老年稳定型冠心病患者衰弱的检出率及其危险因素

Risk factors and prevalence for frailty in elderly people with stable coronary heart disease

目的探讨衰弱及其不同组分在社区老年稳定型冠心病患者中的检出率及其相关危险因素。方法选取2015年7月至2016年6月定期在解放军总医院老年科门诊体检的北京某社区老年稳定型冠心病患者221例。采用Fried衰弱表型评估衰弱,分为非衰弱及衰弱两组。应用多因素logistic回归分析发生衰弱及与衰弱各组分相关的危险因素。结果在221名老年稳定型冠心病患者中,衰弱的检出率为19.9%(n=44)。Fried表型的五种组分在衰弱患者中的检出率由高到低分别为握力减弱100%(n=44)、疲乏95.5%(n=42)、步速下降93.2%(n=41)、活动量下降45.5%(n=20)、体质量减低18.2%(n=8)。衰弱组与非衰弱组相比,年龄高、MNA-SF评分及Barthel指数评分低,更易合并白内障、排尿障碍,应用调脂药物。多因素logistic回归分析显示,年龄(OR=1.08)、日常活动能力下降(轻度依赖:OR=3.15;中度及重度依赖:OR=33.60)、营养不良风险及营养不良(OR=3.57)与老年稳定型冠心病患者合并衰弱呈正相关。检出率较高的前三种衰弱组分的多因素logistic回归分析显示,增龄与握力减弱正相关,女性、日常活动能力下降、营养不良风险及营养不良与疲乏正相关,增龄、日常活动能力下降、营养不良风险及营养不良与步速下降正相关。结论在社区稳定型冠心病老年患者中衰弱的检出率较高,增龄、日常活动能力下降、营养不良风险及营养不良是衰弱的发生的相关危险因素。

Objective To determine the prevalence of frailty among elderly patients with stable coronary heart disease and search for related clinical factors.Methods A total of 221 elderly patients with stable coronary heart disease who came to geriatric outpatient,the PLA Hospital for medical examination between July 2015 and June 2016 were enrolled in the study.Frailty was assessed using the Fried phenotype.The patients were classified as frail and non-frail.Logistic regression analysis was used to analyze the related factors of frailty and different frailty domains for elderly patients with stable coronary heart disease.Results There were 19.9%(n=44)frail patients in the study.The detection rate of the five domains of Fried phenotype from high to low in the frailty patients were 100%(n=44)weak grip strength,95.5%(n=42)exhaustion,93.2%(n=41)slow gait speed,45.5%(n=20)lower physical activity and 18.2%(n=8)weight loss,respectively.There were older age,lower MNA-SF score,lower Barthel index,higher proportion of cataract,urinary incontinence and more lipid-lowering drugs in frail patients as compared to those of non-frail patients.Stepwise multivariate binary logistic regression analysis revealed that age(OR=1.08),activities of daily living(ADL)functional status(mild dependency:OR=3.15;moderate and severe dependency:OR=33.60),MNA-SF at risk/malnourished(OR=3.57)were positively correlated with frailty among elderly patients with stable coronary artery disease.The first three components of frailty with higher detection rate were weak grip strength,exhaustion and slow gait speed.Age was positively correlated with weak grip strength;female,decrease of ADL and poor nutritional status were positively correlated with exhaustion;age,decrease of ADL and poor nutritional status were positively correlated with slow gait speed,respectively.Conclusions Prevalence of frailty is high among community-dwelling elderly patients with stable coronary heart disease.Age,poor nutrition and low ADL are independent risk factors of frailty.