老年住院患者衰弱综合征与认知功能障碍和抑郁的相关性分析

胡寅田; 胡希文

doi:10.16766/j.cnki.issn.1674-4152.002734

老年住院患者衰弱综合征与认知功能障碍和抑郁的相关性分析

doi: 10.16766/j.cnki.issn.1674-4152.002734

胡寅田^,,
胡希文

杭州市第七人民医院浙江大学医学院精神卫生中心精神科，浙江杭州 310013

基金项目:

浙江省医药卫生科技计划项目 2020KY747

详细信息

通讯作者:
胡寅田, E-mail: polibomi@163.com

中图分类号: R749.16
计量
- 文章访问数: 278
- HTML全文浏览量: 76
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2021-10-14
- 网络出版日期: 2022-12-30

Correlation analysis of frailty syndrome with cognitive dysfunction and depression among elderly inpatients

HU Yin-tian^,,
HU Xi-wen

Psychiatry Department, Mental Health Center Zhejiang University School of Medicine, Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang 310013, China

摘要

摘要: 目的探讨老年住院患者衰弱综合征与认知功能障碍及抑郁的相关性。方法选取2019年2月—2020年2月在杭州市第七人民医院治疗的老年患者178例，根据Fried衰弱评估量表将患者分为非衰弱组(42例)、衰弱前期组(64例)和衰弱组(72例)。比较3组患者的一般临床资料，分析衰弱与认知功能障碍和抑郁的相关性，并探讨影响衰弱的危险因素。结果 3组患者性别、年龄、慢性疾病数量、IL-6、CRP、ALB等方面比较差异有统计学意义(均P＜0.05)；衰弱组认知功能障碍和抑郁发生率[43(59.72%)、31(43.06%)]明显高于非衰弱组[3(7.14%)、1(2.38%)]和衰弱前期组[21(32.81%)、15(23.43%)]，均P＜0.017，而衰弱前期组明显高于非衰弱组(均P＜0.017)；衰弱严重程度与认知功能和抑郁发生率呈正相关关系(r=0.138，P=0.017；r=0.163，P=0.004)；Logistic回归分析显示，年龄、慢性疾病数量、认知功能障碍、抑郁是老年患者衰弱发生的独立影响因素。结论老年住院衰弱综合征患者的衰弱程度与认知功能障碍、抑郁呈正相关关系；高龄、认知功能障碍、抑郁、慢性疾病数量多是影响老年衰弱综合征的独立危险因素。
- 衰弱综合征 /
- 认知功能障碍 /
- 抑郁 /
- 老年住院患者
Abstract: Objective To investigate the correlation between frailty syndrome and cognitive dysfunction and depression in elderly inpatients. Methods A total of 178 cases of hospitalised elderly inpatients were selected in Hangzhou Seventh People's Hospital from February 2019 to February 2020. Based on the Fried scale, the inpatients were divided into non-frailty group (42 cases), pre-frailty group (72 cases) and frailty group (64 cases). The general clinical data of the three groups were compared to analyse the correlation between frailty and cognitive dysfunction and depression as well as to explore the risk factors affecting frailty. Results There was statistical significance found in gender, age, number of chronic diseases, IL-6, CRP and ALB among the three groups (all P < 0.05). The incidence of cognitive dysfunction and depression in the frailty group [43 (59.72%), 31 (43.06%)] was significantly higher than that in the non-frailty group [3 (7.14%), 1 (2.38%)] and the pre-frailty group [21 (32.81%), 15 (23.43%)], all P < 0.017, and the pre-frailty group was significantly higher than that in the non-frailty group (all P < 0.017). Meanwhile, the severity of frailty were significantly positively correlated with cognitive function and the incidence of depression (r=0.138, P=0.017; r=0.163, P=0.004), respectively. Logistic regression analysis showed that age, number of chronic diseases, cognitive dysfunction and depression were independent risk factors for frailty in elderly inpatients. Conclusion The frailty degree of elderly inpatient frailty syndrome is positively correlated with cognitive dysfunction and depression. Therefore, old age, cognitive dysfunction, depression and several chronic diseases are independent risk factors for elderly frailty syndrome.
- Frailty syndrome /
- Cognitive dysfunction /
- Depression /
- Elderly inpatients

HTML全文

表 1 3组老年患者临床资料比较

Table 1. Comparison of clinical data of the three groups of elderly patients

组别	例数	性别[例(%)]		年龄[例(%)]			慢性疾病数量[例(%)]
组别	例数	男性	女性	65~70岁	71~75岁	76~85岁	0~1种	2~3种	≥4种
非衰弱组	42	25(59.52)	17(40.48)	23(54.76)	11(26.19)	8(19.05)	13(30.95)	22(52.38)	7(16.67)
衰弱前期组	64	37(57.81)	27(42.19)	26(40.62)	18(28.13)	20(31.25)	11(17.19)	31(48.43)	22(34.38)
衰弱组	72	31(43.06)	41(56.94)	14(19.44)	21(29.17)	37(51.39)	8(11.12)	32(44.44)	32(44.44)
统计量		8.124^a		12.001^b			9.335^b
P值		0.034		＜0.001			0.019

组别	例数	文化程度[例(%)]		BMI	IL-6 (x±s, pg/mL)	CRP (x±s, mg/L)	Hb (x±s, g/L)	ALB (x±s, g/L)
组别	例数	初中及以下	高中及以上	BMI	IL-6 (x±s, pg/mL)	CRP (x±s, mg/L)	Hb (x±s, g/L)	ALB (x±s, g/L)
非衰弱组	42	12(28.57)	30(71.43)	22.31±2.45	4.86±0.26	8.98±0.53	119.18±8.26	39.63±3.72
衰弱前期组	64	19(29.69)	45(70.31)	22.87±2.68	5.23±0.25	9.63±0.45	118.95±8.73	38.58±3.82
衰弱组	72	23(31.94)	49(68.06)	22.96±2.97	6.25±0.87	10.30±0.83	119.65±8.69	37.18±3.91
统计量		1.032^a		0.801^c	89.492^c	58.835^c	0.116^c	5.761^c
P值		0.475		0.451	＜0.001	＜0.001	0.891	0.004

组别	例数	WBC (x±s, ×10⁹/L)		TG (x±s, mmol/L)	TC (x±s, mmol/L)	LDL-C (x±s, mmol/L)	HDL-C (x±s, mmol/L)	FPG (x±s, mmol/L)
非衰弱组	42	6.16±0.68		1.93±0.52	3.62±0.25	2.85±0.28	1.78±0.23	6.23±0.12
衰弱前期组	64	6.18±0.73		1.85±0.43	3.65±0.23	2.71±0.41	1.73±0.16	6.19±0.25
衰弱组	72	6.35±0.85		1.96±0.72	3.71±0.21	2.87±0.63	1.68±0.52	6.28±0.57
统计量		1.315^c		1.668^c	2.369^c	2.012^c	1.037^c	0.876^c
P值		0.406		0.096	0.097	0.137	0.357	0.418
注：^a为χ²值，^b为H值, ^c为F值。

下载: 导出CSV

表 2 3组老年患者认知功能障碍、抑郁发生情况比较[例(%)]

Table 2. Comparison of the incidence of cognitive dysfunction and depression among the three groups of elderly patients [cases (%)]

组别	例数	认知功能障碍	抑郁
非衰弱组	42	3(7.14)	1(2.38)
衰弱前期组	64	21(32.81)^a	15(23.43)^a
衰弱组	72	43(59.72)^ab	31(43.06)^ab
χ²值		12.738	15.986
P值		＜0.001	＜0.001
注：3组间两两比较，校正P值为0.017；与非衰弱组比较，^aP＜0.017；与衰弱前期组比较，^bP＜0.017。

下载: 导出CSV

表 3 各变量赋值方法

Table 3. Variable assignment methods

变量	赋值方法
性别	男性=1，女性=2
年龄	65~70岁=1，71~75岁=2，76~85岁=3
慢性疾病数量	0~1种=1，2~3种=2，≥4种=3
IL-6	以实际值赋值
CRP	以实际值赋值
ALB	以实际值赋值
认知功能障碍	无=0，有=1
抑郁	无=0，有=1
衰弱程度	非衰弱=1，衰弱前期=2，衰弱=3

下载: 导出CSV

表 4 影响衰弱的多因素logistic回归分析

Table 4. Logistic regression analysis of multiple factors influencing frailty

变量	B	SE	Wald χ²	P值	OR值	95% CI
性别	0.201	0.103	1.187	0.276	1.223	0.999~1.496
年龄	0.385	0.317	3.852	0.050	1.470	0.790~2.735
慢性疾病数量	0.418	0.381	8.637	0.003	1.519	0.720~3.205
IL-6	0.218	0.112	1.653	0.199	1.244	0.998~1.549
ALB	-0.161	0.582	2.027	0.155	0.851	0.272~2.663
认知功能障碍	0.793	0.672	16.892	＜0.001	2.210	0.592~8.247
抑郁	0.762	0.658	12.981	＜0.001	2.142	0.590~7.779

下载: 导出CSV

参考文献(18)

[1]	秦丽, 梁珍珍, 葛立宾, 等. 社区老年综合征的影响因素分析[J]. 中国全科医学, 2020, 23(5): 598-603. https://cdmd.cnki.com.cn/Article/CDMD-10132-1020428988.htm QIN L, LIANG Z Z, GE L B, et al. Influencing factors of frailty syndrome in elderly people in the community[J]. Chinese General Practice, 2020, 23(5): 598-603. https://cdmd.cnki.com.cn/Article/CDMD-10132-1020428988.htm
[2]	付梦雪, 张先庚. 老年人衰弱综合征的研究进展[J]. 护理研究, 2019, 33(17): 2973-2976. doi: 10.12102/j.issn.1009-6493.2019.17.012 FU M X, ZHANG X G. Research progress on frailty syndrome in the elderly[J]. Chinese Nursing Research, 2019, 33(17): 2973-2976. doi: 10.12102/j.issn.1009-6493.2019.17.012
[3]	DODDS R, SAYER A A. Sarcopenia and frailty: New challenges for clinical practice[J]. Clin Med, 2016, 16(5): 455-458. doi: 10.7861/clinmedicine.16-5-455
[4]	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. SUN K X. Analysis of Influencing factors of senile frailty syndrome and study on its relationship with serum 25 hydroxyvitamin D[D]. Yangzhou: Yangzhou University, 2018.
[5]	李梦阳. 老年衰弱综合征与认知功能及焦虑抑郁相关性研究[D]. 乌鲁木齐: 新疆医科大学, 2020. LI M Y. The correlation between senile frailty syndrome and cognitive function, anxiety and depression[D]. Urumqi: Xinjiang Medical University, 2020.
[6]	张琦, 夏丽莉. 老年慢性心力衰竭住院病人抑郁状态及相关因素分析[J]. 实用老年医学, 2020, 34(8): 848-851. doi: 10.3969/j.issn.1003-9198.2020.08.025 ZHANG Q, XIA L L. Analysis of depression status and related factors in hospitalized elderly patients with chronic heart failure[J]. Practical Geriatrics, 2020, 34(8): 848-851. doi: 10.3969/j.issn.1003-9198.2020.08.025
[7]	HOOGENDIJK E O, SUANET B, DENT E, et al. Adverse effects of frailty on social functioning in older adults: Results from the longitudinal aging study Amsterdam[J]. Maturitas, 2016, 83(1): 45-50.
[8]	王晓明, 熊波, 周晖. 临床易用性指标对老年慢性阻塞性肺疾病急性加重患者衰弱的预测价值[J]. 中国医药, 2020, 15(8): 1229-1232. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202008019.htm WANG X M, XIONG B, ZHOU H. Easy-to-use indexes in predicting frailty of elderly patients with acute exacerbation of chronic obstructive pulmonary disease[J]. China Medicine, 2020, 15(8): 1229-1232. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202008019.htm
[9]	奚兴, 郭桂芳. 非药物干预改善社区老年人衰弱状况的研究进展[J]. 中国护理管理, 2016, 16(11): 1461-1465. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL201611009.htm XI X, GUO G F. Development of non-pharmacological interventions for community-dwelling frail elders[J]. Chinese Nursing Management, 2016, 16(11): 1461-1465. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL201611009.htm
[10]	CHIOU J H, LIU L K, LEE W J, et al. What factors mediate the inter-relationship between frailty and pain in cognitively and functionally sound older adults? A prospective longitudinal ageing cohort study in Taiwan[J]. BMJ Open, 2018, 8(2): e018716. DOI: 10.1136/bmjopen-2017-018716.
[11]	张占英, 古丽班努, 李玉琴. 血脂异常、高敏C反应蛋白与老年衰弱的相关性研究[J]. 中西医结合心血管病电子杂志, 2019, 7(33): 80, 82. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH201933068.htm ZHANG Z Y, GULI B M, LI Y Q. Study on the correlation between dyslipidemia, high sensitivity C-reactive protein and senile frailty[J]. Cardiovascular Disease Journal Of integrated traditional Chinese and Western Medicine, 2019, 7(33): 80, 82. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH201933068.htm
[12]	KANG J Y, KIM C H, SUNG E J, et al. The association between frailty and cognition in elderly women[J]. Korean J Fam Med, 2016, 37(3): 164-170. doi: 10.4082/kjfm.2016.37.3.164
[13]	郑娟娟. 老年人衰弱与认知功能相关性研究[D]. 乌鲁木齐: 新疆医科大学, 2020. ZHENG J J. Correlation between frailty and cognitive function in the elderly[D]. Urumqi: Xinjiang Medical University, 2020.
[14]	王洁, 莫永珍, 史青凌, 等. 社区老年人衰弱与认知功能的相关性分析[J]. 护理研究, 2019, 33(5): 832-835. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201905023.htm WANG J, MO Y Z, SHI Q L, et al. Correlation analysis of frailty and cognitive function in community elderly[J]. Chinese Nursing Research, 2019, 33(5): 832-835. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201905023.htm
[15]	刘硕, 朱鸣雷, 刘晓红. 老年住院患者衰弱和抑郁的相关性[J]. 中华老年多器官疾病杂志, 2020, 19(6): 419-423. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLQG202006005.htm LIU S, ZHU M L, LIU X H. Correlation between frailty and depression in the elderly hospitalized patients[J]. Chinese Journal of Multiple Organ Diseases in the Elderly, 2020, 19(6): 419-423. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLQG202006005.htm
[16]	杨伟, 王颖, 李汶嘉, 等. 综合医院非精神科患者心理障碍诊断情况分析[J]. 中国医药, 2021, 16(7): 1038-1042. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202107019.htm YANG W, WANG Y, LI W J, et al. Analysis of the diagnosis of mental disorders in non-psychiatric patients from general hospital[J]. China Medicine, 2021, 16(7): 1038-1042. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202107019.htm
[17]	单体茹, 李华. 老年住院患者衰弱状况与抑郁状态的相关性研究[J]. 中西医结合心血管病电子杂志, 2019, 7(3): 12-14. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH201903006.htm SHAN T R, LI H. Study on correlation between frailty and depression in elderly inpatients[J]. Cardiovascular Disease Journal Of integrated traditional Chinese and Western Medicine, 2019, 7(3): 12-14. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXJH201903006.htm
[18]	王苗苗, 李晋军, 王丽, 等. 拉西坦与高压氧联合治疗脑梗死恢复期患者认知功能障碍的效果及安全性[J]. 中国医药, 2018, 13(11): 1661-1665. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG201811017.htm WANG M M, LI J J, WANG L, et al. Efficacy and safety of lasetane combined with hyperbaric oxygen in the treatment of cognitive dysfunction in convalescent patients with cerebral infarction[J]. China Medicine, 2018, 13(11): 1661-1665. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG201811017.htm