老年性骨质疏松症患者衰弱状态对预后的影响  

Effect of frail status on prognosis in elderly osteoporosis patients

作　　者：王鹏[1] 张萍[2] 王青[1] 孙丽莉 李崇新[1] 张清[1] 符琳琳[1] 杨卉[1] 李华[1] 王丽军[1] WANG Peng;ZHANG Ping;WANG Qing;SUN Li-Li;LI Chong-Xin;ZHANG Qing;FU Lin-Lin;YANG Hui;LI Hua;WANG Li-Jun(Department of Geriatrics,Fuxing Hospital Affiliated to Capital Medical University,Beijing 100038,China;Department of Geriatrics,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Radiology,Fuxing Hospital Affiliated to Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属复兴医院老年医学科,北京100038 [2]北京积水潭医院老年医学科,北京100035 [3]首都医科大学附属复兴医院放射科,北京100038

出　　处：《中华老年多器官疾病杂志》2022年第5期326-330,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：国家重点研发计划(2018YFC2002100)。

摘　　要：目的探讨老年原发性骨质疏松症患者衰弱状态与再入院、死亡的关系。方法采取前瞻性队列研究,纳入2017年1月至2019年12月首都医科大学附属复兴医院综合科住院的骨质疏松症患者227例(≥65岁)。入院后根据临床衰弱量表(CFS-09)确定是否衰弱,将老年性骨质疏松症患者分为2组:衰弱组121例(CFS≥5)和非衰弱组106例(CFS<5)。收集患者性别、年龄、病史及口服药种类等一般资料,进行认知功能、营养风险等老年综合评估。出院后随访1~3(1.8±0.7)年,记录患者再入院及死亡信息。采用SPSS 23.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、Wilcoxon检验及χ^(2)检验。采用Cox回归分析衰弱状态与再入院、死亡的关系。结果患者年龄为67~100(85.1±5.0)岁,衰弱患者121例(53.3%)。衰弱组中年龄(P<0.001)、查尔森共病指数(P<0.001)、口服药种类(P=0.004)、服用潜在不适当用药(PIM)的人数(P=0.004)和种类(P=0.001)、存在营养风险人数(P<0.001)、认知功能障碍(P<0.001)、日常生活能力受损(P<0.001)均高于非衰弱组。Cox回归分析结果显示,在校正年龄、共病及潜在不适当用药(PIM)因素后,衰弱状态(CFS≥5)对死亡、再入院无明显影响。将衰弱分组进一步限制为中度以上,其中衰弱组64例(CFS≥6)和轻度衰弱及非衰弱组163例(CFS<6),校正年龄、共病及PIM因素后,中度以上衰弱(CFS≥6)明显增加全因死亡(HR=3.260,95%CI 1.626~6.538,P=0.001)和再入院(HR=1.727,95%CI 1.213~2.458,P=0.002)的风险。结论以CFS-09确定的中度以上衰弱(CFS≥6)增加老年原发性骨质疏松患者死亡、再入院风险。临床医师应重视骨质疏松患者衰弱评估,尽早采取干预措施,减少患者死亡和再入院的风险。Objective To investigate the relationship of frail status with readmission and death in senile patients with primary osteoporosis.Methods A prospective cohort study was conducted to include 227 osteoporosis patients(≥65 years old)admitted to the General Department of Fuxing Hospital from January 2017 to December 2019.According to the results of Clinical Frailty Scale(CFS-09)after admission,they were divided into frailty group(CFS≥5)and non-frailty group(CFS<5).General data,such as gender,age,medical history and oral medication were collected,and comprehensive geriatric assessments,including Mini-Mental State Examination and Mini-Nutritional Assessment-Short Form were performed for their cognitive function and nutritional risk.After discharge,all patients were followed up for 1-3(1.8±0.7)years,and their readmission and death were recorded.SPSS statistics 23.0 was used for statistical analysis.Data comparison between 2 groups was performed using student′s t test,Wilcoxon test or Chi-square test depending on data types.Cox regression analysis was used to investigate the relationship of frailty with readmission as well as death.Results The subjected patients were at a mean age of 67-100(85.1±5.0)years,with a frailty prevalence of 53.3%(121 cases).The frailty group had older age(P<0.001),higher Charlson comorbidity index(CCI)(P<0.001),more types of oral medications(P=0.004),larger number and types of potentially inappropriate medication(PIM)(P=0.004,0.001),and larger proportions of nutritional risk(P<0.001),cognitive dysfunction(P<0.001)and impaired activities daily living(P<0.001)when compared with the non-frailty weak group.Cox regression analysis showed that after adjusting for age,comorbidity and PIM,frail state(CFS≥5)had no significant effects on death and re-hospitalization.When the patients were further assigned into moderate or above frailty subgroup(CFS≥6)and mild or non-frailty group(CFS<6),moderate or above frailty state(CFS≥6)significantly increased the risk of all-cause death(HR=3.260,95%CI

关 键 词：老年人 骨质疏松 衰弱 死亡 再入院 

分 类 号：R592[医药卫生—老年医学]