躯体衰弱老年患者的中医体质特征与相关危险因素

Traditional Chinese medicine constitution characteristics and related risk factors of elderly patients with physicalfrailty

中文关键词: 老年  衰弱  躯体衰弱  中医体质

英文关键词: elderly  frailty  physical frailty  traditional Chinese medicine constitution

中文摘要:

      目的 观察躯体衰弱老年患者的中医体质分布情况及其相关危险因素.方法 采用横断面研究方法,对2022年7月—2023年7月间在复旦大学附属华东医院就诊且符合纳入标准的204例老年人进行躯体衰弱和中医体质评估,通过卡方检验判定躯体衰弱的主要中医体质.此外,收集受试者的基本资料和既往病史,并进行生化指标、骨密度和躯体功能检查,通过二元Logistic回归判定各主要中医体质的相关危险因素.结果 204例老年人中,无衰弱59例(28.9％),衰弱前期77例(37.7％),衰弱期68例(33.4％).3组受试者在生化指标和骨密度方面无明显差异(P＞0.05),而在年龄、泌尿系统病史、衰弱表型评分、握力、4米步行时长、定时端坐起立试验时长、简易体能状况量表评分方面均有显著差异(P＜0.001).躯体衰弱的主要中医体质分别是气虚质、痰湿质、血瘀质和气郁质(P＜0.001),其中男性[OR=1.90,95％CI(1.00～3.62),P=0.046]和髋部骨密度[OR=0.05,95％CI(0.00～0.93),P=0.040]下降是气虚质的危险因素,高密度脂蛋白水平[OR=0.35,95％CI(0.14,0.90),P=0.030]下降是痰湿质的危险因素,高血压[OR=2.33,95％CI(1.19～4.57),P=0.014]和空腹血糖[OR=1.62,95％CI(1.05,2.49),P=0.028]以及糖化血红蛋白[OR=2.16,95％CI(1.05,4.45),P=0.038]水平上升是血瘀质的危险因素,年龄[OR=1.05,95％CI(1.01～1.09),P=0.017]升高、心脑血管疾病[OR=2.08,95％CI(1.31～3.81),P=0.018]和股骨颈骨密度[OR=0.03,95％CI(0.01～0.71),P=0.030]下降是气郁质的危险因素.结论 躯体衰弱患者的主要中医体质类型是气虚质、痰湿质、血瘀质和气郁质,气虚质与男性和髋部骨密度下降有关,痰湿质与高密度脂蛋白水平降低有关,血瘀质与高血压、空腹血糖和糖化血红蛋白水平上升有关;气郁质与年龄升高、心脑血管疾病和股骨颈骨密度下降有关.

英文摘要:

      Objective To explore the traditional Chinese medicine(TCM)constitution characteristics and related risk factors of elderly patients with physical frailty.Methods A cross-sectional study was adopted.204 elderly patients who met the inclusion criteria and received medical treatment in Huadong Hospital Affiliated to Fudan University from July 2022 to July 2023 were evaluated for physical frailty and TCM constitution.The main TCM constitution of physical frailty was identified by Chi-square test.In addition,their basic data and past medical history were collected,and the biochemical indicators,bone min-eral density and physical function were examined.The risk factors of various major TCM constitutions were determined by binary logistic regression.Results Among the 204 elderly people,there were 59 cases(28.9％)without frailty,77 ones(37.7％)in the pre-frailty stage,and 68 ones(33.4％)in the frailty stage.There was no significant difference in biochemical indicators and bone mineral density among the three groups(P＞0.05),but there were significant differences in age,urinary system history,frailty phenotype score,grip strength,4-meter walking time,timed standing up test time and Simple Physical Status Scale score(P＜0.001).The main TCM constitutions associated with physical frailty were Qi-deficiency,Phlegm-dampness,Blood-stasis and Qi-stagnation(P＜0.001).Among them,male[OR=1.90,95％CI(1.00-3.62),P=0.046]and decreasedhip bone mineral density[OR=0.05,95％CI(0.00-0.93),P=0.040]were risk factors for Qi-deficiency;de-creased high-density lipoprotein[OR=0.35,95％CI(0.14,0.90),P=0.030]was risk factor for Phlegm-dampness;hyper-tension[OR=2.33,5％CI(1.19-4.57),P=0.014],increased fasting blood glucose[OR=1.62,95％CI(1.05,2.49),P=0.028]and increased glycated hemoglobin[OR=2.16,95％CI(1.05,4.45),P=0.038]were risk factors for Blood-stasis;age[OR=1.05,95％CI(1.01-1.09),P=0.017],cardiovascular and cerebrovascular diseases[OR=2.08,95％CI(1.31-3.81),P=0.018],and lower femoral neck bone density[OR=0.03,95％CI(0.01-0.71),P=0.030]were risk factors for Qi-depression.Conclusions The main TCM constitutions in elderly patients with physical frailty are Qi-deficiency,Phlegm-dampness,Blood-stasis and Qi-depression.Qi-deficiency is associated with male and decreased hip bone mineral densi-ty.Phlegm-dampness is associatedwithdecreased high-density lipoprotein levels.Blood-stasis is associated withhypertension and the increasedfasting blood glucose and glycated hemoglobin.Qi-depression is associated with age,cardiovascular and cerebro-vascular diseases and the decrease of femoral neck bone density.