老年住院患者生理性衰弱影响因素分析
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1.苏州市第九人民医院(苏州大学附属苏州九院);2.南京医科大学第一附属医院

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2021年度苏州市科技发展计划 (医疗卫生科技创新一应用基础研究〔第二批 〕) 指导性项目,项目编号:SKJYD2021028。


Analysis of Influencing Factors of Physiological Frailty in Elderly Inpatients
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1.Suzhou Ninth People'2.'3.s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University

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    摘要:

    目的 分析影响老年住院患者生理性衰弱的相关因素。方法 入选老年内分泌科年龄≥60岁的住院患者264例。采用Fried生理衰弱量表对患者衰弱状态进行评估,将患者分为非衰弱、衰弱前期和衰弱三组,进行临床资料收集,检测营养指标、血糖、血脂、肾功能、甲状腺功能等临床指标;并对所有患者进行相关老年评估,分析三组患者在肌肉量、肌肉功能、躯体功能、营养、认知、心理、预后等方面的差异,以及这些因素与衰弱的相关性。结果 非衰弱组69例,衰弱前期组149例,衰弱46例。三组患者年龄、体重指数(BMI)、腰臀比无明显差异;所检测临床化验结果:营养指标包括血清转铁蛋白、前白蛋白、白蛋白和25羟维生素D水平,空腹血糖,糖化血红蛋白,血脂,血尿酸,血尿素氮和肌酐,甲状腺功能,三组患者比较均无明显统计学差异。与非衰弱和衰弱前期比较,衰弱组住院老年患者肌肉量明显减少,握力下降,5次起坐时间明显增加;4米步速明显下降,简易躯体能力评定(SPPB)得分也显著减少;日常生活活动能力(ADL)下降。衰弱组老年住院患者营养状况较差;MMSE评估显示认知功能下降,MoCA评估结果无明显差异。焦虑和抑郁评分在衰弱组升高,说明焦虑和抑郁的发生明显增加。衰弱组老年住院患者的死亡率也更高。高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、FT4、握力和营养状况(MNA得分)是衰弱发生的相关因素。结论 老年住院患者衰弱发生率较高,并受多种因素影响,包括血脂、甲状腺功能、营养状况等。诊治老年患者时除了关注疾病本身,更需要注意身体活动能力、认知功能、情绪状态等,为合理诊疗提供依据。

    Abstract:

    Objective:To analyze the influencing factors of frailty in elderly hospitalized patients. Methods:A total of 264 inpatients aged ≥ 60 years were enrolled in the Division of Geriatric Endocrinology. The frail status of the patients was assessed by the Fried Physiological Frailty Phenotype, and the patients were divided into three groups: non-frailty, pre-frailty and frailty. Clinical data were collected, and clinical indicators such as nutritional index, blood glucose, lipids, renal function, and thyroid function were detected. The differences in muscle mass, muscle function, physical function, nutrition, cognition, psychology, prognosis of the three groups, as well as the correlation of these factors with frailty were analyzed by using geriatric assessment. Results:There were 69 patients in the non-frail group, 149 patients in the pre-frail group, and 46 patients in the frail group. There were no significant differences in age, body mass index (BMI), and waist-to-hip ratio among the three groups of patients. The clinical test results of nutritional indicators including serum transferrin, pre-albumin, albumin and 25-hydroxyvitamin D levels, fasting blood glucose, glycosylated hemoglobin, lipids, uric acid, urea nitrogen and creatinine, thyroid function had no significant differences among the three groups of patients. Compared with the non-frail and pre-frail patients, the inpatients in the frail group had significantly decreased muscle mass, decreased grip strength, and increased 5-time sit-up time; significantly decreased 4-meter walking speed, and also decreased SPPB and ADL scores. The nutritional status of elderly inpatients in the frail group was poor. MMSE assessment showed cognitive decline, and there was no significant difference in MoCA assessment results. Anxiety and depression scores were elevated in the frail group, indicating a significant increase in the occurrence of anxiety and depression. Mortality was also higher among older hospitalized patients in the frail group. High-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), FT4, handgrip strength, and nutritional status (MNA score) are factors associated with frailty. Conclusion:The incidence of frailty in elderly hospitalized patients is high and is affected by many factors, Including blood lipids, thyroid function, nutritional status, etc.. In addition to paying attention to the disease itself, it is necessary to pay attention to physical activity, cognitive function, emotional state, etc. in the diagnosis and treatment of elderly patients, so as to provide a basis for reasonable diagnosis and treatment.

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  • 收稿日期:2022-10-10
  • 最后修改日期:2023-03-17
  • 录用日期:2023-10-20
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