老年住院患者心脏结构和功能与衰弱的相关性研究  

Association of cardiac structure and function with frailty in elderly inpatients

作　　者：罗瑶[1] 郑裴裴 孙宁[1] 崔玲玲 董蔚[2] 缪国斌 王华[1] 杨杰孚[1] Luo Yao;Zheng Peipei;Sun Ning;Cui Lingling;Dong Wei;Miao Guobin;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;Department of Cardiology,Chinese PLA General Hospital,Beijing 100039,China;Department of Cardiology,Beijing Tsinghua Changgung Hospital,Beijing 102218,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研究院,北京100730 [2]中国人民解放军总医院心内科,北京100039 [3]北京清华长庚医院心内科,北京102218

出　　处：《中华老年医学杂志》2022年第3期250-255,共6页Chinese Journal of Geriatrics

基　　金：北京市科委基金面上项目资助(D181100000218003);中国医学科学院医学与健康科技创新工程项目资助(2018-I2M-1-00)。

摘　　要：目的探讨老年住院患者心脏结构和功能与衰弱的关系。方法横断面研究,连续入选2018年9月至2019年4月在北京医院、中国人民解放军总医院和北京清华长庚医院住院的年龄≥65岁老年患者,共纳入老年住院患者925例,其中衰弱患者285例、非衰弱患者640例。采用Fried衰弱表型进行评估,收集临床资料和超声心动图数据,分析心脏结构和功能与衰弱的关系。结果与非衰弱组比较,衰弱组患者年龄更大、体质指数更低、心力衰竭、心房颤动/心房扑动、卒中/短暂脑缺血发作史、肾功能不全、既往跌倒史比例更高;N末端B型利钠肽原(NT-proBNP)更高,肌酐清除率、血红蛋白更低(均P<0.05);与非衰弱组比较,衰弱组左心房前后径更大[(37.8±7.1)mm比(36.3±5.1)mm,t=-3.134,P=0.002]、左心房前后径≥45 mm比例更高[15.8%(45/285)比6.1%(39/640),χ^(2)=22.452,P<0.001]、左心室射血分数更低[(60.1±9.5)%比(61.9±7.5)%,t=2.817,P=0.005]、二尖瓣前向血流E峰速度更快[(0.8±0.3)cm/s比(0.7±0.2)cm/s,t=-2.675,P=0.003]。多因素Logistic回归分析结果显示,左心房前后径≥45 mm是衰弱的独立相关因素(OR=2.249、P=0.015);增龄(OR=1.099、P<0.001)、心力衰竭(OR=1.786、P=0.049)、卒中/短暂脑缺血发作史(OR=1.960、P=0.001)和血红蛋白降低(OR=0.984、P=0.008)与衰弱独立相关。结论左心房前后径≥45 mm、心力衰竭与衰弱独立相关,在衰弱患者中应注意评估心脏结构和功能、筛查心血管疾病。Objective To assess whether cardiac structure and function are associated with frailty in elderly inpatients.Methods This was a cross-sectional study.Inpatients aged 65 years or over,admitted to Beijing Hospital,Chinese PLA General Hospital and Beijing Tsinghua Changgeng Hospital,were consecutively recruited from September 2018 to April 2019.A total of 925 elderly inpatients were enrolled in the study,including 285 frailty patients and 640 non-frailty patients.Frailty was assessed with the Fried frailty phenotype.Clinical and echocardiographic data were collected.The association of cardiac structure and function with frailty was analyzed.Results Compared with the non-frailty group,the frailty group was older,had lower body mass index,and had higher rates of heart failure,atrial fibrillation/atrial flutter,history of stroke/transient ischemic attack,renal insufficiency,and history of falls.N-terminal B-type natriuretic peptide(NT-proBNP)levels were higher while creatinine clearance and hemoglobin levels were lower(all P<0.05);The frailty group had a larger anterior-posterior left atrial diameter[(37.8±7.1)mm vs.(36.3±5.1)mm,t=-3.134,P=0.002]and a higher proportion with the left atrial anterior posterior diameter≥45 mm[15.8%(45/285)vs.6.1%(39/640),χ^(2)=22.452,P<0.001],a lower left ventricular ejection fraction[(60.1±9.5)%vs.(61.9±7.5)%,t=2.817,P=0.005]and a faster peak mitral inflow velocity[(0.8±0.3)cm/s vs.(0.7±0.2)cm/s,t=-2.675,P=0.003].Multivariate logistic regression analysis showed that the left atrial anterior posterior diameter≥45 mm was an independent correlation factor for frailty(OR=2.249,P=0.015).Increased age(OR=1.099,P<0.001),heart failure(OR=1.786,P=0.049),history of stroke/transient ischemic attack(OR=1.960,P=0.001)and decreased hemoglobin(OR=0.984,P=0.008)were independently associated with frailty.Conclusions The left atrial anterior posterior diameter≥45 mm and heart failure were independently associated with frailty.Assessing cardiac structure and function and screening for cardiova

关 键 词：衰弱 左心房前后径 心力衰竭 

分 类 号：R592[医药卫生—老年医学]