老年人躯体功能障碍合并认知功能障碍影响因素研究

Research of Influencing Factors for Physical Impairment Combined with Cognitive Impairment in the Elderly

背景近年来躯体功能障碍(PI)合并认知功能障碍(CI)常被视为老年人疾病状态的一种共同体,若能早期发现这种状态并及时干预,可能会对提高老年人生活质量、减轻其家属及社会的负担有帮助,然而目前有关这种共同状态的相关研究较少,相关因素尚不明确。目的观察老年人PI合并CI的临床特征,并寻找其可能的危险因素。方法选取2018年9月—2019年11月于北京大学人民医院住院治疗的老年患者,符合入组标准的研究人群共244例,采用简易躯体能力测试(SPPB)量表评估受试者的躯体功能,采用简易智力状态检查(MMSE)量表评估受试者的认知功能,分别以SPPB得分<10分及MMSE得分<27分作为有无PI和CI的区分标准,将所有受试者分为无PI无CI患者、有PI无CI患者、无PI有CI患者、PI合并CI患者。采集患者的社会人口学、人体测量学、实验室检查等指标,采用Logistic回归分析探究老年患者发生PI合并CI的影响因素。结果244例患者中,无PI无CI患者102例(41.80%),有PI无CI患者64例(26.23%),无PI有CI患者26例(10.66%),PI合并CI患者52例(21.31%)。多因素二分类Logistic回归分析结果显示,与无PI无CI相比,年龄(P<0.001,OR=1.216,95%CI=1.217~1.312)和握力(P<0.001,OR=0.875,95%CI=0.813~0.941)是PI合并CI的独立影响因素;与有PI无CI相比,脂肪肝(P=0.007,OR=0.200,95%CI=0.062~0.646)、高血压(P=0.007,OR=3.596,95%CI=1.414~9.143)、握力(P=0.038,OR=0.943,95%CI=0.891~0.997)是PI合并CI的独立影响因素;与无PI有CI相比,年龄(P=0.008,OR=1.104,95%CI=1.026~1.189)和握力(P=0.004,OR=0.889,95%CI=0.821~0.963)是PI合并CI的独立影响因素。结论握力是老年患者发生PI合并CI的独立影响因素;其中在无PI有CI的老年患者中,年龄和握力是PI合并CI的影响因素;在有PI无CI的老年患者中,脂肪肝、高血压、握力是PI合并CI的影响因素。

Background In recent years,physical impairment(PI)combined with cognitive impairment(CI)is a common comorbidity in the elderly.An early detection of PI combined with CI in the elderly and timely interventions may help to improve the quality of life of the elderly and reduce the burden on their families and society.However,relevant studies on the comorbidity of PI and CI in the elderly and its influencing factors have been rarely reported.Objective To observe the clinical characteristics of the comorbidity of PI and CI in the elderly and the influencing factors.Methods Elderly patients hospitalized in Peking University People's Hospital from September 2018 to November 2019 were selected.A total of eligible 244 subjects meeting the inclusion criteria were surveyed for the physical function and cognitive function using the Short Physical Performance Battery(SPPB)and the Mini-mental State Examination(MMSE),respectively.PI was diagnosed with lower than 10 points of the SPPB,and CI was diagnosed with lower than 27 points of the MMSE.Patients were divided into non-PI+non-CI,PI+non-CI,non-PI+CI,PI+CI.Social demographic,anthropometric,laboratory examination and other indicators of patients were collected,and Logistic regression analysis was used to explore the influencing factors for PI combined with CI in the elderly.Results Among the 244 patients,there were 102(41.80%),64(26.23%),26(10.66%)and 52(21.31%)cases of non-PI+non-CI,PI+non-CI,non-PI+CI and PI+CI,respectively.Multivariate binary Logistic regression analysis showed that compared with non-PI+non-CI cases,age(P<0.001,OR=1.216,95%CI=1.217-1.312)and grip strength(P<0.001,OR=0.875,95%CI=0.813-0.941)were independent influencing factors for PI+CI cases.Compared with PI+non-CI cases,fatty liver disease(P=0.007,OR=0.200,95%CI=0.062-0.646),hypertension(P=0.007,OR=3.596,95%CI=1.414-9.143),and grip strength(P=0.038,OR=0.943,95%CI=0.891-0.997)were independent influencing factors for PI+CI cases.Compared with non-PI+CI cases,age(P=0.008,OR=1.104,95%CI=1.026-1.189)and grip strength(P=0.004,OR=0.889,95%CI=0.821-0.963)were independent influencing factors for PI+CI cases.Conclusion Grip strength is the independent influencing factor for PI combined with CI in the elderly.Among the elderly patients without PI and CI,age and grip strength were the influencing factors of PI and CI.In elderly patients with PI and no CI,fatty liver,hypertension and grip strength were the influencing factors of PI and CI.