肾脏不适当用药对老年糖尿病患者衰弱的影响

The influence of renally inappropriate medication on the frailty of elderly patients with diabetes

目的探讨肾脏不适当用药(RIM)对老年糖尿病患者衰弱的影响。方法收集云南省某三级甲等医院2022年1-12月住院的老年糖尿病患者资料,分别采用2019年版Beers标准和汉化版衰弱指数量表(FRAIL量表)对患者的RIM和衰弱情况进行评估,同时根据是否存在RIM将患者分为试验组(存在RIM)和对照组(不存在RIM),并使用倾向性评分匹配法均衡组间混杂因素,通过Logistic回归模型分析RIM对老年糖尿病患者衰弱的影响。结果共纳入367例患者,其中80例患者(21.80%)存在RIM,RIM涉及的药物分别是螺内酯(82.56%)、利伐沙班(13.95%)和加巴喷丁(3.49%)。采用倾向性评分匹配法使两组达到组间均衡后,试验组患者的衰弱发生率为77.94%,对照组为27.94%(P<0.001),而两组间其余混杂因素比较,差异均无统计学意义(P>0.05)。Logistic回归分析结果显示,试验组患者发生衰弱的风险是对照组的3.118倍(比值比为3.118,95%置信区间为1.758~5.530,P<0.001)。结论RIM是老年糖尿病患者衰弱的危险因素,可考虑将其增补为早期识别和筛查老年糖尿病患者衰弱的一项指标。

OBJECTIVE To investigate the effects of renally inappropriate medication(RIM)on the frailty of elderly patients with diabetes.METHODS The data of elderly patients with diabetes mellitus admitted to a third-grade class A hospital in Yunnan province from January to December 2022 were collected,and Beers criteria(2019 edition)and Chinese version of FRAIL scale were used to evaluate RIM and the frailty of the patients;the patients were divided into the trial group(with RIM)and the control group(without RIM)according to whether there was RIM.The propensity score matching was used to balance confounding factors between two groups,and the influence of RIM on the frailty of elderly diabetic patients was analyzed by the Logistic regression model.RESULTS Among the 367 patients,80 patients(21.80%)had RIM,the drugs involved RIM were spironolactone(82.56%),rivaroxaban(13.95%)and gabapentin(3.49%).After reaching the balance between groups using the propensity score matching method,the incidence of frailty was 77.94%in trial group and 27.94%in control group(P<0.001);the difference was not statistically significant in other confounding factors between the two groups(P>0.05).Results of Logistic regression analysis showed that the risk of frailty in the experimental group was 3.118 times that of the control group(odds ratio was 3.118,95%confidence interval was 1.758-5.530,P<0.001).CONCLUSIONS RIM is a risk factor for the frailty of elderly patients with diabetes,which can be considered as an indicator for early identification and screening of the frailty of elderly diabetes patients.