急诊老年患者衰弱状况与维生素D营养状况的相关性研究  

Study on frailty status and the association between vitamin D nutritional status and frailty in elderly patients in emergency department

作　　者：刘慧珍[1] 郭树彬[2] 商娜 李俊玉 刘小蒙 王国栋[3] Liu Huizhen;Guo Shubin;Shang Na;Li Junyu;Liu Xiaomeng;Wang Guodong(Department of Emergency Medicine,Beijing Bo'Ai Hospital,China Rehabilitation Research Center,Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Emergency Medicine Center,Beijing Chao-Yang Hospital,Capital Medical University,Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing 100020,China;Department of Cardiology,Beijing Bo'AI Hospital,China Rehabilitation Research Center,Capital Medical University School of Rchabilitation Medicine,Beijing 100068,China)

机构地区：[1]首都医科大学康复医学院中国康复研究中心北京博爱医院急诊科,北京100068 [2]首都医科大学附属北京朝阳医院急诊医学中心心肺脑复苏北京市重点实验室,北京100020 [3]首都医科大学康复医学院中国康复研究中心北京博爱医院心血管内科,北京100068

出　　处：《中华老年医学杂志》2024年第8期1043-1048,共6页Chinese Journal of Geriatrics

基　　金：中国康复研究中心科研项目(2023ZX-23);心肺脑复苏北京市重点实验室开放课题(2020XFN-KFKT-02)。

摘　　要：目的探索急诊老年患者衰弱状况及维生素D(VitD)营养状况与衰弱的相关性。方法横断面研究, 收集2021年1-9月于北京博爱医院急诊重症监护病房和急诊留观病房治疗的65岁及以上患者的临床资料;入院后24 h内检测血常规、生化、白细胞介素-6、皮质醇、促甲状腺素、25羟基-维生素D[25(OH)D]水平;进行衰弱筛查问卷(FSQ)、衰弱(FRAIL)、临床衰弱量表(CFS)评分;分别根据3种量表定义患者是否衰弱, 报告不同诊断标准的衰弱患病率, 采用Spearman检验和Kappa系数对3种量表进行一致性评价。比较衰弱与非衰弱组间临床资料及实验室指标的差异;采用多因素Logistic回归模型分析VitD营养状况与衰弱的相关性。比较不同VitD营养状况组间衰弱患病率的差异, 采用受试者工作特征曲线(ROC)评价血清25(OH)D对衰弱的预测能力。结果共317例患者纳入本研究, 依据FSQ、FRAIL、CFS标准, 衰弱患病率依次为47.0%、55.2%、69.4%。3种量表依次进行一致性评价, FSQ与FRAIL的Spearman秩相关系数r为0.761(95%CI:0.715~0.806, P<0.001)、Kappa系数0.536(95%CI:0.451~0.621, P<0.001)均最大。Logistic回归分析结果显示, 调整年龄、性别、体质指数等因素后, VitD缺乏(OR=5.994、95%CI:1.232~29.169、P=0.027)与FSQ衰弱患病率增加呈独立相关。随着VitD营养不良程度加重, 衰弱患病率呈递增趋势;VitD缺乏组高于VitD不足及充足组(均P<0.05)。血清25(OH)D水平预测FSQ、FRAIL、CFS衰弱的ROC曲线下面积(AUC)依次为0.806(95%CI:0.744~0.868)、0.748(95%CI:0.679~0.817)、0.768(95%CI:0.701~0.826)(均P<0.001), 最佳截断值依次为12.0、9.76、11.65 μg/L, 约登指数依次为0.553、0.419、0.462。结论 FSQ、FRAIL、CFS在急诊老年患者衰弱的评估中具有较好的一致性;25(OH)D可作为衰弱的独立预测因子, 检测血清25(OH)D水平有助于识别衰弱, 可改善急诊老年患者的危险分层。Objective To examine the prevalence of frailty among elderly patients in the emergency department and to investigate the potential relationship between vitamin D nutritional status and frailty.MethodsThis study collected clinical data from elderly patients aged over 65 years in the emergency intensive care unit and emergency observation ward of Beijing Bo'Ai Hospital from January to September 2021.The data included blood routine,biochemical indicators,circulating interleukin-6,cortisol,thyrotropin,and 25-hydroxyvitamin D[25(OH)D],which were detected within 24 hours after enrollment.Additionally,the Frailty Screening Questionnaire(FSQ),FRAIL scale,and Clinical Frailty Scale(CFS)were used to score the patients.Based on the scores,the patients were divided into frail or non-frail groups,and the prevalence of frailty was reported accordingly using the criteria of the aforementioned scales.The consistency of the three scales was evaluated using the Spearman rank test and Kappa coefficient.We compared the differences in clinical data and laboratory indicators of patients between the frail and non-frail groups.Additionally,we used a multivariable Logistic regression model to analyze the association between vitamin D nutritional status and frailty.We also analyzed the prevalence of frailty in different vitamin D nutritional statuses and evaluated the predictive ability of serum 25(OH)D for frailty using the receiver operating characteristic(ROC)curve.Results A total of 317 patients were included in the study.The prevalence of frailty in elderly patients in the emergency department was found to be 47.0%,55.2%,and 69.4%according to the FSQ,FRAIL,and CFS scales,respectively.The study evaluated the consistency of these three scales,revealing a Spearman rank correlation coefficient of 0.761(95%CI:0.715-0.806,P<0.001)and a Kappa coefficient of 0.536(95%CI:0.451-0.621,P<0.001)between FSQ and FRAIL,which were the highest correlations observed.Logistic regression analysis,after adjusting for age,gender,BMI,and other factors,indic

关 键 词：流行病学 维生素D 营养状况 衰弱 

分 类 号：R153.3[医药卫生—营养与食品卫生学]