住院老年冠心病患者合并肌少症的相关因素分析  

Related factors of sarcopenia in hospitalized elderly patients with coronary heart disease

作　　者：张宁 朱文玲[2] 刘晓红 陈伟[3] 朱鸣雷 孙晓红 吴炜 Zhang Ning;Zhu Wenling;Liu Xiaohong;Chen Wei;Zhu Minglei;Sun Xiaohong;Wu Wei(Department of Geriatrics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Cardiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Clinical Nutrition,Chinese Academy of Medical Sciences,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院老年医学科,100730 [2]中国医学科学院,北京协和医学院,北京协和医院心内科,100730 [3]中国医学科学院,北京协和医学院,北京协和医院临床营养科,100730

出　　处：《中华心血管病杂志》2019年第12期979-984,共6页Chinese Journal of Cardiology

基　　金：中国医学科学院医学与健康科技创新工程项目(2018-I2M-1-002)。

摘　　要：目的探讨住院老年冠心病患者合并肌少症的情况及其相关因素。方法该研究为单中心观察性研究。按入排标准连续入选2017年12月至2018年12月在北京协和医院老年医学科及心内科住院治疗的老年冠心病患者,根据患者是否患有肌少症分为冠心病合并肌少症组和冠心病不合并肌少症组。肌少症的诊断采用2014年亚洲肌少症工作组标准。评估入院患者的日常生活活动能力[日常生活活动能力评分(ADL)、日常生活活动评分(IADL)]。应用Charlson共病指数(CCI)对患者的共存疾病程度进行评估。核查患者长期服用药物,评估是否存在多重用药。采用简易营养评估量表(MNA-SF)筛查入选患者的营养状况。测试患者全足距站立时间。评估患者近1年内跌倒史、是否合并尿失禁以及居住情况。采用多因素logistic回归模型分析住院老年冠心病患者合并肌少症的相关因素。结果最终入选住院老年冠心病患者364例,其中男性218例(59.9%),年龄65~96(74.6±6.5)岁。入选患者中稳定性冠心病264例,急性冠状动脉综合征(ACS)患者100例。入选患者的中位长期服用药物种类为7种,152例(41.8%)患者合并2型糖尿病,38例(10.4%)患者合并焦虑/抑郁,98例(26.9%)患者近1年内有跌倒史,82例(22.5%)患者合并尿失禁,12例(3.3%)患者合并营养不良,33例(9.2%)患者为独居。入选患者中患有肌少症者81例(22.3%),作为冠心病合并肌少症组;无肌少症者283例(77.7%),作为冠心病不合并肌少症组。与冠心病不合并肌少症组比较,冠心病合并肌少症组患者年龄更大、体重指数(BMI)较低(P均<0.001),CCI更高、长期用药种类更多(P均<0.05),合并营养不良、尿失禁、近1年内跌倒史、独居的比例更高(P均<0.05),ADL、IADL得分较低(P均<0.001),不能完成全足距测试者比例更高(P<0.001),超敏C反应蛋白水平较高(P=0.047),白蛋白水平较低(P=0.004),前白蛋白水平较低(P<0.001)。多Objective To explore the incidence and clinical characteristics of sarcopenia in hospitalized elderly patients with coronary heart disease and search for the related factors.Methods This study was a single-center observational study.According to the inclusion criteria,elderly patients hospitalized with coronary heart disease from Peking Union Medical College Hospital between December 2017 and December 2018 were enrolled.The patients were divided into sarcopenic group and non-sarcopenic group according to the diagnostic criteria of the Asian Working Group for Sarcopenia.Activities of daily living of the patients were assessed(including ADL and IADL).Comorbidity of the patients was evaluated by the Charlson comorbidity index(CCI).Long-term medication use of the patients was recorded to assesse whether there was polypharmacy.The nutritional status of the patients was examined by the mini nutritional assessment-short form(MNA-SF).The full tandem stance time of the patients was evaluated.The history of falls over the previous year,urinary incontinence,and living conditions of the patients were also recorded.Multivariate logistic regression was used to analyze the related factors for sarcopenia of elderly patients with coronary heart disease.Results A total of 364 patients were enrolled in the study.The patients were aged 65-96(74.6±6.5)years and there were 218(59.9%)male patients.There were 264 cases of stable coronary heart disease and 100 cases of acute coronary syndrome.The median number of long-term used medication was 7.One hundred and fifty-two(41.8%)patients were complicated with type 2 diabetes,38(10.4%)patients were complicated with anxiety/depression,and 98(26.9%)patients had the history of falls over the previous year.Eighty-two(22.5%)patients were complicated with urinary incontinence,12 patients(3.3%)were complicated with malnutrition and 33 patients(9.2%)were living alone.There were 81(22.3%)sarcopenic patients and 283(77.7%)non-sarcopenic patients among all the hospitalized elderly patients with corona

关 键 词：冠状动脉疾病 老年人 肌少症 

分 类 号：R6[医药卫生—外科学] R541[医药卫生—临床医学]