高敏肌钙蛋白T对非急性冠脉综合征老年住院衰弱患者预后的影响  

Influence of high-sensitivity cardiac troponin T on prognosis of frail elderly inpatients

作　　者：张少景 王青[1] 崔云婧 杨卉[1] 符琳琳[1] Zhang Shaojing;Wang Qing;Cui Yunjing;Yang Hui;Fu Linlin(Department of Geriatrics,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综合老年科,北京100038

出　　处：《中华老年多器官疾病杂志》2023年第2期97-102,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：首都医学发展科研基金(2016-2-7012);首都医科大学附属复兴医院科研培育基金(PY-Q-202205)。

摘　　要：目的探讨高敏肌钙蛋白T(hs-cTnT)对非急性冠脉综合征(ACS)老年住院衰弱及衰弱前期患者预后的影响。方法选择2017年1月至2019年12月于首都医科大学附属复兴医院综合老年科收住院的经Fried量表评估为衰弱及衰弱前期患者。检测患者的hs-cTnT水平,记录患者的一般资料、实验室检查指标及超声心动指标,出院后每3个月进行电话随访,记录患者的全因死亡情况。根据hs-cTnT三分位数将患者分为低值组、中值组和高值组,采用乘积极限(Kaplan-Meier)法(K-M曲线)比较3组患者生存曲线的差异,采用Cox回归模型分析hs-cTnT三分位分组对患者死亡风险的影响。采用SPSS 18.0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、方差分析、Wilcoxon检验及χ^(2)检验。结果本研究共纳入衰弱及衰弱前期老年住院患者450例,其中72.4%(326/450)患者hs-cTnT超过切点值0.014μg/L。低值组、中值组和高值组年龄[(83.67±5.72)和(86.06±4.93)和(87.67±5.23)岁]、男性患者[62(41.3%)和94(62.7%)和108(72.0%)]、慢性心力衰竭患者[(4(2.7%)和5(3.3%)和22(14.7%)]、高血压患者[(116(77.3%)和119(79.3%)和133(88.7%)]、心律失常患者[41(27.3%)和38(25.3%)和60(40.0%)]、慢性肾脏病患者[27(18.0%)和38(25.3%)和61(40.7%)]、共病(≥4种共病)患者[72(48.0%)和73(48.7%)和99(66.0%)]、血红蛋白[(125.11±16.03)和(121.50±18.08)和(115.38±16.97)g/L]、肾小球滤过率[(87.91±30.74)和(76.73±23.08)和(66.69±27.80)ml/(min·1.73m^(2))]、白蛋白[(38.15±3.81)和(37.60±3.98)和(36.04±4.41)g/L]、总胆固醇[(4.01±0.98)和(3.62±0.88)和(3.70±0.85)mmol/L]、低密度脂蛋白胆固醇[(2.42±0.88)和(2.05±0.73)和(2.19±0.77)mmol/L]、N末端B型钠利尿肽前体[163.5(104.8,398.9)和314.7(171.4,683.8)和547.3(288.3,1568.3)pg/ml]、室间隔厚度[(11.30±0.83)和(11.42±0.79)和(11.71±1.07)mm]、左室后壁厚度[(11.31±0.83)和(11.46±0.75)和(11.65±0.83)mm]、左室质量指数[(107.38±1Objective To explore the influence of high-sensitivity cardiac troponin T(hs-cTnT)on the prognosis of frail and pre-frail elderly hospitalized patients without acute coronary syndrome(ACS).Methods The elderly patients who were admitted to our department and identified as frailty or pre-frailty by Fried Frailty Phenotype assessment from January 2017 to December 2019 were enrolled in this study.Their hs-cTnT level,general information,laboratory indicators and echocardiographic indicators were recorded.Follow-up was conducted each three months through phone call after discharge and all-cause deaths of the patients were observed.These patients were divided into low-,median-,and high-value groups according to hs-cTnT tertiles.The survival curves of the three groups were compared using Kaplan-Meier method(K-M curve).Cox proportional hazard-regression model was used to analyze the effect of 3 hs-cTnT groups on the risk of death.SPSS statistics 18.0 was used for statistical analysis.Data comparison between two groups was perfomed using t test,Fisher exact test,Wilcoxon test orχ^(2)test depending on data type.Results A total of 450 frail and pre-frail elderly inpatients were subjected in this study,72.4%(326/450)of them had hs-cTnT levels exceeding the cut-off value of 0.014μg/L.There were significant differences in age[(83.67±5.72)vs(86.06±4.93)vs(87.67±5.23)years],male ratio[62(41.3%)vs 94(62.7%)vs 108(72.0%)],chronic heart failure ratio[4(2.7%)vs 5(3.3%)vs 22(14.7%)],hypertension ratio[116(77.3%)vs 119(79.3%)vs 133(88.7%)],arrhythmia ratio[41(27.3%)vs 38(25.3%)vs 60(40.0%)],chronic kidney disease ratio[27(18.0%)vs 38(25.3%)vs 61(40.7%)],comorbid conditions[≥4,72(48.0%)vs 73(48.7%)vs 99(66.0%)],hemoglobin level[(125.11±16.03)vs(121.50±18.08)vs(115.38±16.97)g/L],estimated glomerular filtration rate[(87.91±30.74)vs(76.73±23.08)vs(66.69±27.80)ml/(min·1.73m^(2))],albumin level[(38.15±3.81)vs(37.60±3.98)vs(36.04±4.41)g/L],total cholesterol level[(4.01±0.98)vs(3.62±0.88)vs(3.70±0.85)mmol/L],low-density lip

关 键 词：老年人 高敏肌钙蛋白T 衰弱 住院患者 预后 

分 类 号：R592[医药卫生—老年医学]