计学意义(χ^2=4.77,P<0.05)。健康亚组高等教育水平比例、关节炎比例、抑郁情绪比例、使用拐杖人数比例分别为27.9%(409/1464)、12.9(190/1464)、11.2%(164/1464)、19.7%(288/1464),SCC亚组分别为18.9%(289/1531)、16.2(248/1531)、13.2%(202/1531)、22.5%(344/1531),慢速度行走亚组分别为16.6%(34/205)、21.5%(44/205)、20.9(43/205)、47.3%(97/205),3个亚组比较差异有统计学意义(χ^2值为13.08~78.28,P<0.05)。健康亚组体质量指数、用药数量分别(23.4±4.4)kg/m^2、(4.7±2.8)种,SCC组分别为(25.2±4.3)kg/m^2、(5.1±2.9)种,慢速度行走亚组分别为(25.1±3.8)kg/m^2、(6.7±3.1)种,3个亚组比较差异有统计学意义(F值为2.68、7.21,P<0.05)。MCR患者出现跌倒、反复跌倒、跌倒后骨折的风险分别为1.22、1.47、2.54(P<0.05)。年龄对跌倒、反复跌倒、跌倒后骨折的风险分别为1.08、1.01、1.05(P<0.05)。结论 年龄、MCR是老年人跌倒、反复跌倒和跌倒后骨折的高危因素,在临床护理中需要评估MCR,注意高龄老年人。

Objective To investigate the risk factors of elderly,sports cognitive risk syndrome falling,repeated falls and fractures after falls.Methods A total of 3552 people were enrolled in the Department of Neurology,the First Affiliated Hospital of China Medical University from April 2015 to April 2016.The demographics of each selected individual were recorded.The selected individuals were assessed by MMSE for the presence of Subjective Cognitive Complaint(SCC),and the pace was used to assess whether there was slow walking and whether there was MCR(SCC+slow walking).All individuals were divided into MCR group and non-MCR group according to the evaluation results.The non-MCR group was subdivided into SCC subgroup,slow speed walking subgroup and healthy subgroup.Baseline variables were compared between the two groups,and demographics between subgroups,subgroups,and MCR groups were compared.Follow-up was followed every 4 months for a total of 2 years.The number of people who fell during the follow-up period,repeated falls,and fractures were recorded.With all demographics and SCC,walking at a slower pace,MCR was an independent variable,with a fall during follow-up,repeated falls and post-fall fractures as dependent variables,and a COX proportional hazard regression model of independent and dependent variables.Results The proportions of the MCR group in higher education,depression,the use of crutches were 10.2%(36/352),22.4%(79/352),44.9%(158/352),the BMI,number of medications in the MCR group were(27.0±4.3)kg/m^2,(6.8±3.2),the proportions of non-MCR group in higher education,depression,using crutches ratio were 22.9%(732/3200),12.8%(409/3200),22.8%(729/3200),the BMI,number of medications of non-MCR group were(24.8±3.8)kg/m^2,(5.2±3.1),the two groups showed statistical significant difference(χ^2 values were 29.93,3.45,24.98,t values were 12.34,82.71,P<0.05).The proportions of higher education,depression and crutches were 18.9%(289/1531),13.2%(202/1531)and 22.5%(344/1531)in SCC subgroup.The difference between MCR group and SCC subgroup was statistically significant(χ^2 values were 14.99,19.28,73.56,P<0.05).The higher education level of the slow walking group was 16.6%(34/205),which was significantly different from that of the MCR group(χ^2 value was 4.77,P<0.05).The proportions of higher education level,arthritis,depression and crutches in the healthy subgroup were 27.9%(409/1464),12.9(190/1464),11.2%(164/1464)and 19.7%(288/1464),while that in the SCC subgroup were 18.9%(289/1531),16.2(248/1531),13.2%(202/1531)and 22.5%(344/1531),and that in the slow walking subgroup were 16.6%(34/205),21.5%(44/205),20.9(43/205)and 47.3%(97/205).There were significant differences among the three subgroups(χ^2 values were 13.08-78.28,P<0.05).BMI and number of drugs in healthy subgroups were(23.4±4.4)kg/m^2 and(4.7±2.8),SCC group was(25.2±4.3)kg/m^2 and(5.1±2.9)kinds,and slow walking subgroup were(25.1±3.8)kg/m^2 and(6.7±3.1)kinds.The differences among the three subgroups were statistically significant(t values were 2.68,7.21,P<0.05).The risks of falling,repeated falling and fracture after falling in MCR patients were 1.22,1.47 and 2.54(P<0.05).Conclusions Age,MCR is a high risk factor for falls in the elderly,repeated falls and fractures after falls.In clinical care,MCR needs to be evaluated and attention should be payed to the elderly.