老年综合评估相关项目与踝肱指数的关系研究

doi:10.12114/j.issn.1007-9572.2021.00.124

摘要/Abstract

摘要： 背景　老年综合评估（GCA）被广泛用于评价老年人群基本功能情况，血管病变是老年人群各系统疾病的病理基础，踝肱指数（ABI）能有效反映血管状态。解读GCA相关项目在血管病理方面的临床意义，有助于筛查并干预患者的早期血管病变，进而改善其预后。目的　评价GCA相关项目与ABI的相关性及其对低ABI发生的风险预测效果。方法　收集2019年5—11月进行GCA和ABI测量的74例华中科技大学同济医学院附属协和医院老年病科住院患者资料。GCA包括简易营养评价法（MNA-SF）、FRAIL量表、Morse跌倒危险因素评估量表（MFS）、匹兹堡睡眠质量指数（PSQI）、基本日常生活活动能力（BADL）量表、工具性日常生活活动能力（IADL）量表、计时起立行走试验（TUGT）、5次坐立试验（FTSST）、简易精神状态量表（MMSE）。根据患者ABI划分低ABI组（ABI<0.9），正常ABI组（0.9≤ABI<1.3）。分析GCA各项目与ABI的相关性，使用多因素Logistic回归和受试者工作特征（ROC）曲线分析GCA各项目对低ABI发生的风险效果。结果　两组患者的性别、年龄、吸烟、饮酒情况及MNA-SF、MFS、PSQI、BADL量表、IADL量表、FTSST、MMSE得分比较，差异无统计学意义（P>0.05）；低ABI组的BMI明显高于正常ABI组（28.1 kg/m2 vs 23.8 kg/m2），两组患者FRAIL量表、TUGT得分比较，差异有统计学意义（P<0.05）。年龄和MFS、TUGT、FTSST得分与ABI呈明显负相关，BADL量表及IADL量表得分与ABI呈明显正相关。FRAIL量表与TUGT是经多因素调整后预测低ABI发生的有效项目，经年龄段调整对低ABI的OR分别为2.19〔95%CI（1.07，5.14）〕，1.18〔95%CI（1.06，1.38）〕。FRAIL量表对诊断低ABI发生的AUC为0.82〔95%CI（0.69，0.95）〕，最佳截断值对应于衰弱前期；TUGT对诊断低ABI发生的AUC为0.89〔95%CI（0.75，0.89）〕，最佳截断值为13.5 s。结论　FRAIL量表和TUGT对预测低ABI发生具有良好效力。重点关注衰弱前期、衰弱和TUGT结果大于13.5 s的人群的血管健康，对筛查和早期干预血管病变及下游多系统疾病意义具有重要意义。

关键词: 血管病变, 多系统疾病, 踝肱指数, 老年综合评估, 老年人群, 衰弱前期

Abstract: Background　The Geriatric Comprehensive Assessment（GCA） is widely used to evaluate the basic functions within the elderly population.And vascular disease is the pathological basis of various system diseases in the elderly population.The ankle-brachial index（ABI） can effectively reflect the vascular status.Interpretation of the clinical significance of GCA-related items in vascular pathology will contribute to screening and intervening early vascular disease in patients and eventually improving prognosis.Objective　To evaluate the relationship of GCA-related items with ABI，and the performance of GCA-related items in predicting the risk of low ABI.Methods　A total of 74 patients with data of ABI measurement and GCA〔including the Mini Nutritional Assessment Short-Form（MNA-SF），FRAIL Scale，Morse Fall Scale（MFS），Pittsburgh Sleep Quality Index（PSQI），Basic Activities of Daily Living（BADL），Instrumental Activities of Daily Living（IADL），timed up and go test（TUGT），Five Times sit-to-stand test（FTSST），and Mini-Mental State Examination（MMSE）〕 were recruited from Department of Geriatrics，Union Hospital，Tongji Medical College，Huazhong University of Science and Technology from May to November 2019.GCA items were compared between those with low ABI（ABI<0.9）and normal ABI（0.9≤ABI<1.3）.The relationship between each item of CGA and ABI was evaluated by correlation analysis，and the predictive value of each item for low ABI was evaluated using Logistic regression analysis and ROC curve analysis.Results　Low and normal ABI patients had no significant differences in sex ratio，mean age，smoking prevalence，drinking prevalence，mean scores of MNA-SF，MFS，PSQI，BADL，IADL，FTSST and MMSE（P>0.05），but showed notable significant differences in mean scores of FRAIL Scale and TUGT（P<0.05）.But low ABI patients had higher mean BMI（28.1 kg/m2 vs 23.8 kg/m2）（P<0.05）.ABI showed a significant negative correlation with age，score of MFS，TUGT，or FTSST，and a significant positive correlation with BADL or IADL score.After adjustment for multiple variables，the scores of FRAIL and TUGT were found to be effective in predicting low ABI〔 age-adjusted OR=2.19，95%CI（1.07，5.14）；age-adjusted OR=1.18，95%CI（1.06，1.38）〕．The AUC of FRAIL Scale for the diagnosis of low ABI was 0.82〔95%CI（0.69，0.95）〕，with the score for prefrail as the optimal threshold value.The AUC of TUGT for the diagnosis of low ABI was 0.89〔95%CI（0.75，0.89）〕，the optimal threshold value was 13.5 s.Conclusion　The FRAIL Scale and TUGT showed good predictive value for low ABI.Focusing on the vascular health of pre-frail and frail elderly population and those with TUGT results greater than 13.5 s is of great significance for the detection，prevention，and early intervention of vascular diseases and multisystemic downstream diseases.

Key words: Vascular disease, Multisystem disease, Ankle-brachial index, Comprehensive geriatric assessment, Elderly population, Pre-frail

王耀羚,戚本玲,刘丽华,等. 老年综合评估相关项目与踝肱指数的关系研究[J]. 中国全科医学, 2021, 24(17): 2163-2168. DOI: 10.12114/j.issn.1007-9572.2021.00.124.
WANG Yaoling,QI Benling,LIU Lihua, et al. Relationship of Related Items of Comprehensive Geriatric Assessment with Ankle Brachial Index　[J]. Chinese General Practice, 2021, 24(17): 2163-2168. DOI: 10.12114/j.issn.1007-9572.2021.00.124.

参考文献

［1］SUIJKER J J，BUURMAN B M，TER RIET G，et al．Comprehensive geriatric assessment，multifactorial interventions and nurse-led care coordination to prevent functional decline in community-dwelling older persons：protocol of a cluster randomized trial［J］．BMC Health Serv Res，2012，12：85．DOI：10.1186/1472-6963-12-85.
［2］BAI J F，HAN H X，FENG R，et al．Comprehensive Geriatric Assessment（CGA）：a simple tool for guiding the treatment of older adults with diffuse large B-cell lymphoma in China［J］．Oncologist，2020，25（8）：e1202–1208．DOI：10.1634/theoncologist.2019-0738.
［3］FORESTIER E，ROUBAUD-BAUDRON C，FRAISSE T，et al．Comprehensive geriatric assessment in older patients suffering from infective endocarditis.A prospective multicentric cohort study［J］．Clin Microbiol Infect，2019，25（10）：1246-1252．DOI：10.1016/j.cmi.2019.04.021.
［4］PARTRIDGE J S，HARARI D，MARTIN F C，et al．Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery［J］．Br J Surg，2017，104（6）：679-687．DOI：10.1002/bjs.10459.
［5］O'HARE A M，KATZ R，SHLIPAK M G，et al．Mortality and cardiovascular risk across the ankle-arm index spectrum：results from the Cardiovascular Health Study［J］．Circulation，2006，113（3）：388-393．DOI：10.1161/CIRCULATIONAHA.105.570903.
［6］ZANDER，HEINKE，REINDEL，et al．Periphere arterielle Verschlusskrankheit bei Diabetes mellitus Typ 1 und Typ 2：Unterscheiden sich die Risikofaktoren?［J］．Vasa，2002，31（4）：249-254.
［7］ESPELAND M A，NEWMAN A B，SINK K，et al．Associations between ankle-brachial index and cognitive function：results from the lifestyle interventions and independence for elders trial［J］．J Am Med Dir Assoc，2015，16（8）：682-689．DOI：10.1016/j.jamda.2015.03.010.
［8］HIRSCH A T，HASKAL Z J，HERTZER N R，et al．ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease （lower extremity，renal，mesenteric，and abdominal aortic）：executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery，Society for Cardiovascular Angiography and Interventions，Society for Vascular Medicine and Biology，Society of Interventional Radiology，and the ACC/AHA Task Force on Practice Guidelines （Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease） endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation；National Heart，Lung，and Blood Institute；Society for Vascular Nursing；TransAtlantic Inter-Society Consensus；and Vascular Disease Foundation［J］．J Am Coll Cardiol，2006，47（6）：1239-312．DOI：10.1016/j.jacc.2005.10.009.
［9］MATSUSHITA K，BALLEW SH，SANG Y，et al．Ankle-brachial index and physical function in older individuals：the Atherosclerosis Risk in Communities（ARIC） study.Atherosclerosis［J］．2017，257：208-215．DOI：10.1016/j.atherosclerosis.2016.11.023.
［10］MCDERMOTT M M，HOFF F，FERRUCCI L，et al．Lower extremity ischemia，calf skeletal muscle characteristics，and functional impairment in peripheral arterial disease［J］．J Am Geriatr Soc，2007，55（3）：400-406．DOI：10.1111/j.1532-5415.2007.01092.x.
［11］GURALNIK J M，SIMONSICK E M，FERRUCCI L，et al．A short physical performance battery assessing lower extremity function：association with self-reported disability and prediction of mortality and nursing home admission［J］．J Gerontol，1994，49（2）：M85-94．DOI：10.1093/geronj/49.2.m85.
［12］GURALNIK J M，FERRUCCI L，SIMONSICK E M，et al．Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability［J］．N Engl J Med，1995，332（9）：556-561．DOI：10.1056/NEJM199503023320902.
［13］Panel on Prevention of Falls in Older Persons，American Geriatrics Society and British Geriatrics Society.Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons［J］．J Am Geriatr Soc，2011，59（1）：148-157．DOI：10.1111/j.1532-5415.2010.03234.x.
［14］BOHANNON R W.Reference values for the timed up and go test：a descriptive meta-analysis［J］．J Geriatr Phys Ther，2006，29（2）：64-68．DOI：10.1519/00139143-200608000-00004.
［15］NORDIN E，LINDELÖF N，ROSENDAHL E，et al．Prognostic validity of the Timed Up-and-Go test，a modified Get-Up-and-Go test，staff's global judgement and fall history in evaluating fall risk in residential care facilities［J］．Age Ageing，2008，37（4）：442-448．DOI：10.1093/ageing/afn101.
［16］SHIMADA H，SUZUKAWA M，TIEDEMANN A，et al．Which neuromuscular or cognitive test is the optimal screening tool to predict falls in frail community-dwelling older people?［J］．Gerontology，2009，55（5）：532-538．DOI：10.1159/000236364.
［17］HWANG R，MORRIS N R，MANDRUSIAK A，et al．Timed up and go test：a reliable and valid test in patients with chronic heart failure［J］．J Card Fail，2016，22（8）：646-650．DOI：10.1016/j.cardfail.2015.09.018.
［18］MORLEY J E，MALMSTROM T K，MILLER D K，et al．A simple frailty questionnaire （FRAIL） predicts outcomes in middle aged African Americans［J］．J Nutr Health Aging，2012，16（7）：601-8．DOI：10.1007/s12603-012-0084-2.
［19］ALONSO-BOUZÓN C，CARCAILLON L，GARCÍA-GARCÍA F J，et al．Association between endothelial dysfunction and frailty：the Toledo Study for Healthy Aging.Age （Dordr）［J］．2014，36（1）：495-505．DOI：10.1007/s11357-013-9576-1.
［20］CHEN Q，FU Z，WU X，et al．Association of serum androgen concentrations with cardiovascular risk factors in elderly male patients with chronic systolic heart failure in China［J］．Aging Male，2014，17（3）：155-60．DOI：10.3109/13685538.2014.896893.
［21］XUE Q，QIN M Z，JIA J，et al．Association between. frailty and the cardio-ankle vascular index［J］．Clin Interv Aging，2019，26（14）：735-742. DOI：10.2147/CIA.S195109.
［22］REINER A P，ARAGAKI A K，GRAY S L，et al．Inflammation and thrombosis biomarkers and incident frailty in postmenopausal women［J］．Am J Med，2009，122（10）：947-954.

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