老年慢性心力衰竭患者肌少症与衰弱和营养不良的相关性

Correlation of sarcopenia with frailty and malnutrition in older patients with chronic heart failure

中文关键词: 慢性心力衰竭    肌少症    患病率    衰弱    营养不良

英文关键词: chronic heart failuresarcopeniaprevalencefrailtymalnutrition

中文摘要:

      目的 调查老年慢性心力衰竭（CHF）患者肌少症患病率，探讨其与衰弱和营养不良的关系。方法 选取2022年4月至2025年4月邢台市中心医院重症医学科收治的235例老年CHF患者，将患者分为肌少症组（n=54）和非肌少症组（n=181）。比较2组患者的年龄、性别、体重指数（BMI）、基础疾病（高血压、糖尿病）、CHF病因（缺血性、非缺血性）、纽约心脏病协会（NYHA）心功能分级、左室射血分数（LVEF）等临床资料。使用FRAIL衰弱表型量表、《老年人营养不良风险评估》量表评估患者的衰弱状况和营养状况。通过Pearson相关分析探讨肌少症与衰弱、营养不良之间的相关性;多因素Logistic回归模型分析老年CHF患者发生肌少症的影响因素。结果 235例老年CHF患者年龄60～83岁，平均年龄（69.96±8.54）岁，其中男性124例、女性111例，肌少症患病率为22.98%（54/235）。与非肌少症组相比，肌少症组年龄较大，BMI、LVEF、四肢骨骼肌质量指数（ASMI）、握力、步速及营养状况评分较低，FRAIL衰弱表型量表评分较高，差异有统计学意义（P <0.05）。235例老年CHF患者中衰弱50例（21.28%），营养不良46例（19.57%）。与非肌少症组相比，肌少症组衰弱发生率较高（17.68%比33.33%，χ²=6.085,P=0.014），营养不良发生率较高（16.02%比31.48%，χ²=6.314,P=0.012）。Pearson相关性分析显示，FRAIL衰弱表型量表评分与ASMI（r=-0.302,P <0.001）、握力（r=-0.211,P=0.015）、步速（r=-0.258,P=0.007）均呈负相关，营养状况评分与ASMI（r=0.335,P <0.001）、握力（r=0.229,P=0.010）、步速（r=0.241,P=0.008）均呈正相关。多因素Logistic回归分析显示，增龄[比值比（OR）=2.189,95%置信区间（CI）:1.325～3.615),P=0.002]、FRAIL衰弱表型量表评分高（OR=2.512,95%CI:1.260～5.008,P=0.009）均是老年CHF患者发生肌少症的独立危险因素，LVEF高（OR=0.340,95%CI:0.176～0.658,P=0.001）、营养状况评分高（OR=0.267,95%CI:0.127～0.561,P <0.001）为其独立保护因素。结论 老年CHF患者发生肌少症的风险较高，年龄、FRAIL衰弱表型量表评分、LVEF及营养状况评分均为老年CHF患者发生肌少症的独立影响因素，且衰弱、营养不良与肌少症的发生密切相关。

英文摘要:

      Objective To investigate the prevalence of sarcopenia in older patients with chronic heart failure(CHF)and to explore its relationship with frailty and malnutrition.Methods A total of 235 older patients with CHF admitted to Department of Critical Care Medicine of Central Hospital of Xingtai from April 2022 to April 2025 were enrolled and divided into a sarcopenia group(n=54)and a non-sarcopenia group(n=181).Clinical data including age,gender,body mass index(BMI),underlying diseases(hypertension,diabetes),etiology of CHF(ischemic,non-ischemic),New York Heart Association(NYHA)cardiac function classification,and left ventricular ejection fraction(LVEF)were compared between the two groups.The FRAIL frailty phenotype scale and elderly malnutrition risk assessment scale were used to assess frailty status and nutritional status.Pearson correlation analysis was used to explore the correlations of sarcopenia with frailty and malnutrition.A multivariate Logistic regression model was used to analyze the influencing factors for sarcopenia in older patients with CHF.Results The 235 older patients with CHF were aged 60-83 years,with a mean age of(69.96±8.54)years;there were 124 males and 111 females,and the prevalence of sarcopenia was 22.98%(54/235).Compared with the non-sarcopenia group,the sarcopenia group was older and had lower BMI,LVEF,appendicular skeletal muscle mass index(ASMI),grip strength,walking speed,and nutritional status score,and a higher frailty score,with statistically significant differences(P＜0.05).Among the 235 older patients with CHF,50(21.28%)had frailty and 46(19.57%)had malnutrition.Compared with the non-sarcopenia group,the sarcopenia group had a higher incidence of frailty(17.68%vs.33.33%,x2=6.085,P=0.014)and a higher incidence of malnutrition(16.02%vs.31.48%,x2=6.314,P=0.012).Pearson correlation analysis showed that the frailty score was negatively correlated with ASMI(r=-0.302,P＜0.001),grip strength(r=-0.211,P=0.015),and walking speed(r=-0.258,P=0.007),while the nutritional status score was positively correlated with ASMI(r=0.335,P＜0.001),grip strength(r=0.229,P=0.010),and walking speed(r=0.241,P=0.008).Multivariate Logistic regression analysis showed that older age[odds ratio(OR)=2.189,95%confidence interval(CI):1.325-3.615,P=0.002]and a higher FRAIL phenotype scale score(OR=2.512,95%CI:1.260-5.008,P=0.009)were independent risk factors for sarcopenia in older patients with CHF,while a higher LVEF(OR=0.340,95%CI:0.176-0.658,P=0.001)and a higher nutritional status score(OR=0.267,95%CI:0.267-0.561,P＜0.001)were independent protective factors.Conclusion Older patients with CHF have a relatively high risk of sarcopenia.Age,FRAIL phenotype scale score,LVEF,and nutritional status scale are all independent influencing factors for sarcopenia in this population.Frailty and malnutrition are also closely associated with the occurrence of sarcopenia.