老年慢性非传染性疾病患者内在能力下降的影响因素  

Influencing factors of intrinsic capacity decline in elderly patients with chronic non-communicable diseases

作　　者：张冉[1] 郭静[1] 王倩[1] 李冰[1] 赵向娅[1] 杨轶[1] 董玲 李淑莹 田蕊[1] ZHANG Ran;GUO Jing;WANG Qian;LI Bing;ZHAO Xiang-ya;YANG Yi;DONG Ling;LI Shu-ying;TIAN Rui(Department of General Geriatrics,the First Af filiated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院老年综合科,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2023年第4期383-388,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家科技创新2030-“新一代人工智能”重大专项(2021ZD0111001);河南省科技攻关计划项目(222102310435)。

摘　　要：目的分析内在能力(intrinsic capacity,IC)下降的老年慢性非传染性疾病患者血液学指标及临床资料,探讨IC下降的影响因素。方法332例老年慢性非传染性疾病患者均于入院次日评估IC评分,并依据IC评分分为IC下降组(IC评分≥1分)196例和IC正常组(IC评分0分)136例,比较2组年龄、性别、体质量指数、白蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、C反应蛋白、D-二聚体等指标。以年龄为协变量,采用1∶1倾向性评分匹配121对患者。倾向性评分匹配后,对2组行衰弱/衰弱前期、失能、谵妄、疼痛、吞咽困难等老年综合征评估;采用多因素logistic回归分析老年慢性非传染性疾病患者IC下降的影响因素。结果(1)332例患者中IC下降196例,IC下降率为59.0%。(2)倾向性评分匹配前,IC下降组年龄[83(78,87)岁]大于IC正常组[79(76,83)岁](U=8220.000,P<0.001),白蛋白[(40.68±4.74)g/L]水平低于IC正常组[(43.93±2.41)g/L](t=8.095,P<0.001),低密度脂蛋白胆固醇[(2.42±0.96)mmol/L]、总胆固醇[(4.06±1.08)mmol/L]、C反应蛋白[1.99(1.15,3.61)mg/L]、D-二聚体[0.25(0.14,0.39)mg/L]水平均高于IC正常组[(2.22±0.38)mmol/L、(3.86±0.55)mmol/L、0.93(0.77,1.57)mg/L、0.23(0.19,0.41)mg/L](P<0.05),男性比率、体质量指数、白细胞计数及三酰甘油、高密度脂蛋白胆固醇水平与IC正常组比较差异均无统计学意义(P>0.05)。(3)倾向性评分匹配后,IC下降组体质量指数[(23.94±3.75)kg/m^(2)]低于IC正常组[(24.88±3.23)kg/m^(2)](t=2.077,P=0.039),恶性肿瘤、痴呆比率(26.4%、10.7%)均高于IC正常组(15.7%、0)(χ^(2)=4.199,P=0.040;χ^(2)=13.738,P<0.001),男性、独居及胃肠病、2型糖尿病、高血压、冠心病、慢性阻塞性肺疾病、慢性肾脏病、脑梗死、肝病比率,年龄、查尔森合并症指数与IC正常组比较差异均无统计学意义(P>0.05)。IC下降组衰弱/衰弱前期(71.9%)、失能(43.8%)、疼痛(49.6%)、�Objective To analyze the clinical data and hematological indexes in elderly patients with chronic non-communicable diseases complicated with intrinsic capacity (IC)decline and to explore the influencing factors of IC decline.Methods A total of 332elderly patients with chronic non-communicable diseases were divided into 196patients with IC≥1 (IC decline group)and 136patients with IC=0(normal IC group)according to the results of IC evaluation on the second day after admission.The age,gender,body mass index,albumin,total cholesterol,triacylglycerol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,C-reactive protein (CRP),D-dimer and other indexes were compared between two groups.Taking the age as a covariate,121pairs of patients were successfully matched by 1:1 matching the propensity score.After matching,the geriatric syndromes as frail/pre-frail,disability,delirium,pain and dysphagia were evaluated in two groups.Multivariate logistic regression was done to analyze the risk factors of IC decline in elderly patients with chronic non-communicable diseases.Results(1)Among 332patients,IC declined in 196patients,with IC decline rate of 59.0%.(2)Before matching,the patients were older in IC decline group[83 (78,87)years]than normal IC group[79(76,83)years](U=8 220.000,P<0.001),the level of albumin was lower in IC decline group[(40.68±4.74)g/L]than that in normal IC group[(43.93±2.41)g/L](t=8.095,P<0.001),the levels of low-density lipoprotein cholesterol,total cholesterol,CRP and D-dimer were higher in IC decline group[(2.42±0.96)mmol/L,(4.06±1.08)mmol/L,1.99(1.15,3.61)mg/L,0.25(0.14,0.39)mg/L]than those in normal IC group[(2.22±0.38)mmol/L,(3.86±0.55)mmol/L,0.93(0.77,1.57)mg/L,0.23(0.19,0.41)mg/L](P<0.05),and there were no significant differences in the male ratio,body mass index,white blood cell count,triacylglycerol and high-density lipoprotein cholesterol between two groups(P>0.05).(3)After matching,the body mass index was lower in IC decline group[(23.94±3.75)kg/m^(2)]than that in nor

关 键 词：慢性非传染性疾病 内在能力 老年 危险因素 

分 类 号：R592[医药卫生—老年医学]