老年慢性阻塞性肺病患者衰弱影响因素研究

Study on the Influencing Factors of Frailty in Elderly Patients with Chronic Obstructive Pulmonary Disease

【目的】探讨老年慢性阻塞性肺病(COPD)患者衰弱分布情况及其影响因素。【方法】选择2017年1月至2019年12月青岛市中医医院和山东青岛中西医结合医院门诊收治的65~84岁的COPD患者3479例进行横断面调查,依据FRAIL量表分为衰弱组和无衰弱组,比较2组患者的一般情况、心理状态、睡眠状况、实验室检测指标及中医体质类型,采用Logistic回归分析探讨以上因素对衰弱的影响。【结果】(1)3479例患者中,合并衰弱1009例(29.00%),无衰弱2470例(71.00%)。(2)与无衰弱组比较,衰弱组患者年龄大、体质量指数(BMI)低、吸烟指数(SI)高、肺功能差、病程长、合并糖尿病多、Charlson合并症指数(CCI)高,汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、阿森斯失眠量表(AIS)得分高,白蛋白、前白蛋白、血红蛋白含量低,中医体质类型不同,差异均有统计学意义(P<0.01)。(3)根据Logistic回归分析结果,按影响因素的影响程度大小排序,依次为阳虚质[OR=20.712,95%CI(7.927,54.116)]、气虚质[OR=10.858,95%CI(4.221,27.932)]、血瘀质[OR=8.056,95%CI(3.002,21.618)]、痰湿质[OR=2.897,95%CI(1.060,7.920)]、肺功能[OR=2.010,95%CI(1.620,2.494)]、合并糖尿病[OR=1.613,95%CI(1.291,2.014)]、吸烟[OR=1.549,95%CI(1.386,1.732)]、CCI[OR=1.384,95%CI(1.115,1.717)]、抑郁[OR=1.158,95%CI(1.131,1.185)]、AIS[OR=1.131,95%CI(1.106,1.156)]、年龄[OR=1.098,95%CI(1.072,1.124)]、焦虑[OR=1.030,95%CI(1.004,1.057)]、前白蛋白[OR=0.984,95%CI(0.980,0.989)]、血红蛋白[OR=0.982,95%CI(0.973,0.991)]、BMI[OR=0.936,95%CI(0.908,0.965)]、白蛋白[OR=0.767,95%CI(0.741,0.793)],差异均有统计学意义(P<0.05或P<0.01)。【结论】老年COPD患者衰弱患病率高;中医体质类型、肺功能、合并糖尿病、吸烟、CCI、抑郁、AIS、年龄、焦虑、前白蛋白、血红蛋白、BMI、白蛋白是老年COPD患者衰弱的影响因素。

Objective To explore the incidence of frailty in elderly patients with chronic obstructive pulmonary disease(COPD)and its influencing factors.Methods A cross-sectional survey was carried out in 3479 COPD patients aged 65-84 years admitted to the outpatient department of Qingdao Hospital of Traditional Chinese Medicine and Shandong Qingdao Hospital of Integrated Traditional Chinese and Western Medicine from January2017 to December 2019.The patients were divided into frailty group and non-frailty group based on the FRAIL scale scores.The general information,psychological status,sleep status,laboratory indexes and the traditional Chinese medicine(TCM)constitution types of the two groups were compared,and then the influence of the above factors on the frailty was explored using logistic regression analysis.Results(1)Of the 3479 patients,1009(29.00%)were complicated with frailty and 2470(71.00%)had no frailty.(2)Compared with the non-frailty group,the patients in the frailty group were old and had low body mass index(BMI),high smoking index(SI),poor lung function,long duration of disease,high incidence of complicated diabetes,high Charlson comorbidity index(CCI),high Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),and Athens Insomnia Scale(AIS)scores,low albumin,prealbumin and hemoglobin levels,and different TCM body constitution types,and the differences were statistically significant(P<0.01).(3)The results of logistic regression analysis showed that the influencing factors in order of the degree of influence were yang deficiency constitution[OR=20.712,95%CI(7.927,54.116)],qi deficiency constitution[OR=10.858,95%CI(4.221,27.932)],blood stasis constitution[OR=8.056,95%CI(3.002,21.618)],phlegm-damp constitution[OR=2.897,95%CI(1.060,7.920)],lung function[OR=2.010,95%CI(1.620,2.494)],complicated diabetes[OR=1.613,95%CI(1.291,2.014)],smoking[OR=1.549,95%CI(1.386,1.732)],CCI[OR=1.384,95%CI(1.115,1.717)],depression[OR=1.158,95%CI(1.131,1.185)],AIS scores[OR=1.131,95%CI(1.106,1.156)],age[OR=1.098,95%CI(1.072,1.124)],anxiety[OR=1.030,95%CI(1.004,1.057)],prealbumin[OR=0.984,95%CI(0.980,0.989)],hemoglobin[OR=0.982,95%CI(0.973,0.991)],BMI[OR=0.936,95%CI(0.908,0.965)],and albumin[OR=0.767,95%CI(0.741,0.793)],and all of the differences were statistically significant(P<0.05 or P<0.01).Conclusion Frailty is prevalent in elderly COPD patients,and the TCM constitution type,lung function,complicated diabetes,smoking,CCI,depression,AIS scores,age,anxiety,prealbumin,hemoglobin,BMI,and albumin are the factors that influence frailty in elderly COPD patients.