摘要
目的探讨老年非ST段抬高急性冠状动脉综合征(non-ST-segment elevation acute coronary syndrome,NSTE-ACS)患者衰弱现状及其影响因素。方法本研究为横断面研究。选取2020年1月至2021年11月入住首都医科大学附属北京友谊医院心脏中心、老年医学科年龄≥65岁的NSTE-ACS患者,根据FRAIL衰弱评估量表将入组患者分为非衰弱组、衰弱前期组、衰弱组。收集患者一般情况、合并既往疾病情况、实验室相关化验指标、治疗方式以及老年综合评估等临床资料,采用logistic回归探讨老年NSTE-ACS患者合并衰弱的影响因素。结果共纳入528例NSTE-ACS患者,其中男性308例(58.3%)、女性220例(41.7%),年龄65~90岁,中位年龄72(68,76)岁。老年NSTE-ACS患者衰弱患病率11.4%(60/528),衰弱前期患病率51.9%(274/528)、非衰弱组患者36.7%(194/528)。与非衰弱组及衰弱前期组患者比较,衰弱组患者高龄、女性、慢性疾病占比以及炎性指标更高,营养状况和活动能力更差(均P<0.005)。高龄(OR=1.110,95%CI:1.032~1.194,P=0.005)、糖尿病(OR=2.489,95%CI:1.091~5.679,P=0.030)、脑血管疾病(OR=4.151,95%CI:1.660~10.384,P=0.002)、慢性肾功能不全(OR=42.874,95%CI:3.957~464.513,P=0.002)、高白细胞水平(OR=1.424,95%CI:1.125~1.802,P=0.003)是老年NSTE-ACS患者合并衰弱的危险因素,而男性(OR=0.252,95%CI:0.105~0.604,P=0.002)是老年NSTE-ACS患者合并衰弱的保护因素。老年NSTE-ACS患者合并衰弱前期的危险因素为糖尿病(OR=1.882,95%CI:1.199~2.955,P=0.006)、脑血管疾病(OR=1.938,95%CI:1.176~3.195,P=0.009)、慢性肾功能不全(OR=12.137,95%CI:1.536~95.934,P=0.018),而老年NSTE-ACS患者合并衰弱前期的保护因素为男性(OR=0.601,95%CI:0.376~0.961,P=0.033)。结论老年衰弱及衰弱前期NSTE-ACS患者人数占比高,女性、糖尿病、脑血管疾病、慢性肾功能不全是老年NSTE-ACS患者合并衰弱或衰弱前期的共同危险因素。
ObjectiveTo investigate the prevalence and influencing factors of frailty among older adults diagnosed with non-ST-segment elevation acute coronary syndrome(NSTE-ACS).MethodsWe conducted a cross-sectional study involving patients aged 65 years and older with NSTE-ACS,who were admitted to the Cardiology Center and the Department of Geriatrics at Beijing Friendship Hospital,Capital Medical University,between January 2020 and November 2021.Patients were categorized into non-frail,pre-frail,and frail groups based on the FRAIL scale.We collected clinical data,including general health conditions,comorbidities,laboratory results,treatments,and comprehensive geriatric assessments.Logistic regression analysis was employed to identify the influencing factors associated with frailty and pre-frailty in older adults with NSTE-ACS.ResultsA total of 528 patients with NSTE-ACS were included in the study,comprising 308 males(58.3%)and 220 females(41.7%).The age range of participants was from 65 to 90 years,with a median age of 72(68,76)years.The prevalence of frailty among older adults with NSTE-ACS was 11.4%(60/528),while pre-frailty was observed in 51.9%(274/528),and non-frailty in 36.7%(194/528).Compared to the non-frail and pre-frail groups,patients in the frail group were older,had a higher proportion of females,exhibited a greater prevalence of chronic diseases,and presented with elevated inflammatory markers.Additionally,frail patients demonstrated poorer nutritional status and reduced functional ability(all P<0.005).Risk factors for frailty in older adults with NSTE-ACS included older age(OR=1.110,95%CI:1.032-1.194,P=0.005),diabetes(OR=2.489,95%CI:1.091-5.679,P=0.030),cerebrovascular disease(OR=4.151,95%CI:1.660-10.384,P=0.002),chronic kidney disease(OR=42.874,95%CI:3.957-464.513,P=0.002),and elevated white blood cell levels(OR=1.424,95%CI:1.125-1.802,P=0.003).Conversely,being male(OR=0.252,95%CI:0.105-0.604,P=0.002)was identified as a protective factor against frailty in this patient population.For pre-frail older adults with NSTE-ACS,identified risk factors included diabetes(OR=1.882,95%CI:1.199-2.955,P=0.006),cerebrovascular disease(OR=1.938,95%CI:1.176-3.195,P=0.009),and chronic kidney disease(OR=12.137,95%CI:1.536-95.934,P=0.018).Similarly,being male(OR=0.601,95%CI:0.376-0.961,P=0.033)was also a protective factor for pre-frailty in older adults with NSTE-ACS.ConclusionsThe prevalence of frailty and pre-frailty among older adults with NSTE-ACS is notably high.Common risk factors for frailty and pre-frailty in this population include female gender,diabetes,cerebrovascular disease,and chronic kidney disease.
作者
施景文
侯晓沛
卢尚欣
王珊
邢云利
汤雯
贾朝旭
冯枫
胡洁琼
刘冰
阚俊鹏
孙颖
Shi Jingwen;Hou Xiaopei;Lu Shangxin;Wang Shan;Xing Yunli;Tang Wen;Jia Zhaoxu;Feng Feng;Hu Jieqiong;Liu Bing;Kan Junpeng;Sun Ying(Department of Geriatrics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《中华老年医学杂志》
北大核心
2025年第8期1100-1106,共7页
Chinese Journal of Geriatrics
基金
新一代人工智能国家科技重大专项(2021ZD0111002)。
