衰弱对老年心血管疾病住院患者预后的影响  

Impact of frailty on prognosis of elderly inpatients with cardiovascular disease

作　　者：李莹莹[1,2] 梁耀丹 姚思敏 郑裴裴[1] 曾学寨 崔玲玲[1] 果迪 王华 杨杰孚[1,2] Li Yingying;Liang Yaodan;Yao Simin;Zheng Peipei;Zeng Xuezhai;Cui Lingling;Guo Di;Wang Hua;Yang Jiefu(Department of Cardiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Graduate School of Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院心内科,国家老年医学中心,中国医学科学院老年医学研究院,100730 [2]中国医学科学院北京协和医学院研究生院,100730

出　　处：《中国心血管杂志》2021年第1期16-20,共5页Chinese Journal of Cardiovascular Medicine

基　　金：北京市科技重大专项(D181100000218003);中国医学科学院医学与健康科技创新工程(2018-I2M-1-002);中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2019PT320013)。

摘　　要：目的评估因心血管疾病住院的老年患者中衰弱的发生情况,并探讨衰弱对预后的影响。方法本研究为前瞻性队列研究,连续纳入2018年9月至2019年2月在北京医院心内科因心血管疾病住院的老年患者。建立电子数据库,详细记录研究对象的一般临床资料。采用Fried衰弱表型进行衰弱评估。分别在患者入组后3个月、6个月和12个月进行门诊或电话随访,记录主要不良事件发生情况。复合终点事件包含全因死亡、各种原因再次入院或急诊室治疗。结果共纳入502例患者,平均年龄(75.1±6.5)岁,男性254例(50.6%),衰弱患者124例(24.7%)。与无衰弱组相比,衰弱组年龄更大,收缩压更低,脉搏更快,合并心房颤动、糖尿病、卒中/短暂性脑缺血发作、心力衰竭、恶性肿瘤更多,且血红蛋白、白蛋白、肌酐清除率、低密度脂蛋白胆固醇均显著降低,而空腹血糖、N末端B型利钠肽原和高敏C反应蛋白则显著增高。同时,衰弱组患者使用利尿剂、醛固酮受体拮抗剂、华法林和他汀类药物的比例显著高于无衰弱组,但阿司匹林使用比例显著低于无衰弱组(P<0.05)。中位随访时间342 d(197~354 d),随访期间总复合终点发生170例(33.9%),全因死亡11例(2.2%),失访6例(1.2%)。1年随访结果显示,衰弱组患者复合终点事件发生率(49.2%比28.8%,P<0.001)和全因死亡率(5.6%比1.1%,P=0.006)均显著高于无衰弱组。多因素Cox比例风险回归模型显示,衰弱是复合终点事件的独立危险因素(HR=2.023,95%CI:1.360~3.011,P=0.001),也是全因死亡的独立危险因素(HR=7.608,95%CI:2.095~27.633,P=0.002)。结论衰弱在因心血管疾病住院的老年患者中发生率较高,且为不良预后的独立预测因素,需引起临床医生重视。Objective To assess the occurrence of frailty in elderly patients hospitalized with cardiovascular disease and to evaluate its impact on prognosis.Methods We consecutively enrolled elderly patients hospitalized for cardiovascular disease in Department of Cardiology of Beijing Hospital from September 2018 to February 2019 in this prospective cohort study.An electronic database was used to record clinical data.Fried phenotype was used to assess frailty.Patients were followed up at 3 months,6 months,and 12 months after enrollment in clinic or by telephone.Composite endpoints include all-cause mortality,rehospitalization or emergency room treatment.Results A total of 502 patients were included with an average age of 75.1±6.5 years,254 males(50.6%),and 124 frailty patients(24.7%).Compared with the non-frailty patients,the frailty patients were older,had a lower systolic blood pressure,and a faster pulse(all P<0.05).Frailty patients were more likely with atrial fibrillation,diabetes,stroke/transient ischemic attack,heart failure,and cancer(all P<0.05).Hemoglobin,albumin,creatinine clearance and low-density lipoprotein cholesterol were lower,while fasting blood glucose,N-terminal pro-B-type natriuretic peptide and high-sensitivity C-reactive protein were significantly higher in frail patients(all P<0.05).The use of diuretics,aldosterone receptor antagonists,warfarin and statins in the frailty group was more common than that in the non-frailty group,but aspirin use was less common(all P<0.05).During the median follow-up of 342 days(197,354),composite endpoints events occurred in 170(33.9%)cases,11 patients(2.2%)died of all causes,and 6 patients(1.2%)were lost to follow-up.It showed that composite endpoint events were more common in frailty group(49.2%vs.28.8%,P<0.001)and all-cause mortality(5.6%vs.1.1%,P=0.006)were significantly higher.Multivariate Cox survival analysis showed that frailty was an independent risk factor for composite endpoint events(HR=2.023,95%CI:1.360-3.011,P=0.001),and all-cause mortality(HR=7.608,95

关 键 词：衰弱 心血管疾病 老年人 住院病人 预后 

分 类 号：R54[医药卫生—心血管疾病]