老年慢性心力衰竭住院患者衰弱影响因素及风险预测模型构建研究

谭杰; 陈曼曼; 陈凌云; 黄宇理

doi:10.16766/j.cnki.issn.1674-4152.003551

老年慢性心力衰竭住院患者衰弱影响因素及风险预测模型构建研究

doi: 10.16766/j.cnki.issn.1674-4152.003551

1.
阜阳市第五人民医院心血管科，安徽阜阳 236000
2.
蚌埠医科大学第一附属医院心血管科，安徽蚌埠 233004

基金项目:

安徽省教育厅人文社科重点项目 SK2020A0351

详细信息

通讯作者:
黄宇理，E-mail：13956382692@163.com

中图分类号: R541.6R592
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- 文章访问数: 754
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- 被引次数: 0
出版历程
- 收稿日期: 2023-09-21
- 网络出版日期: 2024-07-22

Study on the influence factors of frailty and the construction of risk prediction model in elderly inpatients with chronic heart failure

1.
Department of Cardiovascular Medicine, the Fifth People' s Hospital of Fuyang, Fuyang, Anhui 236000, China

摘要

摘要: 目的探讨老年慢性心力衰竭住院患者衰弱影响因素，构建衰弱风险预测模型，为预防和减少衰弱提供临床参考依据。方法采用便利抽样法选择2022年3月—2023年3月阜阳市第五人民医院心血管科住院的198例老年慢性心力衰竭患者作为研究对象，根据是否发生衰弱分成衰弱组及非衰弱组。采用二元logistic回归分析衰弱的影响因素，通过Hosmer-Lemeshow检验和ROC曲线分别检测模型拟合优度和预测效果。结果老年慢性心力衰竭住院患者衰弱发生率为32.32%(64/198)，疲劳为最主要症状(51.01%, 101/198)。年龄(OR=1.101，P=0.007)、NYHA心功能分级(OR=2.550，P=0.011)、病程(OR=2.210，P=0.014)、睡眠状态(OR=2.215，P=0.010)、N末端脑钠肽前体(OR=1.003，P < 0.001)、左心室射血分数(OR=0.910，P < 0.001)及自我管理水平(OR=0.229，P < 0.001)均是衰弱发生的影响因素。回归模型有较好的拟合优度(χ²=2.915，P=0.940)，AUC为0.913(P < 0.001，95% CI：0.870~0.956)，灵敏度为89.1%，特异度为81.3%。结论老年慢性心力衰竭住院患者衰弱发生率较高，临床应重视高龄、心功能差、病程长、睡眠质量差及自我管理能力低的患者。该研究构建的老年慢性心力衰竭住院患者衰弱风险预测模型效果较好，可为患者衰弱风险评估及干预提供参考依据。
- 慢性心力衰竭 /
- 衰弱 /
- 老年 /
- 影响因素 /
- 风险预测模型
Abstract: Objective To explore the influencing factors of frailty in elderly patients with chronic heart failure, and build a frailty risk prediction model to provide clinical reference for preventing and reducing frailty. Methods A total of 198 elderly patients with chronic heart failure who were hospitalized in the cardiovascular Department of the Fifth People ' s Hospital of Fuyang from March 2022 to March 2023 were selected by convenience sampling method. They were divided into a frailty group and a non-frailty group according to whether frailty occurred. The influencing factors of frailty were analyzed by binary Logistic regression. Hosmer-Lemeshow test and ROC curve were used to detect the goodness of fit and prediction effect respectively. Results The incidence of frailty in elderly CHF patients was 32.32% (64/198), and fatigue was the main symptom (51.01%, 101/198). Age (OR=1.101, P=0.007), NYHA cardiac function grade (OR=2.550, P=0.011), course of disease (OR=2.210, P=0.014), sleep state (OR=2.215, P=0.010), N-terminal brain natriuretic peptide precursor (OR=1.003, P < 0.001), left ventricular ejection fraction (OR=0.910, P < 0.001) and self-management level (OR=0.229, P < 0.001) were influencing factors in the occurrence of frailty. The regression model had good goodness of fit (χ²=2.915, P=0.940), and the AUC under the ROC curve was 0.913 (P < 0.001, 95% CI: 0.870-0.956), sensitivity was 89.1%, specificity was 81.3%. Conclusion The incidence of frailty in elderly patients with chronic heart failure is high. Clinical attention should be paid to elderly patients with poor heart function, long course of disease, poor sleep quality, and low self-management ability. The frailty risk prediction model established in this study is effective in elderly patients with chronic heart failure, which can provide a reference for frailty risk assessment and intervention.
- Chronic heart failure /
- Frailty /
- Old age /
- Influencing factors /
- Risk prediction model

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图 1 患者衰弱风险预测模型的操作特征曲线

Figure 1. Operation characteristic curve of patient frailty risk prediction model

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表 1 老年CHF患者衰弱发生的单因素分析

Table 1. Univariate analysis of the incidence of frailty in elderly CHF patients

项目	非衰弱组(n=134)	衰弱组(n=64)	统计量	P值
性别[例(%)]			0.601^a	0.438
男性	79(58.96)	34(53.12)
女性	55(41.04)	30(46.88)
年龄(x ± s，岁)	73.65±7.15	77.56±6.80	3.660^b	< 0.001
吸烟[例(%)]	42(31.34)	24(37.50)	0.739^a	0.390
饮酒[例(%)]	59(44.03)	23(35.94)	1.169^a	0.280
NYHA心功能分级[例(%)]			15.931^c	< 0.001
Ⅱ	74(55.22)	18(28.13)
Ⅲ	54(40.30)	36(56.25)
Ⅳ	6(4.48)	10(15.62)
病程[例(%)]			8.248^c	0.016
< 5年	38(28.36)	18(28.13)
5~10年	64(47.76)	19(29.68)
＞10年	32(23.88)	27(42.19)
合并症[例(%)]			5.497^a	0.019
1~2个	34(25.37)	7(10.94)
≥3个	100(74.63)	57(89.06)
既往基础病[例(%)]
2型糖尿病	44(32.84)	23(35.94)	0.186^a	0.666
高血压	103(76.87)	47(73.44)	0.277^a	0.599
冠心病	106(79.10)	53(82.81)	0.376^a	0.540
慢性阻塞性肺病	35(26.12)	19(29.69)	0.278^a	0.598
脑卒中	39(29.10)	23(35.94)	0.940^a	0.332
BMI(x ± s)	23.32±2.16	23.66±2.94	0.842^b	0.402
住院时间[M(P₂₅, P₇₅)，d]	8(7, 9)	9(7, 12)	2.134^d	0.033
睡眠状态[例(%)]			6.874^c	0.032
良好	59(44.03)	22(34.38)
一般	53(39.55)	21(32.81)
较差	22(16.42)	21(32.81)
Hb(x ± s，g/L)	125.96±18.06	119.90±18.08	2.208^b	0.028
ALB(x ± s，g/L)	42.76±3.03	42.13±2.73	1.403^b	0.162
HDL-C[M(P₂₅, P₇₅)，mmol/L]	1.32(1.15, 1.49)	1.22(1.13, 1.53)	1.046^d	0.295
LDL-C(x ± s，mmol/L)	1.88±0.44	1.97±0.56	1.172^b	0.244
Scr(x ± s，μmol/L)	106.20±43.04	121.76±47.60	2.299^b	0.023
NT-proBNP(x ± s，pg/mL)	417.98±261.66	650.38±338.80	4.841^b	< 0.001
LVEF(x ± s，%)	65.18±12.76	53.06±11.36	6.471^b	< 0.001
左心房内径(x ± s，mm)	41.19±9.14	42.64±6.82	1.251^b	0.213
主动脉内径(x ± s，mm)	31.78±6.23	32.97±6.60	1.236^b	0.218
自我管理能力[例(%)]			29.542^c	< 0.001
低水平	24(17.91)	35(54.68)
中水平	72(53.73)	23(35.94)
高水平	38(28.36)	6(9.38)
注：^a为χ²值，^b为t值，^c为Z值，^d为U值。

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表 2 老年CHF患者衰弱发生影响因素的自变量赋值情况

Table 2. Independent variable assignment of factors affecting the incidence of fthenia in elderly CHF patients

变量	赋值方法
年龄	以实际值赋值
NYHA心功能分级	Ⅱ=1，Ⅲ=2，Ⅳ=3
病程	< 5年=1，5~10年=2，＞10年=3
合并症	1~2个=1，≥3个=2
住院时间	以实际值赋值
睡眠状态	良好=1，一般=2，较差=3
Hb	以实际值赋值
Scr	以实际值赋值
NT-proBNP	以实际值赋值
LVEF	以实际值赋值
自我管理能力	低水平=1，中水平=2，高水平=3

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表 3 老年CHF患者衰弱发生的影响因素分析

Table 3. Analysis of factors influencing the incidence of frailty in elderly CHF patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.096	0.035	7.395	0.007	1.101	1.027~1.180
NYHA心功能分级	0.936	0.366	6.542	0.011	2.550	1.245~5.223
病程	0.793	0.323	6.024	0.014	2.210	1.173~4.162
合并症	0.896	0.684	1.720	0.190	2.451	0.642~9.357
住院时间	0.163	0.086	3.594	0.058	1.177	0.994~1.393
睡眠状态	0.795	0.310	6.598	0.010	2.215	1.207~4.063
Hb	-0.015	0.013	1.367	0.242	0.985	0.961~1.010
Scr	0.004	0.005	0.526	0.468	1.004	0.993~1.015
NT-proBNP	0.003	0.001	13.729	< 0.001	1.003	1.001~1.004
LVEF	-0.094	0.020	21.426	< 0.001	0.910	0.875~0.947
自我管理能力	-1.473	0.361	16.663	< 0.001	0.229	0.113~0.465

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