衰弱对住院老年冠心病患者短期预后的影响

Effect of frailty on short-term prognosis of hospitalized elderly patients with coronary heart disease

目的 分析衰弱对住院期老年冠心病患者短期预后的影响。方法 回顾性分析2018年5月至2020年5月本院老年医学科和心血管内科收治的677例老年冠心病患者的临床资料,按照衰弱程度分为伴有轻、中度衰弱的衰弱组(n=213)和非衰弱组(n=464)。住院期间收集评估患者衰弱相关因素,患者出院后均随访至少1年。Logistic回归分析衰弱相关因素对老年冠心病患者预后的影响作用。结果 10例患者失访,衰弱组213例(31.46%),其中稳定性冠心病174例、急性冠状动脉综合征(ACS)39例;非衰弱组464例(68.54%),包括稳定性冠心病316例、急性冠状动脉综合征148例。两组体重指数(BMI)、ACS发病率、日常性活动评分、低密度脂蛋白胆固醇(LDL-C)比较差异无统计学意义;两组年龄、性别、住院时间、营养不良发生率、营养评分、2型糖尿病、Charlson合并症指数(CCI)、用药种类、工具性日常评分、握力、步速、机体平衡失败、三酰甘油(TG)、超敏C-反应蛋白(hs-CRP)、糖化血红蛋白(HbA1c)、血尿酸、清蛋白(ALB)比较差异有统计学院意义(P<0.05)。多因素Logistic回归分析显示,年龄(SE=0.032,β=0.073,P<0.05)、步速(SE=0.947,β=-4.542,P<0.001)、机体平衡测试(SE=0.472,β=1.462,P<0.05)、营养评分(SE=0.094,β=-0.214,P<0.05)和CCI(SE=0.146,β=0.398,P<0.05)是衰弱冠心病患者的影响因素。结论 衰弱对住院老年冠心病患者有影响作用,可增加住院老年冠心病患者短期不良事件风险,加速降低老其机体生理功能,诱发冠心病等基础疾病。

Objective To analyze the effect of frailty on the short-term prognosis of hospitalized elderly patients with coronary heart disease.Methods The clinical data of 677 elderly patients with coronary heart disease admitted to the Department of Geriatrics and Cardiovascular Medicine of our hospital from May 2018 to May 2020 were retrospectively analyzed,and they were divided into frail group with mild to moderate frailty frailty and non-frail group according to the degree of frailty.Frailty-related factors were collected and evaluated during hospitalization,and all patients were followed up for at least 1 year after discharge.Logistic regression analysis of the effect of frailty-related factors on the prognosis of elderly patients with coronary heart disease.Results 10 patients were lost to follow-up,213 patients(31.46%) in the frail group,including 174 patients with stable coronary heart disease and 39 patients with acute coronary syndrome(ACS);there were 464 patients(68.54%) in the non-frail group,including316 patients with stable coronary heart disease and 148 patients with acute coronary syndrome.There was no significant difference in body mass index(BMI),incidence of ACS,daily activity score,and low density lipoprotein cholesterol(LDL-C) between the two groups;there were statistically significant differences in age,gender,length of hospital stay,incidence of malnutrition,nutritional score,type 2 diabetes,Charlson comorbidity index(CCI),type of medication,instrumental daily score,grip strength,pace,body balance failure,triglyceride(TG),serum high sensitivity C-reactive protein(hs-CRP),hemoglobin A1c(HbA1c),blood uric acid,albumin(ALB) comparison between the two groups(P<0.05).Multivariate Logistic regression analysis showed that age(SE=0.032,β=0.073,P<0.05),pace(SE=0.947,β=-4.542,P<0.001),body balance test(SE=0.472,β=1.462,P<0.05),nutritional score(SE=0.094,β=-0.214,P<0.05) and CCI(SE=0.146,β=0.398,P<0.05) were the influencing factors of debilitating coronary heart disease patients.Conclusion Frailty has an impact on hospitalized elderly patients with coronary heart disease,which can increase the risk of short-term adverse events in hospitalized elderly patients with coronary heart disease,accelerate the reduction of their physiological functions,and induce coronary heart disease and other basic diseases.