摘要
目的探讨高敏肌钙蛋白T(hs-cTnT)对非急性冠脉综合征(ACS)老年住院衰弱及衰弱前期患者预后的影响。方法选择2017年1月至2019年12月于首都医科大学附属复兴医院综合老年科收住院的经Fried量表评估为衰弱及衰弱前期患者。检测患者的hs-cTnT水平,记录患者的一般资料、实验室检查指标及超声心动指标,出院后每3个月进行电话随访,记录患者的全因死亡情况。根据hs-cTnT三分位数将患者分为低值组、中值组和高值组,采用乘积极限(Kaplan-Meier)法(K-M曲线)比较3组患者生存曲线的差异,采用Cox回归模型分析hs-cTnT三分位分组对患者死亡风险的影响。采用SPSS 18.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、方差分析、Wilcoxon检验及χ^(2)检验。结果本研究共纳入衰弱及衰弱前期老年住院患者450例,其中72.4%(326/450)患者hs-cTnT超过切点值0.014μg/L。低值组、中值组和高值组年龄[(83.67±5.72)和(86.06±4.93)和(87.67±5.23)岁]、男性患者[62(41.3%)和94(62.7%)和108(72.0%)]、慢性心力衰竭患者[(4(2.7%)和5(3.3%)和22(14.7%)]、高血压患者[(116(77.3%)和119(79.3%)和133(88.7%)]、心律失常患者[41(27.3%)和38(25.3%)和60(40.0%)]、慢性肾脏病患者[27(18.0%)和38(25.3%)和61(40.7%)]、共病(≥4种共病)患者[72(48.0%)和73(48.7%)和99(66.0%)]、血红蛋白[(125.11±16.03)和(121.50±18.08)和(115.38±16.97)g/L]、肾小球滤过率[(87.91±30.74)和(76.73±23.08)和(66.69±27.80)ml/(min·1.73m^(2))]、白蛋白[(38.15±3.81)和(37.60±3.98)和(36.04±4.41)g/L]、总胆固醇[(4.01±0.98)和(3.62±0.88)和(3.70±0.85)mmol/L]、低密度脂蛋白胆固醇[(2.42±0.88)和(2.05±0.73)和(2.19±0.77)mmol/L]、N末端B型钠利尿肽前体[163.5(104.8,398.9)和314.7(171.4,683.8)和547.3(288.3,1568.3)pg/ml]、室间隔厚度[(11.30±0.83)和(11.42±0.79)和(11.71±1.07)mm]、左室后壁厚度[(11.31±0.83)和(11.46±0.75)和(11.65±0.83)mm]、左室质量指数[(107.38±13.32)和(109.90±13.86)和(112.72±19.29)g/m^(2)]及左室射血分数[(60.65%±2.97%)和(59.58%±3.91%)和(58.54%±5.08%)]比较,差异均有统计学意义(均P<0.05)。Cox回归模型分析显示,校正性别、年龄、合并疾病、化验指标及超声心动指标后,高值组患者死亡风险较低值组明显增高(HR=3.133,95%CI 1.381~7.109;P<0.01);生存曲线显示,低值组、中值组和高值组中位生存时间估计值分别为53、51和48个月,在出院后10~20个月后高值组生存率明显低于低值组和中值组;在出院后20~30个月后,高值组、中值组患者生存率明显低于低值组,生存曲线Log-Rank检验显示生存率差异有统计学意义(P<0.001)。结论本研究结果显示,无ACS老年衰弱及衰弱前期住院患者,hs-cTnT水平高,高于切点值的比例高,hs-TnT高值组患者死亡风险明显增加,不同水平hs-cTnT升高均会对患者全因死亡产生不良影响,hs-TnT水平越高对死亡风险的影响越明显。
Objective To explore the influence of high-sensitivity cardiac troponin T(hs-cTnT)on the prognosis of frail and pre-frail elderly hospitalized patients without acute coronary syndrome(ACS).Methods The elderly patients who were admitted to our department and identified as frailty or pre-frailty by Fried Frailty Phenotype assessment from January 2017 to December 2019 were enrolled in this study.Their hs-cTnT level,general information,laboratory indicators and echocardiographic indicators were recorded.Follow-up was conducted each three months through phone call after discharge and all-cause deaths of the patients were observed.These patients were divided into low-,median-,and high-value groups according to hs-cTnT tertiles.The survival curves of the three groups were compared using Kaplan-Meier method(K-M curve).Cox proportional hazard-regression model was used to analyze the effect of 3 hs-cTnT groups on the risk of death.SPSS statistics 18.0 was used for statistical analysis.Data comparison between two groups was perfomed using t test,Fisher exact test,Wilcoxon test orχ^(2)test depending on data type.Results A total of 450 frail and pre-frail elderly inpatients were subjected in this study,72.4%(326/450)of them had hs-cTnT levels exceeding the cut-off value of 0.014μg/L.There were significant differences in age[(83.67±5.72)vs(86.06±4.93)vs(87.67±5.23)years],male ratio[62(41.3%)vs 94(62.7%)vs 108(72.0%)],chronic heart failure ratio[4(2.7%)vs 5(3.3%)vs 22(14.7%)],hypertension ratio[116(77.3%)vs 119(79.3%)vs 133(88.7%)],arrhythmia ratio[41(27.3%)vs 38(25.3%)vs 60(40.0%)],chronic kidney disease ratio[27(18.0%)vs 38(25.3%)vs 61(40.7%)],comorbid conditions[≥4,72(48.0%)vs 73(48.7%)vs 99(66.0%)],hemoglobin level[(125.11±16.03)vs(121.50±18.08)vs(115.38±16.97)g/L],estimated glomerular filtration rate[(87.91±30.74)vs(76.73±23.08)vs(66.69±27.80)ml/(min·1.73m^(2))],albumin level[(38.15±3.81)vs(37.60±3.98)vs(36.04±4.41)g/L],total cholesterol level[(4.01±0.98)vs(3.62±0.88)vs(3.70±0.85)mmol/L],low-density lipoprotein cholesterol level[(2.42±0.88)vs(2.05±0.73)vs(2.19±0.77)mmol/L],N-terminal pro-brain natriuretic peptide level[163.5(104.8,398.9)vs 314.7(171.4,683.8)vs 547.3(288.3,1568.3)pg/ml],interventricular septal thickness[(11.30±0.83)vs(11.42±0.79)vs(11.71±1.07)mm],left ventricular post-wall depth[(11.31±0.83)vs(11.46±0.75)vs(11.65±0.83)mm],left ventricular mass index[(107.38±13.32)vs(109.90±13.86)vs(112.72±19.29)g/m^(2)]and left ventricular ejection fraction[(60.65±2.97)%vs(59.58±3.91)%vs(58.54±5.08)%]among 3 groups(all P<0.05).Cox regression model analysis showed that after adjustment for gender,age,comorbidities,laboratory indicators and echocardiographic indicators,the mortality risk was significantly higher in the patients of the high-value group than those in the low-value group(HR=3.133,95%CI 1.381-7.109,P<0.01).Survival curve analysis indicated that median survival time was estimated at 53,51 and 48 months in the low-,median-and high-value groups,respectively.And in 10-20 months after discharge,the survival rate of the high-value group was significantly lower than that of the other two groups,and even in 20-30 months after discharge,the rate of the high-value group and the median-value group was obviously lower than that of the low-value group.Log-Rank test showed that the survival rates of the three groups was significantly different(P<0.001).Conclusion For the frail and pre-frail elderly inpatients without ACS,higher hs-cTnT level,higher than the cut-off value,indicates higher risk of death.The increment exerts adverse effect on all-cause death,with the higher the level,the higher risk of death.
作者
张少景
王青
崔云婧
杨卉
符琳琳
Zhang Shaojing;Wang Qing;Cui Yunjing;Yang Hui;Fu Linlin(Department of Geriatrics,Fuxing Hospital Affiliated to Capital Medical University,Beijing 100038,China)
出处
《中华老年多器官疾病杂志》
2023年第2期97-102,共6页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
首都医学发展科研基金(2016-2-7012)
首都医科大学附属复兴医院科研培育基金(PY-Q-202205)。
关键词
老年人
高敏肌钙蛋白T
衰弱
住院患者
预后
aged
high-sensitivity cardiac troponin T
frailty
inpatients
prognosis
