老年住院患者衰弱发病的影响...素分析及与骨质疏松症的关系_王翠.pdf

山东医药2023 年第 63 卷第 8 期老年住院患者衰弱发病的影响因素分析及与骨质疏松症的关系王翠1，2，鲁喦2，靳冰2，李跃华21 北京中医药大学研究生院，北京100029；2 中国中医科学院西苑医院老年病科摘要：目的分析老年住院患者衰弱发病的影响因素，探讨衰弱与骨质疏松症之间的关系。方法选择于老年病科住院的424例老年患者进入研究。使用Freid量表评估患者衰弱情况；采用双能X线骨密度仪测量患者腰椎及股骨颈骨密度T值，评估骨质疏松症患病情况。收集并比较不同衰弱程度患者的一般资料（性别、年龄、BMI、学历水平、退休前工作性质等）、生理健康状况（用药种数、患病种数、睡眠质量、牙齿状况）、生活习惯（烟酒史、运动频率、饮食习惯）、营养状况（血清白蛋白、上臂围、小腿围）、下肢运动功能与平衡能力（30 s坐立个数、单腿直立时间），将差异有统计学意义的项目纳入Logistic回归，分析老年患者衰弱发病的影响因素。比较骨质疏松症与非骨质疏松症老年患者衰弱的发生率、Freid量表得分及步速和握力水平。结果424例老年住院患者中，衰弱149例（35.1%）、衰弱前期185例（43.6%）、无衰弱90例（21.2%），骨质疏松症227例（53.5%）、非骨质疏松症197例（46.5%）。单因素分析结果显示，不同衰弱水平患者的年龄、BMI、多病共存、多重用药、运动频率、饮食习惯、睡眠质量、牙齿状况、退休前工作性质差异有统计学意义（P均0.05），不同衰弱水平患者的腰椎和股骨颈骨密度T值、骨质疏松症患病率、血清白蛋白、上臂围、小腿围、睁眼单腿直立时间及30 s坐立个数差异有统计学意义（P均0.01）。多因素Logistic回归分析结果显示，多病共存、多重用药、睡眠质量差、牙齿状况差、骨质疏松症是衰弱发病的危险因素，保持3次/周的有氧运动、高血清白蛋白、粗小腿围、30 s 坐立个数多、睁眼单腿直立时间长是衰弱发病的保护因素（P均0.05）。在老年住院患者中，合并骨质疏松症者衰弱和衰弱前期发生率、Freid量表得分高于非骨质疏松症者，步速和握力水平低于非骨质疏松症者（P均0.01）。结论多病共存、多重用药、睡眠质量、牙齿状况、运动频率、血清白蛋白、小腿围、30 s坐立个数、单腿直立时间是老年住院患者衰弱发病的影响因素；骨质疏松症是老年住院患者衰弱发病的危险因素，老年住院患者衰弱与骨质疏松症之间可能存在一定相互作用。关键词：衰弱；骨质疏松症；老年人doi：10.3969/j.issn.1002-266X.2023.08.008 中图分类号：R592 文献标志码：A 文章编号：1002-266X（2023）08-0033-05Factors influencing frailty in geriatric inpatients and relationship between frailty and osteoporosis WANG Cui1，LU Yan，JIN Bing，LI Yuehua1 Graduate School，Beijing University of Chinese Medicine，Beijing 100029，ChinaAbstract：Objective To analyze the influencing factors of frailty in elderly inpatients and to explore the relationship between frailty and osteoporosis.Methods A total of 424 elderly patients（aged 60 years）admitted to the geriatrics department were enrolled in the study.Frailty was assessed by the frailty phenotype.Bone mineral density T values of lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry to evaluate the incidence of osteoporosis.General data（gender，age，BMI，education level，work nature before retirement，etc.），physical health（the number of medications，the number of diseases，sleep quality，dental status），living habits（tobacco and alcohol history，exercise frequency，diet habits），nutritional status（serum albumin，upper arm circumference，calf circumference），and lower limb motor function and balance ability（the number of sitting and standing in 30 seconds，time of standing on one leg）were collected and compared in patients with different degrees of frailty；items with statistically significant differences were included in Logistic regression to analyze the influencing factors of the onset of frailty in elderly patients.The incidence of frailty，frailty phenotype score，walking speed and grip strength were compared between osteoporosis and non-osteoporosis 基金项目：科技部“主动健康和老龄化科技应对”专项项目（SQ2018YFC200194）。第一作者简介：王翠（1994-），女，硕士研究生，主要研究方向为老年病的中医药治疗。E-mail：通信作者简介：李跃华（1960-），女，主任医师，教授，博士研究生导师，主要研究方向为老年病的中西医结合防治。E-mail：开放科学（资源服务）标识码（OSID）33山东医药2023 年第 63 卷第 8 期elderly patients.Results Among 424 hospitalized elderly patients，there were 149 cases of frailty（35.1%），185 cases of pre-frailty（43.6%），90 cases of non-frailty（21.2%），227 cases of osteoporosis（53.5%），and 197 cases of non-osteoporosis（46.5%）.Univariate analysis showed that patients with different frailty levels had statistically significant differences in age，BMI，multimorbidity，polypharmacy，exercise frequency，diet habits，sleep quality，dental status and work nature before retirement（all P0.05）.There were significant differences in T value of bone mineral density of lumbar spine and femoral neck，prevalence rate of osteoporosis，serum albumin，upper arm circumference，calf circumference，time of standing on one leg with eye opening and the number of sitting and standing for 30 seconds between patients with different frailty levels（all P0.01）.The results of multivariate Logistic regression analysis showed that the risk factors of frailty were multimorbidity，polypharmacy，poor sleep quality，poor dental condition and osteoporosis.Aerobic exercise 3 times/week，high level serum albumin，thick calf circumference，higher number of sitting and standing for 30 seconds，and long standing time on one leg with eyes open were the protective factors of frailty（all P0.05）.In the elderly hospitalized patients，the incidence of frailty and prefrailty and the score of frailty phenotype in patients with osteoporosis were higher than those of non-osteoporosis patients，and the walking speed and grip strength levels were lower（all P0.01）.Conclusions Multimorbidity，polypharmacy，sleep quality，dental status，exercise frequency，serum albumin，calf circumference，the number of sitting and standing for 30 seconds，and time of standing on one leg are the factors affecting the incidence of frailty in elderly hospitalized patients.Osteoporosis is a risk factor for frailty in elderly inpatients.There may be some interaction between frailty and osteoporosis in elderly inpatients.Key words：frailty；osteoporosis；elderly衰弱是一种随年龄增长而出现的复杂疾病，其特征是多个器官系统生理储备下降，即使暴露在轻微压力下，也会增加对不良健康结果的易感性1。衰弱被认为是与老龄化相关的最重要的问题之一。衰弱是可逆的，可以通过运动训练、营养支持等措施进行干预。因此，深入了解衰弱的危险因素对预防或延缓衰弱、减少不良健康后果意义重大。近年来多项研究表明，衰弱与骨质疏松症