高龄住院患者血清学指标与衰弱程度相关性分析

章妙玉; 罗科学; 高燕飞; 李宏春; 钟玲玲

doi:10.16766/j.cnki.issn.1674-4152.001809

高龄住院患者血清学指标与衰弱程度相关性分析

doi: 10.16766/j.cnki.issn.1674-4152.001809

浙江省立同德医院干部保健科，浙江杭州 310012

基金项目:

浙江省医药卫生科技计划项目 2020KY511

详细信息

通讯作者:
罗科学，E-mail：flyingsea521@126.com

中图分类号: R592 R446
计量
- 文章访问数: 87
- HTML全文浏览量: 97
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2020-04-29
- 网络出版日期: 2022-02-19

Analysis of the correlation between serum indexes and the degree of frailty in elderly inpatients

Department of Cadre Health Care, Tongde Hospital, Hangzhou, Zhejiang 310012, China

摘要

摘要: 目的分析血清25-羟基维生素D[25(OH)D]、白细胞介素10(IL-10)、D-二聚体(D-D)水平与高龄住院衰弱患者衰弱程度的相关性。方法选取浙江省立同德医院420例高龄住院患者作为研究对象，其中衰弱组47例，非衰弱组373例。比较衰弱组、非衰弱组，衰弱组中不同衰弱程度患者、再入院与未再入院患者血清25(OH)D、IL-10、D-D水平，分析高龄住院患者衰弱发生的影响因素，探讨血清各指标与衰弱程度的相关性及对高龄住院伴衰弱患者再入院的预测价值。结果年龄、住院时间、血清25(OH)D、IL-10、D-D均为高龄住院患者衰弱发生的重要危险因素(OR=4.847、5.887、0.580、4.820、5.120，均P＜0.05)；血清25(OH)D水平(r=-0.415)与高龄住院伴衰弱患者衰弱程度呈负相关性，IL-10(r=0.379)、D-D(r=0.392)水平与衰弱程度呈正相关性(均P＜0.05)；血清25(OH)D、IL-10、D-D联合预测高龄住院伴衰弱患者再入院的曲线下面积为0.844，敏感性为80.96%，特异性为80.77%。结论血清25(OH)D、IL-10、D-D水平异常表达与衰弱程度相关，三者联合可为预测高龄住院伴衰弱患者再入院提供循证指导。
- 高龄 /
- 住院 /
- 25-羟基维生素D /
- 白细胞介素10 /
- D-二聚体 /
- 衰弱程度
Abstract: Objective To analyze the correlation between serum 25-hydroxyvitamin D [25(OH)D], interleukin-10 (IL-10), D-dimer (D-D) levels and the degree of frailty in elderly hospitalized frail patients. Methods A total of 420 elderly inpatients in our hospital were selected as the research objects, including 47 in the frailty group and 373 in the non-frailty group. The serum 25(OH)D, IL-10 and D-D levels of patients with different degrees of debilitating and re-admitted and non-re-admitted patients were compared between the two groups. The influencing factors of the occurrence of frailty in elderly inpatients were analyzed, and the correlation between serum indexes and the degree of frailty and the predictive value of re-admission to elderly frail patients were discussed. Results Age, length of hospital stays, 25(OH)D, IL-10, and D-D were all important risk factors for frailty in elderly hospitalized patients (OR=4.847, 5.887, 0.580, 4.820, 5.120, all P < 0.05). Serum 25(OH)D level (r=-0.415) was negatively correlated with the degree of frailty in elderly hospitalized patients with frailty. IL-10 (r=0.379) and D-D (r=0.392) levels were positively correlated with the degree of frailty (P < 0.05). The area under the curve predicted by the combination of serum 25(OH)D, IL-10, and D-D for re-admission of elderly hospitalized patients with frailty was 0.844, the sensitivity was 80.96%, and the specificity was 80.77%. Conclusion The abnormal expression of serum 25(OH)D, IL-10 and D-D levels is related to the degree of frailty. The combination of the three can provide evidence-based guidance for predicting the re-admission of elderly hospitalized patients with frailty.
- Elderly /
- Hospitalization /
- 25-hydroxyvitamin D /
- Interleukin 10 /
- D-dimer /
- Degree of frailty

HTML全文

图 1 血清25(OH)D、IL-10、D-D单一及联合指标预测价值

下载: 全尺寸图片幻灯片

表 1 2组高龄住院患者一般资料比较 [例(%)]

组别	例数	性别(男/女，例)	体重指数(x±s)	原发疾病类型
组别	例数	性别(男/女，例)	体重指数(x±s)	循环系统疾病	内分泌系统疾病	神经系统疾病	消化系统疾病	呼吸系统疾病	运动系统疾病
衰弱组	47	31/16	20.96±1.45	25(53.19)	10(21.28)	4(8.51)	3(6.38)	3(6.38)	2(4.26)
非衰弱组	373	246/127	21.07±1.19	198(53.08)	79(21.18)	31(8.31)	23(6.17)	24(6.43)	18(4.83)
统计量		<0.001^a	0.582^b	0.034^a
P值		0.999	0.561	0.999
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组高龄住院患者年龄、住院时间、FP评分、血清指标比较(x±s)

组别	例数	年龄(岁)	住院时间(d)	FP评分(分)	25(OH)D (ng/mL)	IL-10 (ng/L)	D-D (μg/L)
衰弱组	47	86.83±1.30	17.74±1.29	3.28±0.19	10.94±4.13	29.14±7.16	495.12±125.96
非衰弱组	373	82.61±1.25	10.46±1.63	1.50±0.22	15.17±6.58	23.01±5.14	257.42±92.84
t值		21.714	29.467	53.020	4.299	7.335	15.826
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

下载: 导出CSV

表 3 高龄住院患者衰弱发生有关影响因素的logistic回归分析

因素	B	SE	Wald χ²	P值	OR值	95% CI
年龄	1.578	0.351	20.222	＜0.001	4.847	2.629~8.937
住院时间	1.773	0.372	22.710	＜0.001	5.887	3.528~9.824
25(OH)D	-0.545	0.128	18.134	＜0.001	0.580	0.348~0.966
IL-10	1.573	0.345	20.782	＜0.001	4.820	2.765~8.402
D-D	1.633	0.369	19.587	＜0.001	5.120	2.628~9.974

下载: 导出CSV

表 4 不同衰弱程度患者血清25(OH)D、IL-10、D-D水平比较(x±s)

衰弱程度	例数	25(OH)D (ng/mL)	IL-10(ng/L)	D-D(μg/L)
轻度	12	13.15±3.47	26.12±4.12	315.74±101.65
中度	19	10.78±2.78	28.95±3.25	489.26±127.83
重度	16	9.47±1.95	31.63±4.74	636.61±139.62
F值		6.271	6.451	22.217
P值		0.004	0.004	＜0.001

下载: 导出CSV

表 5 血清25(OH)D、IL-10、D-D水平与衰弱程度的相关性

指标	r值	P值
25(OH)D	-0.415	＜0.001
IL-10	0.379	＜0.001
D-D	0.392	＜0.001

下载: 导出CSV

表 6 再入院与未再入院高龄住院伴衰弱患者血清25(OH)D、IL-10、D-D水平比较(x±s)

组别	例数	25(OH)D (ng/mL)	IL-10(ng/L)	D-D(μg/L)
再入院	21	8.25±2.15	33.14±5.12	602.84±137.41
未再入院	26	13.11±5.62	25.91±4.78	408.12±115.34
t值		3.742	4.994	5.283
P值		0.001	＜0.001	＜0.001

下载: 导出CSV

参考文献(20)

[1]	杨帆, 王双, 覃海, 等. 社区老年人衰弱状态的过渡及其恶化影响因素分析的前瞻性研究[J]. 中华流行病学杂志, 2019, 40(2): 186-190. doi: 10.3760/cma.j.issn.0254-6450.2019.02.012
[2]	PAGANI S, VERONESI F, ALDINI N N, et al. Complex regional pain syndrome type I, a debilitating and poorly understood syndrome. possible role for pulsed electromagnetic fields: a narrative review[J]. Pain Physician, 2017, 20(6): E807-E822. http://www.ncbi.nlm.nih.gov/pubmed/28934787
[3]	中华医学会老年医学分会骨代谢疾病学组. 老年人维生素D临床应用专家共识(2018)[J]. 中华老年医学杂志, 2018, 37(9): 953-961. doi: 10.3760/cma.j.issn.0254-9026.2018.09.001
[4]	施红, 孟丽, 石婧, 等. 老年人衰弱与血液生物指标的关系研究[J]. 中华老年医学杂志, 2018, 37(12): 1383-1386. doi: 10.3760/cma.j.issn.0254-9026.2018.12.022
[5]	苏琳, 郝秋奎, 杨颖, 等. 老年人衰弱与血清炎性因子和衰老因子的相关性[J]. 中华老年医学杂志, 2018, 37(5): 579-583. doi: 10.3760/cma.j.issn.0254-9026.2018.05.024
[6]	孔建华, 张洁, 樊晓曦, 等. Fried表型衰弱量表及FRAIL量表在社区老人衰弱筛查中的应用[J]. 中国临床保健杂志, 2019, 22(5): 604-608. doi: 10.3969/J.issn.1672-6790.2019.05.008
[7]	卞剑云, 朱洁楠. 体能锻炼和营养干预对衰弱期和衰弱前期老年患者炎症因子的影响[J]. 中华现代护理杂志, 2019, 25(2): 196-199. doi: 10.3760/cma.j.issn.1674-2907.2019.02.015
[8]	路莹. 老年衰弱不同表型的中医体质特征及其与骨代谢的相关性分析[D]. 济南: 山东中医药大学, 2018.
[9]	郭朝唤, 侯莉明, 王宁, 等. 西安市某社区老年人群衰弱的相关危险因素分析[J]. 中华老年多器官疾病杂志, 2019, 18(8): 561-564. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLQG201908001.htm
[10]	YANG L, DONG H, LI Z, et al. Correlation between circulating tumor cells and D-D and platelet in patients with pulmonary malignancies[J]. Oncol Lett, 2018, 15(2): 2169-2172.
[11]	VAN DER POL L M, MAIRUHU A T, TROMEUR C, et al. Use of clinical prediction rules and D-dimer tests in the diagnostic management of pregnant patients with suspected acute pulmonary embolism[J]. Blood Rev, 2017, 31(2): 31-36. doi: 10.1016/j.blre.2016.09.003
[12]	都海燕. 老年衰弱及其表型与炎症反应及凝血功能的相关性研究[D]. 青岛: 青岛大学, 2019.
[13]	李敏, 宋清扬, 王爽, 等. 老年脑梗死患者衰弱相关血清学标记物的研究[J]. 中华老年医学杂志, 2018, 37(6): 641-645. doi: 10.3760/cma.j.issn.0254-9026.2018.06.008
[14]	STEINBRINK K, WÖLFL M, JONULEIT H, et al. Pillars Article: induction of tolerance by IL-10-Treated dendritic cells. J. Immunol. 1997.159: 4772-4780[J]. J Immunol, 2016, 197(5): 1547-1555. http://www.ncbi.nlm.nih.gov/pubmed/27543668
[15]	MONTES DE OCA M, KUMAR R, DE LABASTIDA RIVERA F, et al. Correction: Blimp-1-dependent IL-10 production by Tr1 cells regulates TNF-Mediated tissue pathology[J]. PLoS Pathog, 2016, 12(2): e1005460. doi: 10.1371/journal.ppat.1005460
[16]	韩欣欣, 曹英娟, 孙京文, 等. 住院患者跌倒后心理体验与跌倒预防认知质性研究的系统评价[J]. 中国实用护理杂志, 2019, 35(29): 2315-2321. doi: 10.3760/cma.j.issn.1672-7088.2019.29.015
[17]	MCDONNELL S L, BAGGERLY K A, BAGGERLY C A, et al. Maternal 25(OH)D concentrations ≥40 ng/mL associated with 60% lower preterm birth risk among general obstetrical patients at an urban medical center[J]. PLoS One, 2017, 12(7): e0180483. doi: 10.1371/journal.pone.0180483
[18]	WALKER R E, BARTLEY J, CAMARGO CA J R, et al. Higher serum 25(OH)D concentration is associated with lower risk of chronic otitis media with effusion: a case-control study[J]. Acta Paediatr, 2017, 106(9): 1487-1492. doi: 10.1111/apa.13908
[19]	孙凯旋. 老年衰弱综合征影响因素分析及与血清25羟维生素D关系的研究[D]. 扬州: 扬州大学, 2018.
[20]	王娅迪, 刘玲. 透析患者维生素D水平与衰弱表型的相关性分析[J]. 重庆医学, 2019, 48(11): 1902-1905. doi: 10.3969/j.issn.1671-8348.2019.11.026