老年高血压合并衰弱住院患者的营养状况调查及相关因素分析  

Nutritional status and related factors of elderly hospitalized patients with hypertension and frailty

作　　者：郑淑娟 李瑜[1] 欧阳菊艳[1] 田甜[1] 米叶赛·艾尼瓦尔 王亚楠[1] 王红[1] Zheng Shujuan;Li Yu;Ouyang Juyan;Tian Tian;Miyesai·Ainiwaer;Wang Yanan;Wang Hong(Second Department of Comprehensive Internal Medicine,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆医科大学第一附属医院综合内二科,乌鲁木齐830000

出　　处：《中华老年心脑血管病杂志》2024年第8期886-891,共6页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：新疆维吾尔自治区重点研发计划项目(2022B03009-2)。

摘　　要：目的评估老年高血压合并衰弱住院患者的营养状况,探讨营养和衰弱的相关性。方法连续纳入2022年10月至2023年12月新疆医科大学第一附属医院收治的老年高血压患者801例,通过Fried表型衰弱量表评估患者衰弱程度,分为衰弱组(≥3分)276例、衰弱前期组(1~3分)362例、非衰弱组(0分)163例。同时采用微型营养评定量表(micro nutrition assessment,MNA)对患者进行营养风险评估,记录日常生活活动能力量表(activities of daily living,ADL)评分及年龄校正Charlson合并症指数(age-adjusted Charlson comorbidity index,ACCI)评分。用logistic回归分析老年高血压患者发生衰弱的影响因素,用Spearnman相关性分析衰弱和营养相关指标的关系,用ROC曲线分析营养指标对衰弱发生的预测能力。结果3组患者年龄、平均收缩压、其他慢性病、多重用药、平均握力、小腿周径、血红蛋白、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆固醇、白蛋白、25-羟维生素D[25(OH)D]、骨钙素、维生素B_(12)、同型半胱氨酸、MNA评分、MNA评分分级、ADL评分、ACCI评分等比较,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,多重用药(OR=2.361,95%CI:1.332~4.183)、MNA评分≥24分(OR=0.298,95%CI:0.110~0.808)、ADL评分(OR=1.094,95%CI:1.028~1.166)、白蛋白(OR=0.963,95%CI:0.934~0.994)、25(OH)D(OR=0.989,95%CI:0.980~0.998)是老年高血压患者发生衰弱的独立影响因素(P<0.05,P<0.01)。衰弱与年龄、多重用药、其他慢性病、ACCI评分呈正相关(P<0.01),与MNA评分、MNA评分分级、血红蛋白、白蛋白、25(OH)D、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、同型半胱氨酸、平均握力、小腿周径呈负相关(P<0.01)。ROC曲线显示,25(OH)D、白蛋白和MNA评分预测衰弱发生的曲线下面积分别为0.607、0.588、0.700。结论老年高血压合并衰弱患者营养状况差,识别早期衰弱有赖于营养量表风险评估Objective To survey the nutritional status of elderly hospitalized patients with hypertension and frailty,and explore the correlation between nutrition and frailty.Methods A total of 801 elderly hypertensive patients admitted to our hospital from October 2022 to December 2023 were cosecutively enrolled,and according to Fried frailty phenotype criteria,they were divided into frailty group(score:≥3,276 cases),pre-frailty group(score:1-3,362 cases)and non-frailty group(score:0,163 cases).At the same time,MNA was used to evaluate the nutritional risk of the patients,and the scores of ADL and the score of ACCI were recorded.Logistic regression model was used to analyze the influencing factors of frailty in elderly hypertensive patients,Spearman correlation analysis was employed to analyze the relationship between frailty and nutrition-related indicators,and ROC curve was plotted to analyze the predictive performance of these nutritional indicators in the occurrence of frailty.Results There were statistically differences among the three groups in terms of age,mean SBP,complication of other chronic diseases,polypharmacy,mean handgrip strength,calf circumference,MNA score and classification,ADL and ACCI scores,and levels of hemoglobin,HDL-C,LDL-C,TC,albumin,25-hydroxyvitamin D[25(OH)D],bone alkaline phosphatase,VitB_(12)and Hcy(P<0.05,P<0.01).Multivariate logistic regression analysis revealed that polypharmacy(OR=2.361,95%CI:1.332-4.183),MNA score≥24(OR=0.298,95%CI:0.110-0.808),ADL score(OR=1.094,95%CI:1.028-1.166),albumin(OR=0.963,95%CI:0.934-0.994),and 25(OH)D(OR=0.989,95%CI:0.980-0.998)were independent risk factors for frailty in elderly hypertensive patients(P<0.05,P<0.01).Frailty was positively correlated with age,polypharmacy,other chronic diseases,and ACCI score(P<0.01),and negatively with MNA score,MNA classification,hemoglobin,albumin,25(OH)D,HDL-C,LDL-C,Hcy,average grip strength,and calf circumference(P<0.01).ROC curve analysis showed that the AUC values of 25(OH)D,albumin,and MNA score were 0.607,0.588,and

关 键 词：高血压 衰弱 营养不良 数据相关性 住院患者 

分 类 号：R544.1[医药卫生—心血管疾病]