老年慢性病多重用药患者衰弱发展轨迹与认知功能的相关性分析

Correlation analysis between debilitation development trajectory and cognitive function in elderly chronic disease patients with multiple drug use

中文关键词: 老年    多重用药    衰弱    认知功能

英文关键词: elderly  multidrug use  frailty  cognitive function

中文摘要:

      目的 探究老年慢性病多重用药患者的衰弱发展轨迹，并分析其与认知功能的相关性。方法 选取2022年3月至2023年2月医院收治的138例老年慢性病多重用药患者作为研究对象。依据组基轨迹建模（GBTM）分组准则确定衰弱发展轨迹类别。通过多因素Logistic回归分析确定衰弱轨迹的影响因素。采用Cox回归分析研究衰弱轨迹与认知障碍风险之间的关系。结果 基于GBTM分组选择依据及衰弱轨迹的基线水平和增长速度，识别出4种不同的衰弱发展轨迹，即低-稳定型、低-快速增长型、中-快速增长型和高-缓慢增长型。不同衰弱轨迹患者的年龄、共病数量、受教育水平、用药品种、自理能力、营养状况比较差异均有统计学意义（均P<0.05）;高-缓慢增长型患者中衰弱占比高于低-稳定型、低-快速增长型及中-快速增长型患者，无衰弱及衰弱前期占比低于其他3组（均P<0.001）。多因素Logistic回归分析结果显示，年龄、共病数量、用药品种、营养状况是老年慢性病多重用药患者衰弱轨迹的影响因素（P<0.05）。4组患者的时间定向力、地点定向力、注意力和计算力、延迟回忆、视空间评分及认知障碍发生率比较差异均有统计学意义（均P<0.05）,其中低-稳定型各项评分最高，认知障碍发生率最低。调整年龄、共病数量、用药品种、营养状况等因素后，Cox回归分析显示以低-稳定型为参照，低-快速增长型、中-快速增长型、高-缓慢增长型的HR（95%CI）均有统计学意义（均P<0.001）。亚组分析结果表明，在年龄>70岁、共病数量>2种、受教育水平为初中及以下、用药品种>8种、自理能力为中度依赖和重度依赖以及存在营养不良的亚组，衰弱轨迹与认知障碍风险存在相关性(均P_趋势<0.001)。结论 老年慢性病多重用药患者的衰弱状态与认知功能密切相关，年龄、共病数量、用药品种、营养状况是衰弱轨迹的影响因素。

英文摘要:

      Objective To explore the trajectory of frailty development in elderly chronic disease patients with multiple drug use,and analyze its correlation with cognitive function.Methods From March 2022 to February 2023,138 elderly patients with chronic diseases receiving multiple drug use in our hospital were selected as the study objects.According to the group based trajectory modeling(GBTM)grouping criteria,the group weakening development trajectory was determined.Multivariate Logistic regression analysis was used to determine the influencing factors of the decline trajectory.Cox regression analysis was used to analyze the relationship between the trajectory of decline and the risk of cognitive impairment in elderly patients with chronic disease polymedication.Results Based on the GBTM model group selection basis and the baseline level and growth rate of the debilitation trajectory,four different debilitation development trajectories were identified:"low-stable","low-fast growth","medium-fast growth"and"high-slow growth".The comparison of age,number of comorbidities,education level,drug varieties,self-care ability and nutritional status of patients with different frailty tracks had statistical significance(P<0.05).The frailty proportion of high-slow growth patients was higher than that of low-stable,low-fast growth and medium-fast growth patients,and the proportion of non-frailty and pre-frailty patients was lower than that of the other three groups(P<0.001).The results of multivariate Logistic regression analysis showed that age,number of comorbidities,drug varieties and nutritional status were the influencing factors for the debilitation trajectory of elderly patients with chronic diseases with multiple drugs(P<0.05).The four groups of patients had significant differences in time orientation,place orientation,attention and computation,delayed recall,visual spatial scores and the proportion of cognitive impairment.The low-stable scores were the highest,and the proportion of cognitive impairment was the lowest(P<0.05).After adjusting for confounding factors,Cox regression showed that the trend test of HR value(95%CI)of low-fast growth,medium-fast growth and high-slow growth were statistically significant(P<0.001),taking"low-stable"as the reference.Subgroup analysis showed that frailty trajectory was significantly correlated with the risk of cognitive impairment in subgroups with age>70 years,number of comorbidities>2,education level of junior high school or below,drug varieties>8,self-care ability moderate dependence and severe dependence,and malnutrition(Ptrend<0.001).Conclusion Age,number of comorbidities,drug varieties and nutritional status were the factors influencing the frailty trajectory of elderly patients with chronic disease multidrug use.