老年心力衰竭患者中衰弱评估的预后价值研究  

Prognostic value of frailty assessment in elderly patients with heart failure

作　　者：曾雨徽 万宇皓 孟晨 李莹莹[2] 罗瑶[2] 孙宁[2] 果迪 崔玲玲 杨杰孚[2] 王华[1,2] Zeng Yuhui;Wan Yuhao;Meng Chen;Li Yingying;Luo Yao;Sun Ning;Guo Di;Cui Lingling;Yang Jiefu;Wang Huai(Graduate School,Peking Union Medical College,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]北京协和医学院研究生院,中国医学科学院,北京100730 [2]北京医院心血管内科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2024年第8期1013-1018,共6页Chinese Journal of Geriatrics

基　　金：首都卫生发展科研专项(首发2022-1-4052);中央高水平医院临床科研业务费(BJYY-2023-070);中国医学科学院创新工程(2021-I2M-1-050)

摘　　要：目的评估衰弱对住院老年心力衰竭患者预后的影响。方法本前瞻性队列研究自2018年9月至2019年4月在北京医院、中国人民解放军总医院、北京清华长庚医院连续纳入诊断为心力衰竭的老年住院患者121例。采用Fried衰弱表型对患者进行衰弱评估, 并根据评估结果将患者分为衰弱组与非衰弱组。通过门诊或电话对患者在入组后3个月、6个月、12个月进行随访, 记录不良事件发生情况, 复合终点事件包括全因死亡和因心力衰竭急性加重再次入院。结果 121例患者的平均(78.0±7.4)岁, 男性71例(58.7%), 衰弱患者57例(47.1%)。与非衰弱组相比, 衰弱组患者估算的肾小球滤过率[(49.5±20.7)ml/(min·1.73m2)比(64.0±27.1)ml/(min·1.73m2)]、躯体生活活动能力评估得分[5.0(4.0, 6.0)分比6.0(5.0, 6.0)分]、工具性日常生活活动能力评估得分[2.0(1.3, 7.8)分比7.0(5.0, 8.0)分]、简易智力状态量表得分[26.0(16.0, 28.0)分比27.0(22.3, 29.0)分]均较低, 且住院天数更长[10.5(6.0, 18.8)d比8.0(6.0, 11.8)d], 均P<0.05。随访期间衰弱组复合终点事件发生率高于非衰弱组(43.9%比25.0%, P=0.029), Kaplan-Meier生存曲线分析显示衰弱组1年内复合终点事件发生率高于非衰弱组(P=0.013)。多因素Cox回归分析结果提示衰弱是复合终点事件的独立危险因素(HR=2.201, 95%CI:1.089~4.447, P=0.028)。结论衰弱是影响住院老年心力衰竭患者不良预后的独立危险因素, 应作为该群体临床评估和治疗策略中的重要考虑因素。Objective To assess the prognostic impact of frailty on elderly inpatients with heart failure.Methods s This prospective cohort study enrolled 121 in elderly patients with heart failure from Beijing Hospital,the General Hospital of the People's Liberation Army,and Beijing Tsinghua Changgung Hospital between September 2018 and April 2019.Patients were assessed for frailty using the Fried frailty phenotype and categorized into frail and non-frail groups.Follow-ups were conducted at 3-,6-,and 12-months post-enrollment through clinic visits or phone calls to record adverse events.Composite endpoints include all-cause mortality and rehospitalization duo to deterioration of heart failure.Results The study included 121 patients with an average age of 78.0±7.4 years,of whom 71(58.7%)were male and 57(47.1%)were classified as frail.Compared to the non-frail group,the frail group had lower estimated glomerular filtration rates[49.5±20.7 ml/(min·1.73m^(2))us.(64.0±27.1)ml/(min·1.73m^(2))],lower scores in Basic Activities of Daily Living[5.0(4.0,6.0)us.6.0(5.0,6.0)],Instrumental Activities of Daily Living[2.0(1.3,7.8)s.7.0(5.0,8.0)],and Mini-Mental State Examination[26.0(16.0,28.0)s.27.0(22.3,29.0)]allP<0.05.They also experienced longer hospital stays[10.5(6.0,18.8)days us.8.0(6.0,11.8)days,P=0.008].During the follow-up period,the incidence of composite endpoint events was significantly higher in the frail group(43.9%s.25.0%,P=0.029).Kaplan-Meier survival analysis demonstrated that the one-year incidence of composite endpoint events was significantly higher in the frail group(P=O.O13).Multivariable Cox regression analysisindicated that frailty was an independent risk factor for composite endpoint events(HR=2.201,95%CI:1.089-4.447,P=0.028).ConclusionsFrailty is an independent risk factor for poor outcomes in elderly hospitalized patients with heart failure and should be considered a crucial factor in clinical assessment and treatment strategies.

关 键 词：衰弱 心力衰竭 预后 

分 类 号：R541.6[医药卫生—心血管疾病]