老年住院肺结核患者躯体功能情况及影响因素分析

Analysis of physical function and influencing factors in elderly inpatients with pulmonary tuberculosis

目的:调查老年住院肺结核患者躯体功能情况及影响因素。方法:便利选取2021年6-12月于成都市公共卫生临床医疗中心结核科住院的429例老年肺结核患者(年龄范围为60~95岁)作为研究对象,收集研究对象的年龄、性别、婚姻状况、居住地、文化程度、吸烟史、饮酒史、体质量指数、耐药情况、治疗分类、痰菌检查情况等信息。采用日常生活活动能力量表[Barthel指数(Barthel index,BI)]、Berg平衡量表(berg balance scale,BBS)、Morse跌倒评估量表(Morse fall seale,MFS)评估研究对象躯体功能。结果:研究对象BI得分为(81.97±17.62)分,BBS得分为(49.82±11.09)分,MFS得分为(41.90±12.79)分。年龄>80岁的老年肺结核患者BBS、BI、MFS得分分别为(40.32±14.56)、(72.76±17.66)、(51.58±12.63)分,而60~70岁的老年肺结核患者BBS、BI、MFS得分分别为(51.80±9.78)、(84.92±15.69)、(40.06±12.22)分;多元回归分析显示,年龄越大的老年肺结核患者日常生活活动能力越差(标准回归系数为-0.183,t=-3.797,P<0.001)、平衡和步态能力越差(标准化回归系数为-0.245,t=-5.220,P<0.001)、跌倒风险越大(标准化回归系数为0.187,t=3.802,P<0.001)。体质量指数<18.5的老年肺结核患者BBS、BI、MFS得分分别为(45.07±14.03)、(75.82±17.82)、(46.12±12.83)分,而体质量指数为24.0~28.0的老年肺结核患者BBS、BI、MFS得分分别为(53.13±6.86)、(89.29±12.44)、(37.46±11.74)分;多元回归分析显示,体质量指数越低的老年肺结核患者日常生活活动能力越差(标准化回归系数为0.146,t=3.086,P=0.002)、平衡和步态能力越差(标准化回归系数为0.133,t=2.806,P=0.005)、跌倒风险越大(标准化回归系数为-0.119,t=-2.477,P=0.014)。合并症数量为5~6个的老年肺结核患者BBS、BI、MFS得分分别为(48.18±11.64)、(82.27±20.78)、(38.64±15.35)分,而合并症数量为1~2个的老年肺结核患者BBS、BI、MFS得分分别为(51.55±8.86)、(84.76±14.39)、(41.37±12.35)分;多元回归分析显示,合并症数量越多的老年肺结核患者日常生活活动能力越差(标准化回归系数为-0.139,t=-2.967,P=0.003)、平衡和步态能力越差(标准化回归系数为-0.162,t=-3.494,P=0.001)。痰菌阳性的老年肺结核患者BBS得分为(48.75±11.37)分,明显低于痰菌阴性者[(50.64±10.90)分],差异有统计学意义(t=1.722,P=0.046)。结论:老年肺结核患者年龄越大、体质量指数越低、合并症数量越多及痰菌阳性越容易导致其躯体功能下降,在诊疗过程中应结合躯体功能下降的相关影响因素,对患者进行全面评估及早期干预。

Objective:To investigate the physical function and influencing factors of elderly hospitalized pulmonary tuberculosis patients.Methods:A total of 429 elderly pulmonary tuberculosis patients(aged 60-95 years)who were hospitalized in the Tuberculosis Department of Chengdu Public Health Clinical Medical Center from June 2021 to December 2021 as the research subjects were conveniently selected,and information of them were collected,including the age,gender,marital status,residence,education level,smoking history,drinking history,body mass index,drug resistance,treatment classification,and sputum bacterial test results of the research subjects.The Barthel index(BI),Berg balance scale(BBS),and Morse fall assessment scale(MFS)were used to evaluate the physical function of the study subjects.Results:The BI score of the study subjects was 81.97±17.62,the BBS score was 49.82±11.09,and the MFS score was 41.90±12.79.The scores of BBS,BI,and MFS in elderly tuberculosis patients aged over 80 years old were 40.32±14.56,72.76±17.66,and 51.58±12.63,respectively,while the scores of those aged 60-70 years were 51.80±9.78,84.92±15.69,and 40.06±12.22,respectively;multiple regression analysis showed that the older the elderly patients with pulmonary tuberculosis,the poorer their ability to perform daily activities(standard regression coefficient:-0.183,t=-3.797,P<0.001),balance and gait abilities(standardized regression coefficient:-0.245,t=-5.220,P<0.001),and the greater the risk of falling(standardized regression coefficient 0.187,t=3.802,P<0.001).The scores of BBS,BI,and MFS in elderly tuberculosis patients with body mass index<18.5 were 45.07±14.03,75.82±17.82,and 46.12±12.83,respectively,while the scores of those who with body mass index between 24.0 and 28.0 were 53.13±6.86,89.29±12.44,and 37.46±11.74,respectively;multiple regression analysis showed that elderly tuberculosis patients with lower body mass index had poorer activities of daily living(standardized regression coefficient:0.146,t=3.086,P=0.002),poorer balance and gait abilities(standardized regression coefficient:0.133,t=2.806,P=0.005),and higher risk of falling(standardized regression coefficient:-0.119,t=-2.477,P=0.014).The scores of BBS,BI,and MFS in elderly tuberculosis patients with 5-6 comorbidities were 48.18±11.64,82.27±20.78,and 38.64±15.35,respectively,while the scores in elderly tuberculosis patients with 1-2 comorbidities were 51.55±8.86,84.76±14.39,and 41.37±12.35,respectively;multiple regression analysis showed that elderly tuberculosis patients with more comorbidities had poorer activities of daily living(standardized regression coefficient:-0.139,t=-2.967,P=0.003),as well as poorer balance and gait abilities(standardized regression coefficient:-0.162,t=-3.494,P=0.001).The BBS score of elderly tuberculosis patients with positive sputum bacteria was 48.75±11.37,significantly lower than that of those with negative sputum bacteria(50.64±10.90,t=1.722,P=0.046).Conclusion:In elderly patients with pulmonary tuberculosis,the older the age,the lower the body mass index,the more comorbidities,and the positive sputum bacteria result in lower physical function.In the diagnosis and treatment process,comprehensive evaluation and early intervention should be combined with the relevant influencing factors of decreased physical function.