老年住院患者血液标志物水平与衰弱的相关性研究  

Association of serum biomarkers with frailty in elderly hospitalized patients

作　　者：李莹莹[1] 果迪 崔玲玲 孙宁[1] 曾学寨[1] 王华[1] 杨杰孚[1] Li Yingying;Guo Di;Cui Lingling;Sun Ning;Zeng Xuezhai;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)

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医学研究院,100730

出　　处：《中华老年医学杂志》2023年第5期498-503,共6页Chinese Journal of Geriatrics

基　　金：北京市科技重大专项北京老年人健康评估及维护关键技术研究(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-1-002);中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2019PT320013)。

摘　　要：目的评估老年住院患者不同血液标志物与衰弱的相关性。方法横断面研究,入选2018年9月至2019年2月在北京医院住院的年龄≥65岁老年患者319例,年龄(75.0±6.6)岁,女性151例(47.3%)。采用Fried表型进行衰弱评估,将患者分为非衰弱组244例(76.5%)和衰弱组75例(23.5%),比较两组患者的临床特征和血液标志物检测结果。采用受试者工作特征(ROC)曲线评价不同血液标志物与衰弱的相关性,采用最大约登指数法,获取最佳切点值并计算曲线下面积,联合不同血液标志物,比较ROC曲线下面积(AUC),评估不同血液标志物与衰弱的相关性。结果衰弱组患者血红蛋白、血脂(包括三酰甘油、总胆固醇及低密度脂蛋白胆固醇)、前白蛋白水平低于非衰弱组(均P<0.05);而N端脑钠肽前体(NT-proBNP)和高敏C反应蛋白(hsCRP)水平高于非衰弱组(均P<0.05)。衰弱组患者促甲状腺激素(TSH)和游离三碘甲腺原氨酸(FT3)水平低于非衰弱组(均P<0.05),而反三碘甲状腺原氨酸(rT3)高于非衰弱组(P<0.05)。血红蛋白、前白蛋白、hsCRP、25羟维生素D3[25(OH)D3]、rT3、NT-pro BNP 6种标志物联合与衰弱的相关性最大(AUC=0.705,95%CI:0.652~0.755),但与血红蛋白、rT3和hsCRP3种标志物联合比较差异无统计学意义(ROC=0.010,95%CI:-0.0106~0.0306,P>0.05),均优于血红蛋白与rT3的2种标志物联合(ROC=0.143,95%CI:0.0406~0.245;ROC=0.153,95%CI:0.0498~0.256;均P<0.01)。结论老年住院衰弱患者血红蛋白、血脂、前白蛋白、TSH和FT3水平降低,而NT-proBNP和hsCRP水平升高。血红蛋白、前白蛋白、hsCRP、25(OH)D3、rT3、NT-pro BNP联合检测和血红蛋白、rT3、hsCRP联合检测与衰弱的相关性优于血红蛋白与rT3联合检测。Objective To evaluate the association of different biomarkers with frailty in elderly hospitalized patients.Methods In this cross-sectional study,a total of 319 elderly patients aged 65 years or older hospitalized in Beijing Hospital between September 2018 and February 2019 were enrolled.Patients had a mean age of(75.0±6.6)years and 151(47.3%)were women.Based on the Fried phenotype,patients were divided into a non-frail group(244 cases,76.5%)and a frail group(75 cases,23.5%).The clinical characteristics and biomarker levels of the two groups were compared.The association of different biomarkers with frailty was evaluated by using the receiver operating characteristic(ROC)curve.The Youden index was used for the optimal cutoff values and the area under the curve(AUC)were calculated.AUCs of different biomarkers were compared to assess their correlations with frailty.Results Hemoglobin,lipid levels(triglycerides,total cholesterol and low-density lipoprotein cholesterol),and prealbumin were significantly lower in the frail group than in the non-frail group(P<0.05),while N-terminal pro-B type natriuretic peptide(NT-proBNP)and high-sensitivity C reactive protein(hsCRP)levels were significantly higher than in the non-frail group(P<0.05).Thyrotropin(TSH)and free triiodothyronine(FT3)levels were significantly lower(P<0.05)and trans-triiodothyronine(rT3)was significantly higher(P<0.05)in the frail group.The combination of six biomarkers[hemoglobin,prealbumin,hsCRP,25-dihydroxy vitamin D3[25(OH)D3],rT3 and NT-pro BNP]had the most powerful correlation with frailty(AUC=0.705,95%CI:0.652-0.755),but the correlation was not significantly different from that of the combination of 3 markers(hemoglobin,rT3 and hsCRP)(ROC=0.010,95%CI:-0.0106-0.0306,P>0.05).Either of the two combinations was significantly better than the combination of 2 markers(hemoglobin and rT3)(ROC=0.143,95%CI:0.0406-0.245;ROC=0.153,95%CI:0.0498-0.256;all P<0.01).Conclusions Hemoglobin,lipids,prealbumin,TSH and FT3 levels decrease while NT-proBNP and hsCRP levels

关 键 词：衰弱 血红蛋白类 利钠肽 脑 甲状腺素 

分 类 号：R592[医药卫生—老年医学] R446.11[医药卫生—内科学]