Abstract: Background　Chronic heart failure is associated with high prevalence of frailty in older adult patients，which may increase the rate of hospitalization and mortality.Early recognition and intervention of frailty may improve the prognosis of elderly.However，relevant evidence is limited.Objective　To investigate the prevalence and associated factors of frailty in elderly patients with preserved ejection fraction（HFpEF）.Methods　A total of 95 patients with stable chronic HFpEF（≥65 years old） who hospitalized in Department of Geriatrics，Beijing Friendship Hospital，Capital Medical University from April 2017 to May 2019 due to various causes were selected，and divided into two groups：non-frailty（healthy and pre-frail）（n=64，<3 points） and frailty（n=31，≥3 points） by the Fried Frailty Phenotype.Demographic information（age，gender，height，weight，BMI，smoking history（defined as consuming cigarettes more than 20 a year），comorbidity prevalence（hypertension，diabetes，coronary heart disease，chronic obstructive pulmonary disease，chronic kidney disease，stroke，peripheral vascular disease），and polypharmacy（defined as the use of at least five medications），laboratory test results（white blood cell count，hemoglobin，platelet count，alanine aminotransferase，creatinine，glycosylated hemoglobin，fasting blood glucose，total cholesterol，triacylglycerol，high-sensitivity C-reactive protein，serum iron，albumin，prealbumin），and echocardiographic indicators（left ventricular ejection fraction，left atrial diameter，left ventricular end diastolic dimension，right ventricular diameter，and E/A ratio） were collected.Activities of Daily Living（ADL） scale and the Instrumental Activities of Daily Living（IADL） scale were used to assess the activities of daily living.The Nutritional Risk Screening（NRS2002） scale was used to assess the nutritional risk.Charlson Comorbidity Index was used to assess the comorbidity risk.Multivariate Logistic regression analysis was used to explore the influencing factors of frailty.Results　Compared to non-frail group，the frail group had a greater mean age，higher rate of polypharmacy and higher mean score of Charlson Comorbidity Index（P<0.05）.Moreover，The frail group had lower mean ADL，IADL and albumin levels as well as greater mean left atrial diameter（P<0.05）.Multivariate Logistic regression analysis revealed that older age and polypharmacy were associated with frailty （P<0.05）.Conclusion　The prevalence of frailty was 32.6% among elderly patients with HFpEF，which was associated with older age and polypharmacy.

Key words: Heart failure, Aged, Marasmus, Root cause analysis

摘要： 背景　老年慢性心力衰竭患者的衰弱患病率高，衰弱会增加心力衰竭患者的住院率及死亡率。早期识别衰弱，及早进行干预可能会改善老年患者的预后。目前关于心力衰竭合并衰弱的研究相对较少。目的　探讨老年射血分数保留心力衰竭（HFpEF）患者合并衰弱的情况及其影响因素。方法　选取因各种病因于2017年4月—2019年5月在首都医科大学附属北京友谊医院老年医学科住院、年龄≥65岁的HFpEF患者95例，均处于慢性心力衰竭稳定期。采用Fried衰弱表型评估患者的衰弱状况并分组，分数<3分为非衰弱组（包括衰弱前期和无衰弱）（n=64），分数≥3分为衰弱组（n=31）。收集患者的一般资料〔年龄、性别、身高、体质量、体质指数（BMI）、吸烟史（>20支/年即认为有吸烟史）、合并疾病（高血压、糖尿病、冠心病、慢性阻塞性肺疾病、慢性肾脏病、卒中、外周血管疾病）以及多重用药情况〕、实验室检查结果〔白细胞计数、血红蛋白、血小板计数、丙氨酸氨基转移酶、血肌酐、糖化血红蛋白、空腹血糖、总胆固醇、三酰甘油、超敏C反应蛋白（hs-CRP）、血清铁、清蛋白、前清蛋白〕及超声心动图指标〔左心室射血分数（LVEF）、左心房内径、左心室舒张末内径、右心室内径、E/A〕，采用日常生活活动能力（ADL）量表及工具性日常生活活动能力（IADL）量表评估患者日常生活活动能力，营养风险筛查量表（NRS2002）评估营养风险，同时服用5种及以上药物者定义为多重用药，采用查尔森合并症指数公式计算患者的共病指数。采用多因素Logistic回归分析探讨老年HFpEF患者合并衰弱的影响因素。结果　衰弱组年龄、多重用药比例、查尔森合并症指数高于非衰弱组，ADL评分、IADL评分、清蛋白水平低于非衰弱组，左心房内径大于非衰弱组（P<0.05）。多因素Logistic回归分析结果显示，年龄和多重用药是老年HFpEF患者合并衰弱的影响因素（P<0.05）。结论　老年HFpEF患者合并衰弱的发生率为32.6%，年龄、多重用药是老年HFpEF患者合并衰弱的影响因素。

关键词: 心力衰竭, 老年人, 衰弱, 影响因素分析