老年妇科恶性肿瘤患者的衰弱变化轨迹及其影响因素的纵向研究

余淑炬; 张超南; 滕智敏

doi:10.16766/j.cnki.issn.1674-4152.004157

老年妇科恶性肿瘤患者的衰弱变化轨迹及其影响因素的纵向研究

doi: 10.16766/j.cnki.issn.1674-4152.004157

温州医科大学附属第一医院妇科，浙江温州 325000

基金项目:

浙江省医药卫生科技计划项目 2023KY142

温州市科技局项目 Y2020485

详细信息

通讯作者:
余淑炬，E-mail：yushuju11223@163.com

中图分类号: R737.3 R592
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出版历程
- 收稿日期: 2025-01-13
- 网络出版日期: 2025-11-17

A longitudinal study on the trajectory of frailty and its influencing factors in elderly patients with gynecological malignancies

Department of Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的随访观察妇科恶性肿瘤患者衰弱的变化，以期能为患者的衰弱管理提供一定的参考。方法使用方便抽样选取2022年11月—2024年4月在温州医科大学附属第一医院妇科治疗的223例妇科恶性肿瘤患者为研究对象。首次住院后第1天或第2天(T0)收集人口统计学资料，并进行衰弱、营养状况和抑郁评估。距离T0时点1个月后(T1)、3个月后(T2)和6个月后(T3)通过门诊或病房，对患者再次进行衰弱评估。结果患者4个时点衰弱发生率分别为33.2%(74/223)、35.0%(78/223)、36.3%(81/223)和31.8%(71/223)。可拟合4个衰弱变化潜在轨迹类别：“低水平衰弱-平稳组”(24.2%)、“低水平衰弱-先升后降组”(4.9%)、“中水平衰弱-缓降组”(39.9%)、“中水平衰弱-缓升组”(30.9%)。宗教信仰、基础慢性病数量、营养状况和抑郁症状是患者衰弱变化潜在轨迹类别的影响因素。结论医护人员应尽早判断患者衰弱变化的轨迹，充分尊重患者信仰，引导其进行积极的生活和行为改变，定期进行心理和营养评估及干预，并对患者进行共病管理，避免患者衰弱的持续进展。
- 老年 /
- 妇科恶性肿瘤 /
- 衰弱 /
- 潜在轨迹类别
Abstract: Objective To explore the changes in frailty levels among patients diagnosed with gynecological malignancies by following up and provide a valuable reference point for the clinical management of frailty. Methods A total of 223 gynecological malignancies patients were collected from the First Affiliated Hospital of Wenzhou Medical University between November 2022 and April 2024, through the utilization of convenience sampling. Demographic data, frailty, nutritional status and depression assessment was conducted on the 1st or 2nd day following hospitalization (T0). At one month (T1), three months (T2) and six months (T3) after T0, patients were re-evaluated for frailty through outpatient or inpatient visits. Results The incidence of frailty at the four respective time points was found to be 33.2% (74/223), 35.0% (78/223), 36.3% (81/223) and 31.8% (71/223), respectively. It is possible to categorize the data into four potential trajectory categories: "low level frailty-stable group" (24.2%), "low level frailty-first rise then decline group" (4.9%), "moderate level frailty-slow decline group" (39.9%), and "moderate level frailty e-slow rise group" (30.9%). Religious beliefs, the number of chronic diseases comorbidity, nutritional status and depressive symptoms were the influencing factors of potential trajectory categories of frailty changes. Conclusion Health workers should judge the trajectory of the patient' s decline as early as possible, fully respect for patients' beliefs, guidance towards positive changes in life and behavior, regularly conduct psychological and nutritional assessments and interventions, and manage comorbidities is also crucial to prevent the continuous progression of frailty.
- Elderly /
- Gynecological malignancy /
- Frailty /
- Potential trajectory categories

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图 1 老年妇科恶性肿瘤患者衰弱变化潜变量增长模型轨迹

Figure 1. Trajectory of latent variable growth model for frailty changes in elderly women with gynecological malignancies

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表 1 老年妇科恶性肿瘤患者衰弱变化潜在轨迹类别拟合指标

Table 1. Indicators for fitting potential trajectory categories of frailty changes in elderly patients with gynecological malignancies

类别数	AIC	BIC	aBIC	信息熵	LMRT(P值)	BLRT(P值)	类别概率(%)
1	3 312.148	3 328.413	3 314.112				100.0
2	3 007.842	3 026.574	3 009.763	0.988	< 0.001	< 0.001	54.7/45.3
3	2 814.654	2 836.214	2 816.687	0.976	< 0.001	< 0.001	32.3/39.0/28.7
4	2 621.433	2 645.367	2 623.370	0.971	0.019	< 0.001	24.2/4.9/39.9/30.9
5	2 597.846	2 625.279	2 598.506	0.965	0.081	0.061	23.8/13.9/18.8/19.3/24.2
6	2 565.358	2 596.378	2 567.689	0.966	0.129	0.284	20.2/13.9/17.5/16.6/18.4/13.4
注：AIC为赤池信息量准则；BIC为贝叶斯信息标准准则；aBIC为校正贝叶斯信息标准准则；LMRT为罗蒙戴尔鲁本校正似然比；BLRT为基于Bootstrap的似然比检验指数。AIC、BIC和aBIC越小，拟合越好；信息熵越接近1，拟合越好；LMRT和BLRT代表第k个类别和k-1个类别间的拟合差异。

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表 2 老年妇科恶性肿瘤患者衰弱变化潜在轨迹类别的单因素分析[例(%)]

Table 2. Univariate analysis of potential trajectory categories of frailty changes in elderly patients with gynecological malignancies[cases(%)]

项目	类别1+2 (n=65)	类别3 (n=89)	类别4 (n=69)	统计量	P值
年龄				6.811^a	0.033
< 70岁	41(63.1)	52(58.4)	29(42.0)
≥70岁	24(36.9)	37(41.6)	40(58.0)
宗教信仰				8.162^a	0.017
有	13(20.0)	6(6.7)	5(7.2)
无	52(80.0)	83(93.3)	64(92.8)
日常锻炼频率				11.427^b	0.022
≤1周/次	8(12.3)	14(15.7)	18(26.1)
2~3次/周	22(33.8)	46(51.7)	29(42.0)
≥4次/周	35(53.9)	29(32.6)	22(31.9)
是否独居				8.291^a	0.016
是	8(12.3)	9(10.1)	18(26.1)
否	57(87.7)	80(89.9)	51(73.9)
基础慢性病数量				12.781^a	0.002
≤3个	43(66.2)	36(40.4)	27(39.1)
≥4个	22(33.8)	53(59.6)	42(60.9)
营养状况				10.089^b	0.039
营养不良	6(9.2)	8(9.0)	13(18.9)
有营养不良的风险	13(20.0)	16(18.0)	21(30.4)
正常营养	46(70.8)	65(73.0)	35(50.7)
抑郁得分				6.348^a	0.042
≤9分	54(83.1)	74(83.1)	47(68.1)
≥10分	11(16.9)	15(16.9)	22(31.9)
注：^a为χ²值，^b为H值；类别1+2为低水平衰弱-平稳组和低水平衰弱-先升后降组，类别3为中水平衰弱-缓降组，类别4为中水平衰弱-缓升组。本表仅列出差异有统计学意义的指标。

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表 3 自变量赋值情况

Table 3. The assignment situation of independent variables

自变量	赋值方法
年龄	< 70岁=0，≥70岁=1
宗教信仰	无=0，有=1
日常锻炼频率	≤1次/周=0，2~3次/周=1，≥4次/周=2
是否独居	否=0，是=1
基础慢性病数量	≤3个=0，≥4个=1
营养状况	正常营养=0，有营养不良的风险=1，营养不良=2
抑郁得分	≤9分=0，≥10分=1

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表 4 老年妇科恶性肿瘤患者衰弱变化潜在轨迹类别的多分类logistic回归分析

Table 4. Multi-class logistic regression on the potential trajectory categories of frailty changes in elderly women with gynecological malignancies

变量	自变量	B	SE	Waldχ²	P值	OR(95% CI)
类别1+2与类别3^a	宗教信仰	-0.357	0.159	5.041	0.025	0.699(0.432~0.921)
类别1+2与类别4^b	基础慢性病数量	-0.218	0.095	5.266	0.022	0.804(0.613~0.934)
	营养状况	-1.021	0.392	6.784	0.009	0.360(0.196~0.593)
	抑郁	-0.933	0.284	10.793	0.001	0.393(0.105~0.687)
类别4与类别3^a	营养状况	0.896	0.297	9.101	0.003	2.450(1.686~3.311)
	抑郁	1.154	0.315	13.421	< 0.001	3.171(2.556~3.915)
	宗教信仰	-0.528	0.214	6.088	0.014	0.590(0.311~0.807)
注：类别1+2为低水平衰弱-平稳组和低水平衰弱-先升后降组，类别3为中水平衰弱-缓降组，类别4为中水平衰弱-缓升组；^a为以类别3为参照组，^b为以类别4为参照组。

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