慢性心血管疾病老年住院患者营养状态与衰弱情况、肌肉衰减症情况的相关性分析  

Correlation among nutritional status, sarcopenia and frailty in elderly inpatients with chronic cardiovascular disease

作　　者：王丽娟[1] 丁丽丽[1] 陈丽如[1] 程博[1] 朱明炜[1] 王华[2] Wang Lijuan;Ding Lili;Chen Liru;Cheng Bo;Zhu Mingwei;Wang Hua(Department of Clinical Nutrition,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Cardiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院临床营养科,国家老年医学中心,中国医学科学院老年医学研究,100730 [2]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

出　　处：《中华临床营养杂志》2022年第6期346-353,共8页Chinese Journal of Clinical Nutrition

基　　金：北京市科委基金面上项目(D181100000218003);中国医学科学院医学与健康科技创新工程项目(2021-I2M-C&T-B-094)。

摘　　要：目的分析慢性心血管疾病老年住院患者的营养状态与衰弱情况、肌肉衰减症情况的关系。方法横断面研究, 选择2018年9月至2019年2月在北京医院心内科因慢性心血管疾病住院治疗的≥65岁的老年患者。营养状态的评估采用微型营养评定简表(mini nutritional assessment-short form, MNA-SF), 衰弱情况的评估采用衰弱筛查量表(the FRAIL scale, FRAIL), 根据亚洲肌少症工作组发布的2019肌少症诊断及治疗专家共识评估肌肉衰减症情况。分析营养状态、衰弱情况、肌肉衰减症情况的患病率和重叠患病率, 以及营养状态对衰弱情况和肌肉衰减症情况的影响。结果符合入选标准的147例老年患者进入本研究, 平均年龄74.45岁(65~88岁)。营养不良风险的发生率25.9%(38/147), 营养不良的发生率1.4%(2/147);肌肉衰减症风险发生率37.4%(55/147), 肌肉衰减症发生率6.8%(10/147);衰弱前期发生率55.8%(82/147), 衰弱发生率10.2%(15/147)。按疾病分层, 慢性心功能不全的营养不良风险、肌肉衰减症风险、肌肉衰减症、衰弱比例均最高, 分别为66.7%、50%、16.7%、50.0%。按年龄分层, 随着年龄的增加, 肌肉衰减症风险、肌少症的发生率呈上升趋势, 年龄与小腿围(r=-0.219, P=0.008)、握力(r=-0.307, P<0.01)、步速(r=-0.390, P<0.01)呈负相关, 与5次起坐时间呈正相关(r=0.406, P<0.01);随着年龄的增加, 衰弱的发生率也呈上升趋势, 年龄与FRAIL量表得分呈正相关(r=0.232, P=0.005)。超重和肥胖[体重指数(body mass index, BMI)≥24]患者占63.9%, 其营养不良风险发生率为20.2%(19/94), BMI正常组营养不良风险的发生率为32.0%(16/50), 消瘦组100%处于营养不良风险或营养不良状态;MNA-SF量表得分与BMI呈正相关(r=0.334, P<0.01)。肌肉衰减症风险和肌肉衰减症的发生率在超重组和肥胖组分别为23.4%(22/94)、2.1%(2/94), BMI正常组为62.0%(31/50)、14.0%(7/50), 消瘦组为66.7%(2/3)、33.3%(1/3)Objective:To analyze the correlation among nutritional status, sarcopenia and frailty in elderly inpatients with chronic cardiovascular disease.Methods:A cross-sectional study was conducted in a total of 147 patients aged 65-88 years old who were hospitalized for chronic cardiovascular disease between September 2018 and February 2019. Nutritional status was assessed by mini nutritional assessment short form (MNA-SF), frailty by FRAIL scale and sarcopenia by criteria from Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. The prevalence and overlapping prevalence of nutritional status, frailty and sarcopenia were analyzed, as well as the influence of nutritional status on frailty and sarcopenia.Results:The mean age was 74.45 (range: 65-88). The prevalence was 25.9% (38/147) for risk of malnutrition, 1.4% (2/147) for malnutrition, 37.4% (55/147) for risk of sarcopenia, 6.8% (10/147) for sarcopenia, 55.8% (82/147) for pre-frailty and 10.2% (15/147) for frailty. When stratified by disease, the subgroup with chronic heart failure showed the highest prevalence of malnutrition risk, sarcopenia risk, sarcopenia and frailty (66.7%, 50%, 16.7% and 50.0%, respectively). The prevalence of sarcopenia risk and sarcopenia increased with age. Age was negatively correlated with calf circumference ( r = -0.219, P = 0.008), grip strength ( r = -0.307, P < 0.01) and walking speed ( r = -0.390, P < 0.01) and was positively correlated with the five times sit-to-stand test time ( r = 0.406, P < 0.01). The prevalence of frailty also increased with age and age was positively correlated with the FRAIL score ( r = 0.232, P = 0.005). As for stratification based on BMI, the majority (63.9%) patients were overweight or obese (BMI ≥ 24.0) and the prevalence of malnutrition risk in this subgroup was 20.2% (19/94). The prevalence of malnutrition risk in patients with normal BMI was 32.0% (16/50). The subgroup with BMI < 18.5 were either at malnutrition risk or with malnutrition. MNA-SF score was po

关 键 词：慢性心血管疾病 住院患者 营养不良风险 肌肉衰减症风险 衰弱 

分 类 号：R54[医药卫生—心血管疾病]