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-东南大学学报医学版

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

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.

参考文献：

[1] 张运,张澄,徐铭俊,等.努力实现心血管疾病风险的精准预测[J].中华心血管病杂志,2021,49(9):851-855.
[2] 张新卉,谷雨萌,王仲言,等.三甲医院和社区医院老年慢性病共病现状调查[J].临床荟萃,2021,36(1):39-43.
[3] ZHAO D,LIU J,WANG M,et al.Epidemiology of cardiovascular disease in China:current features and implications[J].Nat Rev Cardiol,2019,16(4):203-212.
[4] 殷琪,何扬利,孙翠芳,等.多维度综合诊疗方案在老年慢性病治疗中的应用[J].中国老年学杂志,2021,41(5):1031-1033.
[5] 王丽娜,姜春燕.老年综合评估的临床应用进展[J].中国全科医学,2019,22(9):999-1003.
[6] 徐海红,王永利,闫巍.老年衰弱共病患者:紧密医联体模式下全科医学面临的挑战与应对策略[J].中国全科医学,2021,24(24):3026-3031.
[7] 唐钧.世界和中国的人口老龄化及其原因[J].社会政策研究,2022(3):3-18.
[8] 陈旭娇,严静,王建业,等.老年综合评估技术应用中国专家共识[J].中华老年医学杂志,2017,36(5):471-477.
[9] WANG Y,ZHANG J F,CHEN S Z,et al.ACC/AHA risk score for predicting the presence and severity of coronary artery disease in a Chinese population:a cross-sectional study[J].Chinese Medical Journal,2020,133(22):2753-2755.
[10] 李静,范利,华琦,等.中国老年高血压管理指南2019[J].中国心血管杂志,2019,24(1):1-23.
[11] 邓明群,潘琦,肖新华,等.《中国老年糖尿病诊疗指南(2021 年版)》解读[J].中华内科杂志,2021,60(11):954-959.
[12] 蒋端,李静.多重用药对冠心病患者发生氯吡格雷抵抗的影响研究[J].中国全科医学,2019,22(30):3709-3713.
[13] 孙至佳,樊俊宁,余灿清,等.中国10个地区成年人共病流行特征分析[J].中华流行病学杂志,2021,42(5):755-762.
[14] 王雪辉,彭聪.我国老年人口群体特征的变动趋势研究[J].人口与社会,2020,36(4):29-45.
[15] 胡世莲,王静,程翠,等.中国居民慢性病的流行病学趋势分析[J].中国临床保健杂志,2020,23(3):289-294.
[16] ROSENBLIT P D.Extreme atherosclerotic cardiovascular disease(ASCVD) risk recognition[J].Current Diabetes Reports,2019,19(8):61.
[17] VOLGMANA S,PALANIAPPAN L S,AGGARWAL N T,et al.Atherosclerotic cardiovascular disease in South Asians in the United States:epidemiology,risk factors,and treatments:a scientific statement from the American Heart Association[J].Circulation,2018,138(1):e1-e34.
[18] MICHAEL E W,FERNANDO R,SASKIA S,et al.Validation of an integrated risk tool,including Polygenic Risk Score,for atherosclerotic cardiovascular disease in multiple ethnicities and ancestries[J].The American Journal of Cardiology,2021(148):157-164.
[19] DALTON J E,ROTHBERG M B,DAWSON N V,et al.Failure of traditional risk factors to adequately predict cardiovascular events in older populations[J].Am Geriatr Soc,2020,68(4):754-761.
[20] LIPSKA K J,KRUMHOLZ H,SOONES T,et al.Polypharmacy in the aging patient:a review of glycemic control in older adults with type 2 diabetes[J].JAMA,2016,315:1034-1045.
[21] 金锐,柳鑫,马力.高龄冠心病患者多重用药1例(续)[J].临床药物治疗杂志,2019,17(2):20-22.
[22] 郭立,姚淮芳.中医药治疗老年性冠状动脉粥样硬化性心脏病合并失眠[J].实用中医内科杂志,2015,29(9):64-65.
[23] 苏增锋,胡文彬.睡眠障碍与动脉粥样硬化的相关性研究进展[J].齐齐哈尔医学院学报,2020,41(5):602-604.
[24] 刘用,李蒙,刘佳,等.从血瘀论治冠心病合并抑郁的研究进展[J].中西医结合心脑血管病杂志,2022,20(1):62-64.
[25] 李浩,崔青扬,丁建东.冠心病合并抑郁症的研究进展[J].东南大学学报(医学版),2014,33(6):820-823.
[26] 钱琦,陈忠,马根山,等.血浆超敏C反应蛋白和补体因子H浓度与冠心病的关系研究[J].东南大学学报(医学版),2008,27(5):336-339.
[27] 王莎.高龄老人血糖波动的特征及CGMS评估参数的探讨[D].长沙:中南大学,2013.
[28] 杨春凤,刘文斌,马晓芬,等.社区糖尿病患者糖化血红蛋白影响因素分析[J].上海医药,2012,33(12):28-30.
[29] 徐辉,李玉华.65岁以上老年人体检血糖、血脂水平分析[J].医学食疗与健康,2020,18(18):173-175.
[30] 2019 American Geriatrics Society Beers Criteria Update Expert Panel.American Geriatrics Society 2019 Updated AGS Beers Criteria for potentially inappropriate medication use in older adults[J].J Am Geriatr Soc,2019,67(4):674-694.

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