老年脑梗死患者衰弱相关血清学标记物的研究

摘要

目的 探讨老年脑梗死患者衰弱相关血清学标记物,判断其对衰弱的诊断价值. 方法 连续纳入老年科住院的≥65岁老年脑梗死患者114例,根据Fried表型定义分为衰弱及无衰弱组,再根据临床衰弱量表将衰弱组分为轻度、中度及重度衰弱组.分析衰弱和无衰弱组合并慢性病、老年综合征患病率及血清学指标差异,对与衰弱相关的血清学指标绘制受试者工作特征曲线(ROC) . 结果 老年脑梗死患者衰弱组78例(68.4%) ,衰弱组脑梗死合并高血压、心绞痛、心肌梗死、心力衰竭、慢性肾脏疾病、恶性肿瘤的患病率(88.5%、53.8%、32.1%、34.6%、28.2%、24.4%)较无衰弱组(69.4%、27.8%、8.3%、13.9%、11.1%、8.3%)明显升高(χ2＝6.158 、6.747 、7.478 、5.241 、4.088 、4.062 ,均 P＜0.05) .衰弱组营养不良、跌倒发生率分别为28.2%(22/78) 、29.5%(23/78) ,明显高于无衰弱组患者0.0%(0/36) 、2.8%(1/36 ) (χ2＝ 12.582 、10.572 ,均 P＜ 0.05 ) .衰弱组血清血红蛋白(115.1 ± 19.7)g/L 、低密度脂蛋白胆固醇(LDL-C)(2.5 ± 0.9)mmol/L 、白蛋白(35.3 ± 4.3)mg/L水平较无衰弱组[(135.8 ± 11.7)g/L、(3.1 ± 0.7)mmol/L、(37.9 ± 2.3)mg/L]明显下降(t＝ －4.918、－2.536、－3.036 ,均 P＜0.05) ,衰弱组血清超敏 C反应蛋白(hs-CRP)(10.8 ± 14.3)mg/L 、D-二聚体(494.2 ± 412.9)μg/L 、B型钠尿肽(BNP)(458.0 ± 324.4)ng/L 水平较无衰弱组[(3.1 ± 2.9)mg/L 、(256.4 ± 221.5)μg/L 、(88.3 ± 68.4)ng/L]明显升高(t＝ 3.266 、2.735 、6.838 ,均 P＜ 0.05).其中血红蛋白、LDL-C 、BNP的ROC曲线下面积超过0.75 . 结论 老年脑梗死患者衰弱相关的血清学标记物有血红蛋白、LDL-C 、白蛋白、hs-CRP 、D-二聚体、BNP ,以血红蛋白、LDL-C 、BNP的诊断价值较高.%Objective To investigate the frailty-related serum markers in elderly patients with cerebral infarction and to determine their diagnostic value for frailty. Methods A hundred and fourteen inpatients aged 65 years and over were continuously recruited from department of geriatrics. Participants were assigned into a frailty group and a non-frailty group according to the Fried Frailty Criteria. The frailty group was further divided into mild ,moderate ,and severe feeble groups according to the clinical frailty scales.We analyzed the differences in serum indexes ,the prevalence and incidence of chronic complications and geriatric syndrome between the frailty group and non-frailty group. The ROC curves of frailty-related serum indexes were drawn and the optimal cut-off points were determined. Finally ,the area under ROC curves were calculated and compared. Results A total of 114 elderly patients with cerebral infarction were divided into a frailty group (78/114 ,68.4%)and a non-frailty group (36/114 ,31.6%).Seventy-eight patients (68.4%)in the frailty group had senile cerebral infarction. The prevalence of cerebral infarction combined with hypertension (88.5%) ,angina (53.8%) ,myocardial infarction (32.1%) ,heart failure (34.6%) ,chronic renal disease (28.2%) ,and malignant tumor (24.4%)was significantly higher in the frailty group than in the non-frailty group (69.4%,27.8%,8.3%,13.9%,11.1%,and 8.3%,respectively ;χ2＝ 6.158 ,6.747 ,7.478 ,5.241 , 4.088 ,4.062 ;all P＜0.05). The incidences of malnutrition and falling were significantly higher in the frailty group[28.2%(22/78)and 29.5%(23/78)]than in the non-frailty group[0.0%(0/36)and 2.8%(1/36) ,χ2＝12.582 ,10.572 ;all P＜0.05].Comparing the frailty with the non-frailty group ,the lower serum levels were found in HGB [(115.1 ± 19.7 )g/L vs. (135.8 ± 11.7 )g/L ] ,in LDL-C [(2.5 ± 0.9)mmol/L vs.(3.1± 0.7)mmol/L]and in ALB[(35.3 ± 4.3)g/L vs. (37.9 ± 2.3)g/L](t ＝－4.918 ,－2.536 ,－3.036 ;P＜0.05) ,while the higher serum levels were found in hs-CRP[(10.8 ± 14.3)mg/L vs.(3.1±2.9)mg/L],inD-Dimer[(494.2±412.9)μg/L ,vs.(256.4±221.5)μg/L],and in BNP[(458.0 ± 324.4)ng/L vs. (88.3 ± 68.4)ng/L](t ＝ 3.266 ,2.735 ,6.838 ;all P ＜ 0.05) . Furthermore ,the area under ROC curves of HGB , LDL-C and BNP were more than 0.75. Conclusions Serological markers related to frailty in elderly patients with cerebral infarction are HGB ,LDL-C ,ALB ,hs-CRP ,D-Dimer ,and BNP ,among which the diagnostic values of HGB , LDL-C and BNP are higher.