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老年综合评估在筛查高龄老年人群动脉粥样硬化性心血管疾病危险因素中应用的研究
作者:胡心仪1  顾一航2  顾静彧2  沙江明2  邵荣2  张恬2  吴晓2  江黎明2  王琳2  蒋文竹2  杨威2  缪健2  周湘云2  殷泉忠< 
单位:1. 南通大学 医学院, 江苏 南通 226001;
2. 南通大学附属江阴医院 全科医学科, 江苏 江阴 214400
关键词:老年综合评估 高龄老年 动脉粥样硬化性心血管疾病 危险因素 
分类号:R541.4; R543
出版年·卷·期(页码):2023·42·第六期(857-864)
摘要:

目的:利用老年综合评估(CGA)对医联体内高龄老年人群进行动脉粥样硬化性心血管疾病(ASCVD)相关危险因素分析。方法:连续选取2018年1月至2022年9月期间在南通大学附属江阴医院医疗集团医联体内部分全科医学单位就诊的老年患者,观察非高龄(≥65岁~<80岁)和高龄(≥80岁)人群的ASCVD发病率差异。以高龄老年人群为研究对象,将合并ASCVD的患者设为观察组,不合并ASCVD的患者设为对照组,进行CGA。采用二元 Logistic 回归分析对高龄人群ASCVD相关危险因素进行分析。结果:共纳入422例病例,高龄老年人群ASCVD发病率明显高于非高龄老年人群(P<0.05)。其中,238例高龄老年患者ASCVD的发病率为62.2%。单因素分析显示,高龄ASCVD组与高龄非ASCVD组间的性别、体重、体重指数、低密度脂蛋白胆固醇、血肌酐、糖化血红蛋白、高密度脂蛋白胆固醇、总胆固醇、共病数量、多重用药、吸烟史、失眠、日常活动能力、衰弱、认知功能以及抑郁等评估指标存在的差异有统计学意义(P<0.05),两组患者的年龄、身高、收缩压、舒张压、空腹血糖、三酰甘油、尿酸、尿素氮、婚姻状况、饮酒史、家族史、营养状况、平衡障碍以及焦虑等评估指标的差异无统计学意义(P>0.05)。Logistic 回归分析结果显示:男性、失眠、衰弱、抑郁、低密度脂蛋白胆固醇、多重用药是高龄人群ASCVD发病的危险因素(OR>1,P<0.05)。结论:利用CGA多维度筛查高龄ASCVD患者的危险因素,发现了失眠、衰弱、抑郁以及多重用药数量这些在高龄ASCVD患者中的非传统危险因素,在全科临床工作中应尽早对其进行干预,以最大限度地改善高龄ASCVD患者的生活质量。

Objective: To analyze the risk factors associated with atherosclerotic cardiovascular disease(ASCVD) in the advanced aged people using Comprehensive Geriatric Assessment(CGA). Methods: From January 2018 to September 2022,the advanced aged people from part of the general medical departments of Jiangyin People's Hospital of Nantong University were enrolled. The incidence rate of ASCVD in the ≥65—<80 years old and the≥80 years old was observed. Among the ≥80 years old, patients with ASCVD were divided as the observation group and those without ASCVD as the control group.They were surveyed by a suit of scales of CGA.Binary Logistic regression was used to identify risk factors of ASCVD. Results: A total of 422 subjects were included. The incidence rate of ASCVD in the≥80 years old was significantly higher than that in the ≥65—<80 years old(P<0.05). Among 238 patients(≥80 years old), the incidence rate of ASCVD was 62.2%. The results of univariate analysis showed that there were significant differences in gender, weight, body mass index(BMI), low density lipoprotein cholesterol(LDL-C), serum creatinine(Scr), glycosylated hemoglobin(HbA1c), total cholesterol(TC),high density lipoprotein cholesterol(HDL-C), multimorbidity, polypharmacy, smoking history, insomnia, ability of daily living(ADL), asthenia, dementia and depression(P<0.05). The age, height, systolic blood pressure(SBP),diastolic blood pressure(DBP), fasting blood glucose(FBG), triglyceride(TG), uric acid(UA), urea nitrogen(BUN), marital status, drinking history, family history, nutriture, balance function and anxiety showed no significant differences(P>0.05). Binary Logistic regression analysis showed that male, insomnia, asthenia, depression, LDL-C, and polypharmacy were the risk factors of ASCVD in the advanced aged patients(OR>1,P<0.05). Conclusion: Many non-traditional risk factors related to the onset of ASCVD, such as insomnia, asthenia, depression and polypharmacy, have been found in the advanced aged population that have been ignored in previous studies by using CGA tools. In general practice, it is necessary to intervene as soon as possible to improve the quality of life of the advanced aged ASCVD patients to the hilt.

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