T_(12)水平竖脊肌横截面积与老年急性冠脉综合征住院患者衰弱的相关性分析

The association between transverse area of vertical spinal muscle at T_(12) level and the frailty in hospitalized elderly patients with acute coronary syndrome

目的分析第十二胸椎(T_(12))水平竖脊肌横截面积与老年急性冠脉综合征(ACS)住院患者衰弱的相关性。方法采用前瞻性队列研究,收集2019年1月至2022年12月首都医科大学康复医学院中国康复研究中心北京博爱医院心血管内科病房住院的老年ACS患者临床资料;入院后24 h内检测血常规、生化、促甲状腺素(TSH)、皮质醇(COR)、25-羟维生素D[25(OH)D]及白细胞介素(IL)-6水平;24 h内完成胸部CT检查,计算T_(12)水平左、右侧竖脊肌横截面积后求和。12个月后随访,测量握力及步速,完成Fried衰弱表型(FP)评分,将患者分为衰弱与无衰弱组。比较衰弱与无衰弱组间临床资料及实验室指标差异;采用多因素Logistic回归模型分析T_(12)水平竖脊肌横截面积与衰弱的相关性。采用受试者工作特征(ROC)曲线评价T_(12)水平竖脊肌横截面积对衰弱的预测能力,计算ROC曲线下面积(95%置信区间)[AUC(95%CI)];采用Spearman秩检验进行T_(12)水平竖脊肌横截面积与握力及步速之间的线性相关性分析。结果共372例患者纳入本研究。依据Fried FP标准,老年ACS患者衰弱患病率为25.3%。衰弱组女性比例(χ^(2)=10.810,P=0.001)、年龄(Z=4.218,P<0.001)、血清超敏C-反应蛋白(hs-CRP,Z=2.795,P=0.005)、COR(Z=2.496,P=0.013)及IL-6(Z=2.548,P=0.011)高于无衰弱组,体重指数(BMI,t=3.041,P=0.003)、T_(12)水平竖脊肌横截面积(t=5.682,P<0.001)、血红蛋白(HGB,t=3.385,P=0.001)、血清白蛋白(ALB,t=3.788,P<0.001)及25(OH)D(Z=4.235,P<0.001)低于无衰弱组。Logistic回归分析显示,女性(OR=2.391,95%CI 1.090~5.770,P=0.046)、增龄(OR=1.056,95%CI 1.004~1.110,P=0.025)、T_(12)水平竖脊肌横截面积减少(OR=0.928,95%CI 0.880~0.979,P=0.005)、血清ALB降低(OR=0.899,95%CI 0.826~0.978,P=0.032)及25(OH)D水平降低(OR=0.914,95%CI 0.851~0.982,P=0.014)是衰弱的独立危险因素。T_(12)水平竖脊肌横截面积预测衰弱的AUC(95%CI)为0.802(0.733~0.859)(P<0.001),最佳截断值为≤21.25 cm^(2),敏感度79.0%,特异度80.9%。T_(12)水平竖脊肌横截面积与握力及步速间的秩相关系数(r_(S),95%CI)依次为0.816(0.749~0.870)及0.809(0.759~0.855)(P均<0.001)。结论T_(12)水平竖脊肌横截面积可作为老年ACS患者衰弱的独立预测因子,测量老年ACS患者T_(12)水平竖脊肌横截面积可早期预警衰弱。

Objective To analyze the association between the transverse area of vertical spinal muscle at the level of 12th thoracic vertebra(T_(12))and the frailty in hospitalized elderly patients with acute coronary syndrome(ACS).Methods This was a prospective cohort study.Clinical data of elderly patients with ACS admitted to the cardiovascular internal medicine ward of Beijing Boai Hospital,China Rehabilitation Research Center,Capital Medical University School of Rehabilitation Medicine from January 2019 to December 2022 were collected.Blood routine,biochemical indicators,thyroid-stimulating hormone(TSH),cortisol(COR),25-hydroxy vitamin D[25(OH)D]and interleukin(IL)-6 levels were detected within 24 h after admission;the chest CT examination was completed within 24 h,and the cross-sectional areas of the left and right vertical spinal muscles at T_(12) level were calculated and summed.The patients were followed up for 12 months,grip strength and stride speed were measured,Fried frailty phenotype(FP)score was performed,and the patients were divided into frail group and non-frail group.The differences of clinical data and laboratory indexes between the frail group and the non-frail group were compared,the multivariate Logistic regression model was used to analyze the association between the cross-sectional area of vertical spinal muscle at T_(12) level and frailty.Receiver operating characteristic(ROC)curve was used to evaluate the ability of the cross-sectional area of vertical spinal muscle at T_(12) level to predict frailty and the area under ROC curve(95%confidence intervals)[AUC(95%CI)]was calculated.Spearman rank test was used to analyze the linear correlation of the cross-sectional area of vertical spinal muscle at T_(12) level with grip strength and stride speed.Results A total of 372 patients were included in the study.According to Fried FP standard,the prevalence of frailty in elderly patients with ACS was 25.3%.The female proportion(χ^(2)=10.810,P=0.001),age(Z=4.218,P<0.001),serum hypersensitive C-reactive protein(hs-CRP,Z=2.795,P=0.005),serum COR(Z=2.496,P=0.013)and serum IL-6(Z=2.548,P=0.011)of patients in the frail group were higher than those in non-frail group;and the body mass index(BMI,t=3.041,P=0.003),the cross-sectional area of vertical spinal muscle at T_(12) level(t=5.682,P<0.001),hemoglobin(HGB,t=3.385,P=0.001),serum albumin(ALB,t=3.788,P<0.001)and serum 25(OH)D(Z=4.235,P<0.001)were lower than those in the non-frail group.Logistic regression analysis showed that female(OR=2.391,95%CI 1.090-5.770,P=0.046),aging(OR=1.056,95%CI 1.004-1.110,P=0.025),the decrease of the cross-sectional area of vertical spinal muscle at T_(12) level(OR=0.928,95%CI 0.880-0.979,P=0.005),the decrease of serum ALB(OR=0.899,95%CI 0.826-0.978,P=0.032),the decrease of serum 25(OH)D(OR=0.914,95%CI 0.851-0.982,P=0.014)were independent risk factors for frailty.The AUC(95%CI)of the cross-sectional area of vertical spinal muscle at T_(12) level for diagnosing frailty was 0.802(0.733-0.859)(P<0.001)and the optimal cut-off value was≤21.25 cm^(2),which yielded a sensitivity of 79.0% and a specificity of 80.9%.The r S(95%CI)of the cross-sectional area of vertical spinal muscle at T_(12) level with grip strength and stride speed was 0.816(0.749-0.870)and 0.809(0.759-0.855)respectively(all P<0.001).Conclusions The cross-sectional area of vertical spinal muscle at T_(12) level can serve as an independent predictor of frailty and measuring the transverse area of vertical spinal muscle at T_(12) level in elderly patients with ACS is beneficial to early warning of frailty.