老年衰弱动态变化特征及中西医结合干预的前瞻性队列研究  

Prospective cohort study on dynamic characteristics of elderly frailty and the intervention of traditonal Chinese and Western medicine

作　　者：张亚强 成晓强 王宝[3] 关欣[4] 李怡[3] 王培[5] 王正 王峥[6] 李金辉[7] 陶睿 王晓莉[9] 滑莹莹[10] ZHANG Yaqiang;CHENG Xiaoqiang;WANG Bao;GUAN Xin;LI Yi;WANG Pei;WANG Zheng;WANG Zheng;LI Jinhui;TAO Rui;WANG Xiaoli;HUA Yingying(Traditional Medicine Department,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Beijing Mentougou Hospital of Traditional Chinese Medicine,Beijing 102300,China;Department of Traditional Chinese Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatrics,Chinese Academy of Medical Sciences,Beijing 100730,China;Party Committee Office,Beijing Hospital,National Center of Gerontology,Institute of Geriatrics,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Traditional Chinese Medicine,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China;Department of Endocrinology and Immunology,Yuquan Hospital,Tsinghua University,Beijing 100040,China;Department of Traditional Chinese Medicine,Beijing Geriatric Hospital,Beijing 100095,China;Department of Traditional Chinese Medicine,Emergency General Hospital,Beijing 100028,China;Department of Traditional Chinese Medicine,Beijing Pinggu Hospital,Beijing 101200,China;Traditional Chinese Medicine Department,Fuxing Hospital of Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京同仁医院传统医学科,北京100730 [2]北京市门头沟区中医医院,北京102300 [3]北京医院中医科,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 [4]北京医院党委办公室,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 [5]首都医科大学附属北京潞河医院中医科,北京101149 [6]清华大学玉泉医院内分泌免疫科,北京100040 [7]北京老年医院中医科,北京100095 [8]应急总医院中医科,北京100028 [9]北京市平谷区医院中医科,北京101200 [10]首都医科大学附属复兴医院中医科,北京100038

出　　处：《中华中医药杂志》2024年第10期5659-5664,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：中央高水平医院临床科研业务费(N o.B J-2022-153);北京市重大疑难疾病老年衰弱中西医协同攻关项目(No.2023BJSZDYNJBXTGG-020);北京市中医药科技发展资金项目(No.JJ-2020-31);北京市卫生健康和科技成果适宜技术推广项目(No.BHTPP202009);第六批北京市级中医药专家学术经验继承工作项目。

摘　　要：目的:探索中西医结合干预老年衰弱的临床价值。方法:采用便利抽样法,选取2021年1月至12月北京市7家综合医院中医科就诊的老年患者为研究对象,根据实际是否系统采用中医药干预分为中西医结合治疗组和西医治疗组进行真实世界的动态观察性研究,对其衰弱指数(IM-FI)进行动态随访(共4次)。结果:本研究共纳入774例观察对象,西医组278例,中西医结合组496例。第1次随访结果:无衰弱113例,衰弱前期204例,衰弱期457例,衰弱前期和衰弱期发生率分别为26.36%、59.04%。根据第1次随访结果的衰弱状态分为无衰弱组、衰弱前期组、衰弱期组,第4次随访的结局:无衰弱组73.25%维持状态,24.78%、1.77%分别进展为衰弱前期、衰弱期;衰弱前期组37.25%维持状态,39.22%逆转为无衰弱期,23.53%进展为衰弱期;衰弱期组73.52%维持状态,25.16%、1.31%分别逆转为衰弱前期、无衰弱期。中西医结合组第4次随访无衰弱人数高于第1次随访,衰弱期人数低于第1次随访。西医组第4次随访无衰弱人数低于第1次随访,衰弱期人数高于第1次随访。中西医结合组第2、3、4次随访的IM-FI显著均低于第1次随访(P<0.01)。重复测量结果显示:随着评估次数增加,中西医结合组IM-FI显著逐渐下降(P<0.05)。卡方检验提示:中西医结合组总有效率高于西医组[95.97%(476/496)vs 79.14%(220/278)](P<0.05)。二元Logistic回归模型结果提示:中西医结合是衰弱干预的有效手段(OR=7.429,95%CI[4.121,13.392],P=0.000)。结论:衰弱前期具有不稳定性,是干预的最佳切入点;相较于单纯西医干预,中西医结合可有效改善衰弱情况。Objective:To explore the clinical value of the combination of traditional Chinese and Western medicine intervention in the elderly frailty.Methods:By convenient sampling method,elderly patients who visited the Department of Traditional Chinese Medicine in each general hospital in seven urban areas of Beijing from January to December 2021 were selected as the research objects,divided into two groups(Western medicine group and integrated Chinese and Western medicine group),and their frailty index was followed up dynamically(a total of 4 times).Results:A total of 774 observation subjects were included in this study,including 278 in the Western medicine group and 496 in the integrated Chinese and Western medicine group.Results of the first follow-up:a total of 113 cases had no asthenia,204 cases had preasthenia and 457 cases had asthenia.The incidence of preasthenia and asthenia were 26.36%and 59.04%,respectively.According to the results of the first follow up,the frailties were divided into the non-frailties group,the pre-frailties group and the frailties stage group.The frailties of the fourth follow-up were the outcome:in the non-frailties group,73.25%cases maintained the status,24.78%cases and 1.77%cases progressed to the pre-frailties and the frailties stage,respectively.In the pre-asthenic group,37.25%cases maintained the state,39.22%cases reversed to no asthenic stage,and 23.53%cases progressed to asthenic stage.In the asthenic stage group,73.52%cases maintained the state,25.16%cases and 1.31%cases reversed to pre-asthenic stage and non-asthenic stage,respectively.The number of non-fthenic patients at the fourth follow-up was higher than that at the first follow-up,the number of patients in the pre fthenic period had no significant change,and the number of patients in the fthenic period was lower than that at the first follow up.In the Western medicine group,the number of patients without fadility at the fourth follow-up was lower than that at the first follow-up,there was no significant change in the pre-fadi

关 键 词：老年衰弱 中西医结合 干预 动态 衰弱评估 

分 类 号：R592[医药卫生—老年医学]