Effect of nutritional risk on physical fitness during hospitalization in elderly patients with reduced ejection fraction heart failure
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摘要:
目的 通过本研究判断营养风险程度对老年射血分数减低型心力衰竭(HFrEF)患者在住院期间体适能的影响程度。 方法 连续纳入2019年1月—2021年12月在首都医科大学附属北京安贞医院心内重症医学中心收治的老年HFrEF患者228例, 根据老年营养风险指数(GNRI)分为合并营养不良风险组121例和对照组107例, 分析2组基线资料和住院期间体适能状况；根据简易躯体能力测试(SPPB)分为体适能较差患者185例和体适能良好患者43例；采用二分类logistic回归分析研究导致2组患者院内体适能下降的主要影响因素。 结果 营养不良风险组的HFrEF患者椅子站立测试评分[(2.19±0.87)分vs. (2.46±0.82)分，P=0.017]及简易躯体能力测试总分明显低于对照组[(7.65±1.79)分vs. (8.23±1.79)分，P=0.039]；女性握力水平低于对照组[(17.65±4.43)kg vs. (19.89±3.74)kg，P=0.041]；与体适能良好患者比较，体适能较差患者年龄更大，血BNP水平更高，血清白蛋白水平、GNRI分值、LVEF值更低(均P＜0.05)。二分类logistic回归分析显示：BNP升高(OR=1.003，95% CI: 1.001~1.005, P＜0.001)、营养不良风险(OR=2.642，95% CI: 1.248~5.591, P=0.011)是影响老年HFrEF患者住院期间体适能的主要危险因素。 结论 营养不良是导致老年HFrEF患者住院期间体适能下降的独立危险因素。 -
关键词:
- 老年营养风险指数 /
- 射血分数减低型心力衰竭 /
- 简易躯体功能
Abstract:Objective To evaluate the effect of nutritional risk on physical fitness in elderly patients with reduced ejection fraction heart failure (HFrEF) during hospitalization. Methods A total of 228 elderly patients with HFrEF admitted to the Cardiac Intensive Care Center of Beijing Anzhen Hospital affiliated with Capital Medical University from January 2019 to December 2021 were included. According to the geriatric Nutritional risk index (GNRI), they were divided into 121 patients in the malnutrition risk group and 107 patients in the control group. Baseline data and physical fitness during hospitalization of the two groups were analyzed. According to short physical performance battery (SPPB), there were 185 patients with poor physical fitness and 43 patients with good physical fitness. Binary logistic regression was used to analyze the main influencing factors leading to the two groups' decline in-hospital fitness. Results The chair standing test score and total score of the simple body achievement test of HFrEF patients in the malnutrition risk group were significantly lower than those in the control group [(2.19±0.87) points vs. (2.46±0.82) points, P=0.017; (7.65±1.79) points vs. (8.23±1.79) points, P=0.039]. The grip strength level of women in the malnutrition risk group was lower than that of the control group [(17.65±4.43) kg vs. (19.89±3.74) kg, P=0.041]. Compared with patients with good physical fitness, patients with poor physical fitness were older and had higher blood B-type natriuretic peptide (BNP) levels, lower serum albumin levels, GNRI scores, and LVEF values (all P < 0.05). Binary logistic regression analysis showed that elevated BNP (OR=1.003, 95% CI: 1.001-1.005, P < 0.001) and malnutrition (OR=2.642, 95% CI: 1.248-5.591, P=0.011) were the main risk factors affecting physical fitness in elderly patients with HFrEF during hospitalization. Conclusion Malnutrition is an independent risk factor for the decline of physical fitness in elderly patients with HFrEF during hospitalization. -
表 1 不同营养风险患者一般资料比较
Table 1. Comparison of general data of patients with different nutritional risks
组别 例数 年龄(x±s, 岁) 性别[例(%)] 吸烟史[例(%)] 既往病史[例(%)] 收缩压(x±s, mmHg) 舒张压(x±s, mmHg) 男性 女性 心房颤动 高血压病 糖尿病 营养风险组 121 70.49±6.82 77(63.6) 44(36.4) 65(53.7) 31(25.6) 65(53.7) 43(35.5) 110.97±22.08 68.92±12.96 无营养风险组 107 69.31±6.59 82(76.6) 25(23.4) 59(55.1) 27(25.2) 61(57.0) 43(40.2) 109.50±22.41 69.07±13.51 统计量 1.324a 4.547b 0.046b 0.004b 0.249b 0.523b 0.496a -0.089a P值 0.187 0.033 0.830 0.947 0.618 0.470 0.621 0.929 组别 例数 心率(x±s, 次/min) 肌酐(x±s, μmol/L) 血红蛋白(x±s, g/L) 血小板(x±s, ×109/L) BNP [M(P25, P75), pg/mL] 血钾(x±s，mmol/L) LVEDD (x±s, mm) 营养风险组 121 90.96±21.61 116.91±22.97 132.59±22.62 200.94±62.76 610(384, 761) 4.15±0.48 55.46±8.68 无营养风险组 107 86.07±18.03 97.92±46.87 134.53±18.70 187.29±66.66 556(400, 720) 4.17±0.56 56.29±8.40 统计量 1.863a -2.305a -0.710a 1.586a 0.702c -0.249a -0.729a P值 0.064 0.022 0.478 0.114 0.483 0.804 0.467 组别 例数 LVSDD (x±s, mm) LVEF (x±s, %) 阿司匹林[例(%)] 他汀类[例(%)] ACEI/ARB [例(%)] β受体阻滞剂[例(%)] 利尿剂[例(%)] 醛固酮受体拮抗剂[例(%)] 营养风险组 121 41.13±10.68 34.19±5.86 24(19.8) 110(90.9) 67(55.4) 101(83.5) 92(76.0) 80(66.1) 无营养风险组 107 42.85±10.46 33.54±5.91 28(26.2) 93(86.9) 61(57.0) 89(83.2) 82(76.6) 65(60.7) 统计量 -1.225a 0.829a 1.294b 0.927b 0.062b 0.004b 0.011b 0.707b P值 0.222 0.408 0.255 0.336 0.804 0.953 0.915 0.401 注：a为t值，b为χ2值，c为Z值；1 mmHg=0.133 kPa；ACEI为血管紧张素转换酶抑制剂(angiotensin converting enzyme inhibitor)；ARB为血管紧张素Ⅱ受体阻断剂(angiotensin Ⅱ receptor blocker)。 
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表 2 不同营养风险患者体适能比较(x ±s)
Table 2. Comparison of physical fitness of patients with different nutritional risks(x ±s)
组别 例数 平衡测试(分) 4 m步行(分) 椅子站立(分) SPPB总分(分) 握力(kg) 男性 女性 营养风险组 121 3.16±0.66 2.32±0.80 2.19±0.87 7.65±1.79 24.00±4.51 17.65±4.43 无营养风险组 107 3.29±0.69 2.49±0.87 2.46±0.82 8.23±1.79 24.66±3.84 19.89±3.74 t值 -1.484 -1.471 -2.399 -2.441 -0.990 -2.132 P值 0.139 0.143 0.017 0.015 0.324 0.039
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表 3 不同体适能水平患者影响因素分析
Table 3. Analysis of influencing factors in patients with different physical fitness levels
组别 例数 年龄(x±s, 岁) BMI (x±s) 白蛋白(x±s，g/L) GNRI (x±s，分) BNP [M(P25, P75), pg/mL] LVEF (x±s，%) 血红蛋白(x±s, g/L) 血钾(x±s, mmol/L) 外周血管病[例(%)] 脑卒中[例(%)] 心脏手术治疗[例(%)] 体适能减低组 185 70.42±6.84 24.07±2.86 32.61±4.41 93.48±9.39 610(430, 794) 33.46±6.00 133.18±20.64 4.14±0.51 14(7.6) 46(24.9) 52(28.1) 体适能良好组 43 67.86±5.83 24.70±2.48 34.72±4.74 97.61±9.65 500(220, 607) 35.70±5.02 134.89±21.93 4.23±0.55 3(7.0) 12(27.9) 16(37.2) 统计量 2.501a -1.454a -2.785a -2.541a 4.085b -2.527a -0.465a -0.970a 0.018c 0.170c 1.381c P值 0.015 0.150 0.006 0.014 ＜0.001 0.014 0.643 0.333 0.894 0.680 0.240 注：a为t值，b为Z值，c为χ2值。
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表 4 各变量赋值方法
Table 4. Variable assignment method
变量 赋值方法 年龄 以实际值赋值 LVEF ＜35%=0，≥35%=1 BNP ＜800 pg/mL=0，≥800 pg/mL=1 握力下降 以实际值赋值 营养不良风险 无=0，有=1 外周动脉疾病 无=0，有=1 贫血 无=0，有=1 低钾血症 无=0，有=1
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表 5 影响体适能下降的logistic回归分析
Table 5. Logistic regression analysis of influence on physical fitness decline
变量 B SE Wald χ2 P值 OR值 95% CI 年龄 0.061 0.038 2.615 0.106 1.063 0.987~1.144 LVEF -0.065 0.040 2.577 0.108 0.937 0.866~1.014 BNP 0.003 0.001 12.422 ＜0.001 1.003 1.001~1.005 握力 -0.041 0.049 0.717 0.397 0.960 0.873~1.056 营养不良风险 0.971 0.382 6.450 0.011 2.642 1.248~5.591 外周动脉疾病 0.475 0.719 0.435 0.509 1.608 0.392~6.586 贫血 0.003 0.009 0.073 0.788 1.003 0.984~1.021 低钾血症 -0.542 0.357 2.305 0.129 0.581 0.289~1.171
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