机体复原力复合指标对高龄社区获得性肺炎患者预后的预测效果

An Analytical Study on the Prognostic Effect of Composite Index of Physical Resilience in Elderly Patients with Community-acquired Pneumonia

目的研究机体复原力复合指标对高龄社区获得性肺炎患者预后预测效果。方法采用便利抽样法,选取2021年6月-2023年6月于中国人民解放军总医院及首都医科大学附属北京天坛医院就诊的高龄社区获得性肺炎患者为调查对象,根据治疗结果分为治愈结局和不良结局两组。收集患者的社会、疾病、生理和机体复原力4个方面信息,使用R软件3.6.3版本进行数据分析,采用主成分分析的方法,计算Pearson相关系数,利用公式求得各分量,将有共线性的同类指标进行合并计算复合指标。结果共纳入106例患者,76例治愈,30例出现不良结局。不良结局组呼气流量峰值、小腿围、握力、基本日常生活能力(BADL)评分、工具性日常生活能力(IADL)评分和简易智能精神状态检查量表(MMSE)评分均低于治愈结局组(P<0.05),1年内呼吸道感染率、Fried衰弱量表(FFP)和临床衰弱程度量表(CFS)评分均高于治愈结局组(P<0.05)。经主成分分析对多重共线性的指标进行降维,建立营养状态(小腿围、体质量指数和握力)、功能能力(BADL评分和IADL评分)、精神状态(MMSE评分和阿森斯失眠量表评分)和衰弱状态(FFP评分和CFS评分)4个复合指标。Cox比例风险模型多因素分析结果显示,1年内有呼吸道感染史是影响治愈结局的独立危险因素(P<0.05),营养状态和功能能力是影响治愈结局的独立保护因素(P<0.05)。结论机体复原力复合指标中的营养状态、功能能力对高龄社区获得性肺炎患者的预后有预测效果。

Objective To study the prognostic effect of composite index of physical resilience in elderly patients with community-acquired pneumonia.Methods Convenience sampling method was used to select elderly patients with community-acquired pneumonia who were treated in Chinese PLA General Hospital and Beijing Tiantan Hospital affiliated to Capital Medical University from June 2021 to June 2023 as the investigation objects.According to the treatment results,they were divided into cure outcome group and adverse outcome group.Four aspects of patients social,disease,physiological and physical resilience information were collected.R software version 3.6.3 was used for data analysis.Pearson correlation coefficient was calculated by principal component analysis method,and each component was obtained by formula.Results A total of 106 cases were included,76 cases were cured and 30 cases had adverse outcomes.The peak expiratory flow rate,calf circumference,grip strength,basic activities of daily living(BADL)score,intermediate activities of daily living(IADL)score and mini-mental state examination(MMSE)score of the adverse outcome group were all lower than those of the treatment outcome group(P<0.05).The 1-year respiratory infection rate,fried frail phenotype(FFP)and clinical frailty scale(CFS)scores in the adverse outcome group were higher than those in the cure outcome group(P<0.05).The dimensions of multicollinearity were reduced by principal component analysis,and four composite indexes,namely nutritional status(calf circumference,body mass index and grip strength),functional ability(BADL score and IADL score),mental status(MMSE score and Athens insomnia scale)and frailty status(FFP score and CFS score),were established.Multivariate analysis of Cox proportional risk model showed that the history of respiratory tract infection within 1 year was an independent risk factor(P<0.05),and nutritional status and functional ability were independent protective factors(P<0.05).Conclusion The nutritional state and functional ability of the composite index of physical resilience are effective in predicting the prognosis of elderly patients with community-acquired pneumonia.