老年慢性阻塞性肺疾病患者衰弱状态和中医特征调查

Investigation of Frailty and Traditional Chinese Medicine Characteristics in Elderly Patients with Chronic Obstructive Pulmonary Disease

目的:观察老年慢性阻塞性肺疾病稳定期患者的衰弱状态和中医特征。方法:采用横断面研究方法,调查2017年1月至2019年12月青岛市中医医院、青岛市第五人民医院门诊就诊,年龄≥65岁COPD患者1083例,以衰弱(FRAIL量表)、中医证候、中医体质(《老年版中医体质分类》量表)、认知功能(蒙特利尔认知评估量表,MoCA)、运动耐量(改良版英国医学研究委员会呼吸困难问卷,mMRC)、肌肉质量、步行速度、握力为观察指标,比较衰弱组和无衰弱组患者差异。结果:1083例老年COPD患者中,衰弱患者355例(32.8%),无衰弱患者728例(67.2%)。男867例,女216例;平均年龄(71.24±6.99)岁。中医证候类型以肺肾两虚证为主;中医体质以气虚质为主。合并认知功能障碍742例(68.5%)。以mMRC评估运动耐量,结果中度呼吸困难426例(39.3%),重度呼吸困难75例(6.9%)。肌肉质量低下487例(45.0%)、步行速度低下590例(54.5%)、握力低下633例(58.4%);衰弱与无衰弱组比较,中医证候(χ^(2)=10.322,P=0.035)、中医体质(χ^(2)=17.859,P=0.022)、认知功能(χ^(2)=10.078,P=0.002)、运动耐量(χ^(2)=10.868,P=0.004)、肌肉质量(χ^(2)=4.535,P=0.033)、握力(χ^(2)=18.233,P<0.001)差异有统计学意义。结论:老年COPD患者中医证候类型以肺肾两虚证为主,中医体质以气虚质多见,部分患者合并衰弱、认知障碍、运动耐量下降和肌肉衰减。

Objective:To observe the frailty and traditional Chinese medicine(TCM)characteristics of elderly patients with chronic obstructive pulmonary disease(COPD)in the stable stage.Methods:From January 2017 to December 2019,1083 patients with COPD aged 65 or above in Qingdao Hospital of Traditional Chinese Medicine and The Fifth People’s Hospital of Qingdao City,were studied through cross-sectional study.Frailty(FRAIL scale),TCM syndromes,TCM constitution(TCM constitution scale for elder people),cognitive function(Montreal cognitive assessment scale,MoCA),exercise tolerance(modified British Medical Research Council questionnaire,mMRC),muscle mass,walking speed and grip strength were observed to compare the differences between the frailty group and the non-frailty group.Results:Among the 1083 elderly patients with COPD,355(32.8%)were with frailty,and 728(67.2%)were without frailty.There were 867 males and 216 females,with an average age of 71.24±6.99 years.The main syndrome of TCM was lung and kidney deficiency syndrome.TCM constitutions were dominated by qi deficiency.There were 742 cases(68.5%)with cognitive dysfunction.mMRC was used to evaluate exercise tolerance,and the results showed that there were 426 cases(39.3%)with moderate dyspnea and 75 cases(6.9%)with severe dyspnea.There were 487 cases(45.0%)with low muscle mass,590 cases(54.5%)with low walking speed and 633 cases(58.4%)with low grip strength.There were statistical difference between frailty group and non-frailty group,on TCM syndrome types(χ^(2)=10.322,P=0.035),TCM constitution type(χ^(2)=17.859,P=0.022),cognitive function(χ^(2)=10.078,P=0.002),exercise tolerance(χ^(2)=10.868,P=0.004),muscle mass(χ^(2)=4.535,P=0.033),and grip strength(χ^(2)=18.233,P<0.001).Conclusions:In elderly patients with COPD,the main types of TCM syndrome are deficiency of lung and kidney,and qi deficiency is the most common TCM constitution.Some patients are companied with frailty,cognitive impairment,low exercise tolerance and low muscle mass.