老年慢性心力衰竭患者肌少症的筛查及干预研究

马璐瑶; 林萍; 王琴; 任谦

doi:10.16766/j.cnki.issn.1674-4152.002367

老年慢性心力衰竭患者肌少症的筛查及干预研究

doi: 10.16766/j.cnki.issn.1674-4152.002367

浙江中医药大学附属杭州第三医院老年科，浙江杭州 310009

基金项目:

杭州市卫生计生科技计划重点项目 2018Z05

浙江省医药卫生科技计划面上项目 2018KY593

浙江省医药卫生科技计划面上项目 2019KY502

杭州市医学重点学科建设项目杭卫发〔2021〕21号

详细信息

通讯作者:
林萍，E-mail: yjlp1@163.com

中图分类号: R541.6 R592
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出版历程
- 收稿日期: 2021-02-03
- 网络出版日期: 2022-08-13

Screening and intervention of sarcopoenia in elderly patients with chronic heart failure

Department of Geriatrics, Hangzhou Third Hospital Affiliated to Zhejiang Traditional Chinese Medicine University, Hangzhou, Zhejiang 310009, China

摘要

摘要: 目的筛查老年慢性心力衰竭(CHF)住院患者中肌少症的发生率，评价运动训练及营养支持结合标准心衰治疗对老年CHF患者肌少症及心功能的改善情况。方法收集2018年1月—2020年2月于杭州市第三人民医院住院治疗的老年CHF患者200例，进行肌少症筛查。比较CHF合并与不合并肌少症患者心功能、肌少症指标的差异。将筛选出的CHF合并肌少症患者按随机数字表法分为对照组(标准心衰治疗，33例)和观察组(运动训练+营养支持+标准心衰治疗，33例)。治疗2个月后，比较2组患者肌少症及心功能改善情况。结果 (1) 本研究中老年CHF住院患者肌少症的发生率为33%。(2)CHF合并与不合并肌少症患者NT-proBNP水平[(1 559.59±485.95)pg/mL vs. (1 362.60±336.75)pg/mL]、左室射血分数(LVEF)[(45.56±4.25)% vs. (46.98±3.12)%]、心功能分级Ⅲ级[37(56.06%) vs. 53(39.55%)]比较，差异均有统计学意义(均P＜0.05)。(3)治疗2个月后，观察组6分钟步行距离、四肢肌肉质量、握力、生长分化因子11(GDF-11)水平均高于对照组，GDF-15水平低于对照组，差异均有统计学意义(均P＜0.05)；观察组LVEF和NYHA心功能分级也均较对照组改善(均P＜0.05)。(4)线性回归分析显示：GDF-15水平与四肢肌肉质量及6分钟步行距离呈负相关关系(β=-0.449、-0.708，均P＜0.05)，GDF-11水平与四肢肌肉质量及握力呈正相关关系(β=0.537、0.759，均P＜0.05)。结论肌少症在老年CHF住院患者中发生率高；运动训练及营养支持结合标准心衰治疗能改善老年CHF合并肌少症患者肌少症及心功能情况；GDF-15、GDF-11可作为肌少症患者的临床观测指标。
- 老年慢性心力衰竭 /
- 肌少症 /
- 运动训练 /
- 营养支持
Abstract: Objective To screen the incidence of sarcopoenia in elderly inpatients with chronic heart failure (CHF) and to evaluate the effect of exercise training and nutritional support in combination with standard heart-failure treatment on the improvement in sarcopoenia and cardiac function in elderly inpatients with CHF. Methods Two hundred elderly inpatients with CHF who were in the Hangzhou Third People's Hospital from January 2018 to February 2020 were collected to be screened for sarcopoenia. The differences of cardiac function, sarcopoenia, in the 200 selected patients were observed. The selected patients with CHF combined with sarcopoenia were randomly divided into control (standard heart-failure treatment, 33 cases) and observation (exercise training+nutritional support+standard heart-failure treatment, 33 cases) groups. After two months of treatment, the improvement in sarcopoenia and cardiac function were compared between the two groups. Results (1) The incidence of sarcopoenia in elderly inpatients with CHF was 33%. (2) In patients with CHF complicated with sarcopoenia and those who without sarcopoenia, NT-proBNP levels were (1 559.59±485.95) pg / mL vs. (1 362.60±336.75) pg / mL, the LVEFs were (45.56±4.25) % vs. (46.98±3.12) %, and the proportions of cardiac function Ⅲ were 37(56.06%) vs. 53(39.55%), the difference was statistically significant respectively. (3) After treatment, between two groups, the 6 min walking distance, appendicular muscle mass, grip strength, and GDF-11 level of the observation group were all higher; GDF-15 level was lower in the observation group (all P < 0.05). The LVEF and NYHA cardiac-function grading in the observation group also improved compared with that of the control group (all P < 0.05). (4) Multiple linear-regression analysis showed that the GDF-15 level was inversely correlated with appendicular muscle mass and 6 min walking distance (β=-0.449, -0.708, all P < 0.05), GDF-11 level was positively correlated with appendicular muscle mass and grip strength (β=0.537, 0.759, all P < 0.05). Conclusion Sarcopoenia has a high incidence in elderly inpatients with CHF. Exercise training and nutritional support combined with standard heart-failure treatment can improve sarcopoenia and cardiac function in elderly patients with CHF complicated with sarcopoenia. GDF-15 and GDF-11 can be used as clinical-observation indices in patients with sarcopoenia.
- Elderly chronic heart failure /
- Sarcopoenia /
- Exercise training /
- Nutritional support

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表 1 合并与不合并肌少症慢性心力衰竭患者心功能指标比较

Table 1. Comparison of cardiac function in CHF patients with and without sarcopenia

组别	例数	NT-proBNP (x±s，pg/mL)	LVEF (x±s，%)	NYHA分级[例(%)]
组别	例数	NT-proBNP (x±s，pg/mL)	LVEF (x±s，%)	Ⅱ级	Ⅲ级
合并肌少症	66	1 559.59±485.95	45.56±4.25	29(43.94)	37(56.06)
不合并肌少症	134	1 362.60±336.75	46.98±3.12	81(60.45)	53(39.55)
统计量		2.962^a	-2.407^a	4.869^b
P值		0.004	0.018	0.027
注：^a为t值，^b为χ²值。

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表 2 合并与不合并肌少症慢性心力衰竭患者肌少症指标比较(x±s)

Table 2. Comparison of sarcopenia indexs in CHF patients with and without sarcopenia (x±s)

组别	例数	四肢肌肉质量(kg)	6分钟步行距离(m)	握力(kg)	GDF-15(ng/L)	GDF-11(ng/L)
合并肌少症	66	17.21±4.31	215.94±4.16	15.35±4.62	866.09±180.06	653.83±48.36
不合并肌少症	134	23.42±0.95	364.91±6.13	27.46±5.06	732.29±119.98	706.69±47.58
t值		-11.560	-202.243	-16.368	5.469	-7.349
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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表 3 2组CHF合并肌少症的老年患者基线资料比较

Table 3. Comparison of baseline data between two groups of elderly patients with CHF complicated with sarcopenia

组别	例数	年龄 (x±s，岁)	BMI (x±s)	FPG (x±s，mmol/L)	TC (x±s，mmol/L)	TG (x±s，mmol/L)	LDL (x±s，mmol/L)	高血压 [例(%)]	糖尿病 [例(%)]	吸烟 [例(%)]
观察组	33	70.85±3.81	22.83±3.78	6.73±1.32	5.33±0.38	1.83±0.31	3.19±0.37	15(45.45)	17(51.52)	15(45.45)
对照组	33	71.15±3.61	23.45±4.23	6.39±1.41	5.14±0.57	1.78±0.28	3.20±0.52	13(39.39)	14(42.42)	16(48.48)
统计量		-0.332^a	-0.623^a	1.000^a	1.583^a	0.607^a	-0.071^a	0.248^b	0.547^b	0.061^b
P值		0.741	0.535	0.321	0.119	0.546	0.944	0.804	0.622	0.999
注：^a为t值，^b为χ²值。

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表 4 2组CHF合并肌少症的老年患者治疗前后肌少症相关指标比较(x±s)

Table 4. Comparison of sarcopenia indexes in two groups of elderly patients with CHF complicated with sarcopenia before and after treatment (x±s)

组别	例数	四肢肌肉质量(kg)		6分钟步行距离(m)		握力(kg)		GDF-15(ng/L)		GDF-11(ng/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	33	17.43±4.46	20.38±2.94^a	216.24±4.39	220.42±4.64^a	15.35±4.31	18.05±3.88^a	867.39±193.07	765.12±129.87^a	659.42±45.71	681.12±37.68^a
对照组	33	17.00±4.22	17.72±4.02	215.64±3.96	217.33±4.16	15.34±4.99	15.63±4.63	864.79±169.03	843.85±160.38	648.24±50.96	656.88±42.81
t值		0.402	3.065	0.589	2.851	0.016	2.303	0.058	-2.191	0.938	2.442
P值		0.689	0.003	0.558	0.006	0.987	0.025	0.954	0.032	0.352	0.017
注：与同组治疗前比较，^aP＜0.05。

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表 5 2组CHF合并肌少症的老年患者治疗前后心功能指标比较

Table 5. Comparison of cardiac function in two groups of elderly patients with CHF complicated with sarcopenia before and after treatment

组别	例数	血清NT-proBNP(x±s, pg/mL)		LVEF(x±s, %)		治疗前NYHA分级[例(%)]		治疗后NYHA分级[例(%)]
组别	例数	治疗前	治疗后	治疗前	治疗后	Ⅱ级	Ⅲ级	Ⅱ级	Ⅲ级
观察组	33	1 539.24±474.17	1 250.27±417.20^b	46.09±4.56	48.76±3.44^b	14(42.42)	19(57.58)	24(72.73)^b	9(27.27)^b
对照组	33	1 579.94±503.96	1 271.21±424.10^b	45.03±3.91	46.97±3.74^b	15(45.45)	18(54.55)	16(48.48)	17(51.52)
统计量		-0.338^a	-0.202^a	1.014^a	2.023^a	0.062^c		4.062^c
P值		0.737	0.840	0.314	0.047	0.804		0.044
注：^a为t值，^c为χ²值；与同组治疗前比较，^bP＜0.05。

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表 6 肌少症相关指标的线性回归分析

Table 6. Linear regression analysis of indicators to sarcopenia

自变量	因变量	B	SE	β	t值	P值
GDF-15	6分钟步行距离	-0.016	0.002	-0.708	-8.031	＜0.001
GDF-11	握力	0.073	0.008	0.759	9.332	＜0.001
GDF-15	四肢肌肉质量	-0.011	0.002	-0.449	-5.356	＜0.001
GDF-11	四肢肌肉质量	0.048	0.007	0.537	6.410	＜0.001

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