社区老年衰弱与血清因子的相关性研究

秦丽; 葛立宾; 梁珍珍; 陈亮; 陈川

doi:10.16766/j.cnki.issn.1674-4152.002240

社区老年衰弱与血清因子的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.002240

秦丽¹,
葛立宾¹,
梁珍珍¹,
陈亮¹,
陈川^2, ,

1.
上海市嘉定区安亭镇黄渡社区卫生服务中心，上海 201804
2.
上海市中医老年医学研究所，上海 200031

基金项目:

上海市嘉定区农业和社会事业科研项目 JDKW-2017-W40

上海市中医药事业发展三年行动计划(2018-2020年)项目 ZY(2018-2020)-CCCX-4004

2019年上海市“医苑新星”青年人才培养资助计划项目沪卫人事[2020]87号

2019年嘉定区“嘉医新星”青年人才培养计划项目 2019JDJYXX007

详细信息

通讯作者:
陈川，E-mail：ch9453@126.com

中图分类号: R197.61R592
计量
- 文章访问数: 153
- HTML全文浏览量: 58
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2020-08-25
- 网络出版日期: 2022-03-02

Correlation between frailty and related serum factors in elderly community

1.
Anting Town Huangdu Community Health Service Center, Jiading District, Shanghai 201804, China

摘要

摘要: 目的了解社区老年衰弱情况，分析血清因子与老年衰弱的相关性，并给予社区医务人员相应的建议。方法选取2018年4—9月在上海市嘉定区安亭镇黄渡社区卫生服务中心进行健康体检的老年人375例作为研究对象。研究者自制一般资料调查问卷；血常规、肝肾功能等指标均从本社区老年人体检数据库导出；白细胞介素6、胰岛素生长因子1等指标由合作单位上海市中医老年医学研究所负责测定。采用有序多因素logistic回归分析老年衰弱与上述血清因子水平的相关性。结果 (1) 375例老年人中，非衰弱期173例、衰弱前期188例、衰弱期14例。不同衰弱程度老年人的性别、年龄、文化程度、吸烟史、饮酒史比较，差异均有统计学意义(均P＜0.05)。(2)不同衰弱程度社区老年人血清生化指标中，仅血红蛋白组间比较差异有统计学意义(P＜0.05)。(3)不同衰弱程度社区老年人特殊血清生化指标的胰岛素生长因子、促卵泡激素、雌二醇比较，差异均有统计学意义(均P＜0.05)。(4)有序多因素logistic回归分析结果发现，血红蛋白、胰岛素生长因子、促卵泡激素、雌二醇等因子水平与衰弱发生无相关性。结论血清因子与社区老年衰弱的相关性受多种因素影响，社区全科医生应对社区老年人群早期进行衰弱的全方面综合评估。
- 社区老年 /
- 衰弱 /
- 血清因子
Abstract: Objective To understand the situation of senile frailty in community, analyze the correlation between serum factors and senile frailty, and give corresponding suggestions to community medical staff. Methods A total of 375 elderly people who underwent physical examination in Huangdu Community Health Service Center, Anting Town, Jiading District, Shanghai from April to September 2018 were selected as the research subjects. The researchers made their own general data questionnaire.The indexes of blood routine and liver and kidney function were derived from the physical examination database of the elderly in this community. Interleukin-6 (IL-6), insulin growth factor 1 (IGF-1) and other indicators were measured by Shanghai Institute of Traditional Chinese Medicine. Ordered multifactor logistic regression was used to analyze the correlation between senile frailty and the levels of the above serum factors. Results (1) Among the 375 elderly patients, 173 were at non-frailty stage, 188 at pre-frailty stage and 14 at frailty stage. The gender, age, educational level, smoking history and drinking history of the elderly with different degrees of frailty had statistical significance (all P < 0.05). (2) Among the serum biochemical indexes of the elderly in the community with different degrees of frailty, only hemoglobin had the differences were statistically significant (P < 0.05). (3) The differences of insulin growth factor (IGF-1), follicle-stimulating hormone (FSH) and estradiol (E₂) in special serum biochemical indexes of the elderly in the community with different frailty levels were statistically significant (all P < 0.05). (4)The results of logistic regression analysis showed that the levels of hemoglobin (HB), insulin growth factor (IGF-1), follicle-stimulating hormone (FSH), estradiol (E₂) and other factors had no correlation with the occurrence of frailty. Conclusion The correlation between serum factors and community geriatric frailty is affected by many factors, so community general practitioners should conduct comprehensive assessment of community geriatric frailty in the early stage.
- The community elderly /
- Frailty /
- Serum factor

HTML全文

表 1 社区老年衰弱人群基本特征比较[例(%)]

项目	非衰弱期(n=173)	衰弱前期(n=188)	衰弱期(n=14)	统计量	P值
性别[例(%)]				21.666^a	＜0.001
男性	102(59.0)	72(38.3)	2(14.3)
女性	71(41.0)	116(61.7)	12(85.7)
年龄(x±s, 岁)	72.3±4.7	75.6±5.6	78.9±7.9	22.363^b	＜0.001
腰围(x±s, cm)	86.3±8.7	86.9±8.5	86.4±9.1	0.219^b	0.804
臀围(x±s, cm)	95.8±8.0	97.2±7.9	96.1±12.7	1.364^b	0.257
BMI(x±s)	24.8±3.0	24.7±3.4	23.4±5.6	1.080^b	0.341
文化程度[例(%)]				51.820^c	＜0.001
大学及以上	2(1.2)	0(0.0)	0(0.0)
高中/中专	7(4.0)	8(4.3)	0(0.0)
初中	64(37.0)	39(20.7)	0(0.0)
小学	80(46.2)	81(43.1)	4(28.6)
文盲或半文盲	20(11.6)	60(31.9)	10(71.4)
吸烟史[例(%)]				16.567^a	0.002
否	102(59.0)	136(72.3)	14(100.0)
每天吸烟	45(26.0)	25(13.3)	0(0.0)
已戒烟	26(15.0)	27(14.4)	0(0.0)
饮酒史[例(%)]				10.114^a	0.029
否	119(68.8)	151(80.3)	14(100.0)
饮酒	34(19.7)	22(11.7)	0(0.0)
已戒酒	20(11.5)	15(8.0)	0(0.0)
注：^a为χ²值，^b为F值，^c为H值。

下载: 导出CSV

表 2 不同衰弱程度社区老年人血清生化指标的比较[M(P₂₅，P₇₅)]

项目	例数	血红蛋白(g/L)	白细胞(×10⁹/L)	血小板(×10⁹/L)	空腹血糖(mmol/L)	糖化血红蛋白(%)	血清谷丙转氨酶(U/L)	血清谷草转氨酶(U/L)	总胆红素(μmol/L)
非衰弱期	173	138(129，148)	5.6(4.8, 6.5)	191(157, 233)	5.1(4.6, 6.0)	5.8(5.5, 6.2)	17.0(13.0, 22.5)	22.0(18.0，25.0)	14.2(10.5, 19.2)
衰弱前期	188	135(125，143)	5.4(4.7, 6.4)	181(152，227)	5.1(4.6, 5.8)	5.9(5.5, 6.3)	16.0(12.0, 22.0)	22.0(19.0, 26.0)	13.9(10.7, 18.5)
衰弱期	14	131(117，138)	5.1(4.5, 6.8)	167(120, 229)	5.6(5.0, 6.6)	6.5(5.6, 7.3)	18.5(14.0，21.3)	22.5(21.3, 32.8)	13.3(11.1, 17.9)
H值		14.817	1.694	2.797	2.309	3.147	1.560	3.252	0.272
P值		0.001	0.429	0.247	0.315	0.207	0.459	0.197	0.873

项目	例数	血清肌酐(μmol/L)	血尿素氮(mmol/L)	尿酸(μmol/L)		总胆固醇(mmol/L)	甘油三酯(mmol/L)	血清低密度脂蛋白胆固醇(mmol/L)	血清高密度脂蛋白胆固醇(mmol/L)
非衰弱期	173	71.0(61.0, 81.3)	5.7(4.7, 6.6)	324(280, 396)		4.7(4.0, 5.4)	1.2(0.9, 1.6)	2.8(2.3, 3.4)	1.4(1.1, 1.6)
衰弱前期	188	69.5(58.0, 83.8)	5.8(4.6, 6.8)	326(269, 386)		4.8(4.1, 5.6)	1.2(0.9, 1.7)	2.9(2.2, 3.6)	1.4(1.2, 1.7)
衰弱期	14	65.2(54.6，83.0)	5.5(4.9, 7.0)	296(270, 446)		5.0(4.3, 5.6)	1.2(0.9, 1.7)	3.0(2.3, 3.3)	1.5(1.0, 1.6)
H值		1.085	0.141	0.937		0.295	0.001	0.037	0.604
P值		0.581	0.932	0.626		0.863	0.999	0.982	0.739

下载: 导出CSV

表 3 不同衰弱程度社区老年人特殊血清生化指标的比较[M(P₂₅，P₇₅)]

项目	例数	IL-6(ng/L)	IGF-1(μg/L)	PRL(ng/mL)	T(ng/mL)
非衰弱期	173	14.30(3.55，52.35)	129.00(103.50，153.00)	8.24(6.31, 11.22)	10.54(0.85, 18.77)
衰弱前期	188	13.20(4.69，29.33)	116.00(89.63，143.00)	8.67(6.56, 13.82)	7.40(0.77, 17.45)
衰弱期	14	23.35(8.12, 51.35)	104.50(84.45，127.25)	10.47(7.21, 22.81)	1.07(0.62, 13.05)
H值		2.249	12.697	4.066	5.114
P值		0.325	0.002	0.131	0.078

项目	例数	P(ng/mL)	FSH(mIU/mL)	E₂(pg/mL)	LH(mIU/mL)
非衰弱期	173	6.67(2.12, 15.70)	15.0(10.0，25.0)	13.7(8.2，49.3)	0.19(0.11，6.59)
衰弱前期	188	10.00(3.75, 18.72)	10.00(10.0，22.0)	34.4(10.0，60.4)	0.20(0.13, 6.12)
衰弱期	14	11.59(5.39, 22.52)	10.0(10.0，27.5)	36.1(14.2，50.7)	0.13(0.10, 0.22)
H值		5.673	7.922	6.252	5.204
P值		0.059	0.019	0.044	0.074

下载: 导出CSV

表 4 社区老年衰弱与血清因子相关性的多因素logistic回归分析

项目	B	SE	Wald χ²	P值	OR(95%CI)
血红蛋白(g/L)	-0.009	0.012	0.626	0.429	0.991(0.969~1.014)
IGF-1(μg/L)	-0.005	0.003	3.182	0.074	0.995(0.989~1.001)
FSH(mIU/mL)	-0.006	0.011	0.345	0.557	1.006(0.985~1.028)
E₂(pg/mL)	-0.004	0.007	0.279	0.598	0.996(0.983~1.010)

下载: 导出CSV

参考文献(28)

[1]	SIEBER C C. Frailty-From concept to clinical practice[J]. Exp Gerontol, 2017, 87(Pt B): 160-167. https://www.sciencedirect.com/science/article/pii/S0531556516301395
[2]	BURTON J R, LEE A G, POTTER J F. Frailty[M]. Springer: Geriatrics for Specialists, 2017: 3-12. https://doi.org/10.1007/978-3-319-31831-8_1.
[3]	NATHALIE C, BENJAMIN B, SANDRA D B, et al. Study of the association of total and differential white blood cell counts with geriatric conditions, cardio-vascular diseases, seric IL-6 levels and telomere length[J]. Exp Gerontology, 2015, 61: 105-112. doi: 10.1016/j.exger.2014.11.016
[4]	LEONIE E, BENDIX R S, MATTHIAS K, et al. Frailty and transplantation[J]. Transplantation, 2016, 100(4): 727-33. doi: 10.1097/TP.0000000000001003
[5]	MORLEY J E, MALMSTROM T K, MILLER D K. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans[J]. J Nutr Health Aging, 2012, 16(7): 601-608. doi: 10.1007/s12603-012-0084-2
[6]	CHAMBERLAIN A M, ST SAUVER J L, JACOBSON D J, et al. Social and behavioural factors associated with frailty trajectories in a population-based cohort of older adults[J]. BMJ Open, 2016, 6(5): e011410. doi: 10.1136/bmjopen-2016-011410
[7]	SIRIWARDHANA D D, HARDOON S, RAIT G, et al. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: A systematic review and meta-analysis[J]. BMJ Open, 2018, 8(3): e018195. doi: 10.1136/bmjopen-2017-018195
[8]	KOJIMA G, ILIFFE S, TANIGUCHI Y, et al. Prevalence of frailty in Japan: A systematic review and meta-analysis[J]. J Epidemiol, 2017, 27(8): 347-353. doi: 10.1016/j.je.2016.09.008
[9]	王坤, 陈长香, 李淑杏. 石家庄某社区老年人衰弱现状及影响因素[J]. 中国公共卫生, 2018, 34(2): 196-198. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW201802009.htm
[10]	GORDON E H, PEEL N M, SAMANTA M, et al. Sex differences in frailty: A systematic review and meta-analysis[J]. Exp Gerontol, 2017, 89: 30-40. doi: 10.1016/j.exger.2016.12.021
[11]	董碧蓉. 老年衰弱综合征的研究进展[J]. 中华保健医学杂志, 2014, 16(6): 417-420. https://www.cnki.com.cn/Article/CJFDTOTAL-JFJB201406002.htm
[12]	EYIGOR S, KUTSAL Y G, DURAN E, et al. Frailty prevalence and related factors in the older adult-FrailTURK Project[J]. Age (Dordr), 2015, 37(3): 9791. https://pubmed.ncbi.nlm.nih.gov/25948502/
[13]	SHIMADA H, MAKIZAKO H, DOIT, et al. Combined prevalence of frailty and mild cognitive impairment in a population of elderly Japanese people[J]. J Am Med Dir Assoc, 2013, 14(7): 518-524. doi: 10.1016/j.jamda.2013.03.010
[14]	侯晓琳. 养老机构老年人衰弱现状及分析[J]. 中华护理杂志, 2018, 53(1): 88-93. doi: 10.3761/j.issn.0254-1769.2018.01.016
[15]	陈旭. 老年糖尿病患者衰弱影响因素及干预对策研究[J]. 中国全科医学, 2019, 22(15): 1772-1777. doi: 10.12114/j.issn.1007-9572.2019.00.149
[16]	VETRANO D L, PALMER K, MARENGONI A, et al. Frailty and multimorbidity: A systematic review and meta-analysis[J]. J Gerontol A Biol Sci Med Sci, 2019, 74(5): 659-666. doi: 10.1093/gerona/gly110
[17]	宁晓暄, 欧阳敏, LENG SEAN X. 老年人衰弱综合征的发病机制和评估及管理[J]. 中华老年医学杂志, 2015, 34(12): 1282-1285. doi: 10.3760/cma.j.issn.0254-9026.2015.12.002
[18]	RUAN Y, GUO Y, KOWAL P, et al. Association between anemia and frailty in 13175 community-dwelling adults aged 50 years and older in China[J]. BMC Geritar, 2019, 19(1): 327. doi: 10.1186/s12877-019-1342-5
[19]	HUBBARD R E, O'MAHONY MSAVVA G M, CALVER B L, et al. Inflammation and frailty measures in older people[J]. J Cell Mol Med, 2009, 13: 3103-3109. doi: 10.1111/j.1582-4934.2009.00733.x
[20]	VERLAAN S, LIGTHART-MELIS G C, WIJERS S L J, et al. High prevalence of physical frailty among community-dwelling malnourished older adults: A systematic review and meta-analysis[J]. J Am Med Dir Assoc, 2017, 18(5): 374-382. doi: 10.1016/j.jamda.2016.12.074
[21]	MACCIO A, MADEDDU C. Management of anemia of inflammation in the elderly[J]. Anemia, 2012, 2012: 563251. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3471391/
[22]	TAVENIER J, LENG S X. Inflammatory pathways to anemia in the frail elderly[J]. Clin Geritar Med, 2019, 35(3): 339-348. doi: 10.1016/j.cger.2019.03.005
[23]	VAN NIEUWPOORT I C, VLOT M C, SCHAAP L A, et al. The relationship between serum IGF-1, handgrip strength, physical performance and falls in elderly men and women[J]. Eur J Endocrinol, 2018, 179(2): 73-84. doi: 10.1530/EJE-18-0076
[24]	DOIT, MAKIZAKO H, TSUTSUMIMOTO K, et al. Association between insulin-like growth factor-1 and frailty among older adults[J]. J Nutr Health Aging, 2018, 22(1): 68-72. doi: 10.1007/s12603-017-0916-1
[25]	MAGGIO M, CAPPOLA A R, CEDA G P, et al. The hormonal pathway to frailty in older men[J]. J Endocrinol Invest, 2005, 28: 15-19. doi: 10.1007/BF03347215
[26]	SHIVAPPA N, STUBBS B, HÉBERT J R, et al. The relationship between the dietary inflammatory index and incident frailty: A longitudinal cohort study[J]. J Am Med Dir Assoc, 2018, 19: 77-82. doi: 10.1016/j.jamda.2017.08.006
[27]	SINDHU S, AKHTER N, KOCHUMON S, et al. Increased expression of the innate immune receptor TLR 10 in obesity and type-2 diabetes: Association with ROS-Mediated oxidative stress[J]. Cellular Physiology and Biochemistry, 2018, 45: 572-590. doi: 10.1159/000487034
[28]	CARCAILLON I. GARCIA-GARCIA F J, TRESGUERRES J A, et al. Higher levels of Endogenous estradiol are associated with frailty in postmenopausal women from the Toledo study for healthy aging[J]. J Clin Endocrinol Metab, 2012, 97: 2898-2906. doi: 10.1210/jc.2012-1271