协和医学杂志

2021, v.12(01) 59-66

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衰弱对住院老年冠心病患者短期预后的影响:前瞻性队列研究
Impact of Frailty on the Short-term Prognosis of Hospitalized Elderly Patients with Coronary Heart Disease:A Prospective Cohort Study

张宁;朱文玲;刘晓红;陈伟;康军仁;朱鸣雷;田然;
ZHANG Ning;ZHU Wen-ling;LIU Xiao-hong;CHEN Wei;KANG Jun-ren;ZHU Ming-lei;TIAN Ran;Department of Geriatrics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Cardiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Clinical Nutrition,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

目的探讨衰弱对住院老年冠心病患者短期预后的影响。方法前瞻性收集并分析2017年12月至2018年11月在北京协和医院住院治疗的老年冠心病患者临床资料。根据是否合并衰弱,将患者分为衰弱组和非衰弱组。对两组患者随访,终点事件包括非常规就诊、主要不良心脑血管事件(major adverse cardiac and cerebral events,MACCE)、全因死亡。采用多因素Cox回归分析衰弱与冠心病患者预后的关系。绘制两组无MACCE的Kaplan-Meier生存曲线,并采用Log-Rank检验进行比较。结果共345例符合纳入和排除标准的老年冠心病患者入选本研究,包括稳定性冠心病250例,急性冠状动脉综合征95例。衰弱组74例(21.4%),其中轻度衰弱38例、中度衰弱36例,非衰弱组271例(78.6%)。中位随访时间351(300, 394)d,失访3例。与非衰弱组比较,衰弱组非常规就诊发生率(36.1%比21.5%)、全因死亡率(11.1%比4.1%)均升高(P均<0.05),MACCE发生率(9.7%比4.8%)无显著差异(P>0.05)。多因素Cox回归分析结果显示,轻度和中度衰弱是稳定性冠心病患者全因死亡的危险因素(HR=4.169,95%CI:1.055~16.474,P=0.042),对其非常规就诊(HR=1.704,95%CI:0.947~3.066,P=0.075)、MACCE(HR=1.268,95%CI:0.331~4.863,P=0.729)无显著影响。在急性冠状动脉综合征患者中,轻度和中度衰弱对其非常规就诊(HR=1.159,95%CI:0.342~3.924,P=0.812)、MACCE(HR=0.822,95%CI:0.092~7.369,P=0.861)及全因死亡(HR=1.445,95%CI:0.210~9.964,P=0.708)均无显著影响。Kaplan-Meier生存曲线显示,衰弱组和非衰弱组患者的无MACCE生存曲线无显著差异(P>0.05)。结论住院老年冠心病患者合并轻中度衰弱的比率较高,其可能增加稳定性冠心病患者近期死亡风险。
Objective To analyze the effect of frailty on the short-term prognosis of hospitalized older patients with coronary heart disease. Methods The clinical data were prospectively collected and analyzed in elderly patients with coronary heart disease that were hospitalized in Peking Union Medical College Hospital from December 2017 to November 2018. According to whether they were combined with frailty, the patients were divided into frailty group and non-frailty group.All the patients were followed up, and endpoint events included unscheduled return visits, major adverse cardiac and cerebral events(MACCE), and death from all causes. Multivariate Cox regression was used to analyze the relationship between frailty and the prognosisof patients with coronary heart disease. The Kaplan-Meier method and Log-Rank test were used to compare the MACCE-free survival curves between patients with and without frailty. Results A total of 345 elderly patients with coronary heart disease who met the inclusion and exclusion criteria were selected for this study, including 250 cases of stable coronary heart disease and 95 cases of acute coronary syndrome. There were 74 cases(21.4%) in the frailty group including 38 cases of mild frailty and 36 cases of moderate frailty, and 271 cases(78.6%) in the non-frailty group. The median follow-up time was 351(300, 394) days, and 3 cases were lost to follow-up. Compared with the non-frailty group, the incidence of unscheduled return visits(36.1% vs. 21.5%) and all-cause mortality(11.1% vs. 4.1%) in the frailty group increased(all P<0.05), and there is no significant difference in the incidence of MACCE(9.7 % vs. 4.8%) between the two groups(P>0.05). The results of multivariate Cox regression analysis showed that mild and moderate frailty were risk factors for all causes of death in patients with stable coronary heart disease(HR=4.169, 95% CI: 1.055-16.474, P=0.042), but had no significant effect on unscheduled return visits(HR=1.704, 95% CI: 0.947-3.066, P=0.075) and MACCE(HR=1.268, 95% CI: 0.331-4.863, P=0.729). In patients with acute coronary syndrome, mild and moderate frailty had no significant effect on unscheduled return visits(HR=1.159, 95% CI: 0.342-3.924, P=0.812), MACCE(HR=0.822, 95% CI: 0.092-7.369, P=0.861) and death from all causes(HR=1.445, 95% CI: 0.210-9.964, P=0.708). The Kaplan-Meier curve showed that there was no significant in the MACCE-free survival curve between the two groups(P>0.05). Conclusions The prevalence of mild and moderate frailty in hospitalized older patients with coronary heart disease is high, which may increase the risk of short-term mortality for those with stable coronary heart disease.

关键词(KeyWords): 老年;冠心病;衰弱;预后
elderly;coronary heart disease;frailty;prognosis

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基金项目(Foundation): 中国医学科学院医学与健康科技创新工程(2018-I2M-1-002)~~

作者(Author): 张宁;朱文玲;刘晓红;陈伟;康军仁;朱鸣雷;田然;
ZHANG Ning;ZHU Wen-ling;LIU Xiao-hong;CHEN Wei;KANG Jun-ren;ZHU Ming-lei;TIAN Ran;Department of Geriatrics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Cardiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Clinical Nutrition,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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