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1.
摘要:目的 调查武汉市某医院老年慢性阻塞性肺疾病(COPD)住院患者发生衰弱现状,并分析其影响因素。方法 采用便利抽样法选取2021年1月-2022年12月我院住院的260例老年COPD住院患者。采用自制一般资料问卷对患者开展调查;使用临床衰弱量表(Fried)对患者的衰弱状况进行评估;采用全自动血液分析仪对血红蛋白的水平进行检测;采用化学发光免疫法对25-羟基维生素D(25-OH-D)的水平进行检测;采用噶庖呶椒ǘ园紫赴樗�-6(IL-6)的水平进行检测;单因素及多因素Logistic回归分析影响老年COPD住院患者发生衰弱的因素。结果 本研究对武汉市某医院老年COPD住院患者一共发出260份调查问券,收回260份,有效率为100.00%。260例患者中,发生衰弱的有67例,发生率为25.77%(67/260);其中性别、年龄、吸烟、锻炼习惯、营养状态比较均有统计学意义(P<0.05);衰弱组患者的血红蛋白、25-OH-D水平显著低于未衰弱组,IL-6水平显著高于为衰弱组(P<0.05);根据Logistic回归分析得知性别(OR=3.174,95%CI:1.415-7.117)、年龄(OR=1.556,95%CI:1.049-2.307)、吸烟(OR=3.162,95%CI:1.337-7.476)、锻炼习惯(OR=1.735,95%CI:1.103-2.729)、血红蛋白低表达(OR=1.314,95%CI:1.014-1.701)、25-OH-D低表达(OR=1.974,95%CI:1.073-3.631)、IL-6高表达(OR=2.173,95%CI:1.198-3.943)是老年COPD住院患者发生衰弱的危险因素(P<0.05)。结论 武汉市某医院老年COPD住院患者发生衰弱的发生率较高,性别、年龄、吸烟、锻炼习惯、营养状态、血红蛋白、25-OH-D、IL-6水平均有影响,临床上应进行合理的干预,从而减少衰弱的发生。  相似文献   

2.
An elevated white blood cell (WBC) count and elevated C-reactive protein (CRP) have been associated with an increased risk of adverse cardiac events. The relation between these 2 parameters of heightened systemic inflammation was characterized in patients who underwent percutaneous coronary intervention (PCI). Femoral arterial blood samples from a prospective registry of 100 patients who underwent PCI were obtained immediately before the procedure. The concentrations of CRP and interleukin-6 were determined by an enzyme-linked immunosorbent assay. Patients were stratified according to tertiles of ascending WBC counts before PCI. Univariate analysis compared patients in the highest WBC count tertile with the lower tertiles for clinical, angiographic, and procedural characteristics, as well as pre-PCI cytokine concentrations. Multiple logistic regression analysis was performed to examine the association between the elevated WBC count and baseline elevations in either CRP or interleukin-6, accounting for the simultaneous effect of confounding characteristics. Approximately 75% of patients had stable or unstable angina pectoris versus a marker-positive acute coronary syndrome. Patients in the highest WBC count tertile were more likely to be smokers, have received unfractionated heparin, have a marker-positive acute coronary syndrome, and have a CRP >3.0 mg/L. Multivariate analysis showed that only elevated troponin-I before PCI was independently associated with the highest WBC count tertile (odds ratio 10.9, 95% confidence interval 3.7 to 32.4, p < 0.01). In patients with negative troponin I findings, CRP >3.0 mg/L was a powerful independent predictor of an elevated pre-PCI WBC count (odds ratio 3.78, 95% confidence interval 1.07 to 13.3, p = 0.04). In conclusion, in patients with troponin I negative coronary syndromes, a pre-PCI elevation in the WBC count reflected cytokine-mediated inflammation.  相似文献   

3.
PURPOSE: White blood cell (WBC) count is a marker of inflammation and has been associated with the development of cardiovascular disease. We investigated the relationship between WBC counts and the incidence of ischemic cerebrovascular disease in a large cohort of patients with pre-existing atherothrombotic disease and defined blood lipid boundaries. SUBJECTS AND METHODS: We followed up patients with documented coronary heart disease for 4.8 to 8.1 years. An extensive medical evaluation, conducted at baseline, included assessment of vascular risk factors and measures of blood lipids. Among 5435 patients with WBC counts, free of stroke, 295 developed an ischemic cerebrovascular disease (fatal and nonfatal). After review of available medical records, 186 of these cases had ischemic stroke or TIA. RESULTS: Higher WBC counts were associated with increased risk for ischemic cerebrovascular disease. Age-adjusted hazard ratio (HR) was 1.55 with 95% confidence interval (CI) 1.16-2.07, upper WBC tertile compared with the lowest. Adjusting for clinical covariates, WBC count remained an independent predictor for ischemic cerebrovascular disease (HR = 1.39; 95% CI 1.03-1.87, upper WBC tertile compared with the lowest). A similar trend appeared for the endpoint of ischemic stroke/transient ischemic attack (TIA). Further adjustment for plasma fibrinogen did not change the association materially (HR = 1.32; 95% CI 1.01-1.80; upper tertile of WBC compared with lowest). CONCLUSIONS: These findings support the role of WBC count as a simple inexpensive and readily available marker for risk stratification of ischemic cerebrovascular disease among patients with pre-existing atherothrombotic disease and defined blood lipid boundaries.  相似文献   

4.
OBJECTIVES: Overweight (body mass index (BMI)>25) and obesity (BMI>30) are associated with adverse outcomes in the general population. In older people, an increased risk of adverse events was observed in leaner and overweight older subjects. We evaluated the association between BMI and cardiac surgery complications in subjects aged 75 and older. DESIGN: Retrospective review of complication rates compiled as part of the New York State Department of Health Adult Cardiac Surgery Report. SETTING: Academic tertiary care medical center. PARTICIPANTS: One thousand four hundred forty-eight subjects aged 75 and older who underwent cardiac surgery in an academic hospital between 1991 and 1999.MEASUREMENTS: Subjects were divided into tertiles based on their BMI. Logistic regression was used in multivariate analyses examining the association between tertiles of BMI (<23, 23-26,>26) and complications from cardiac surgery, adjusting for age and gender or using a full model adjusting for history of diabetes mellitus, hypertension, myocardial infarction (MI), congestive heart failure, smoking, chronic obstructive pulmonary disease, peripheral vascular disease, renal disease, surgical priority, age, and gender. RESULTS: Mean age was 79 (range 75-94); 58% of the subjects were male. The incidence of any postoperative complication, respiratory failure, or death was U-shaped, with higher incidence in the first tertile of BMI, followed by the last tertile and then the middle tertile. Subjects in the lowest tertile of BMI in the full model had a higher adjusted risk of stroke (odds ratio (OR) = 1.58, 95% confidence interval (CI) = 0.96-2.59), bleeding (OR = 1.71, 95% CI = 0.79-3.67), respiratory failure (OR = 1.65, 95%CI = 0.95-2.87), cardiovascular complications (stroke, MI, arrhythmia) (OR = 1.59, 95% CI = 0.93-2.73), and all complications (OR = 1.45, 95% CI = 1.05-2.00) than subjects in the middle tertile. The risk of most complications in subjects in the highest tertile of BMI was similar to that of subjects in the middle tertile except for wound infections (OR = 3.51, 95% CI = 0.92-13.33). The risk of death was higher in subjects in the lower tertile of BMI (OR = 1.97, 95% CI = 1.12-3.44) than in subjects in the middle tertile. The association between BMI and adverse cardiac surgical outcomes was stronger in men than women and decreased with advancing age. CONCLUSIONS: In the geriatric population, subjects with lower BMI have a higher risk of complications and death from cardiovascular surgery than subjects with higher BMI. An increased BMI does not increase the risk of complications from cardiovascular surgery, with the exception of wound infections.  相似文献   

5.
There is a growing body of evidence indicating that high triglyceride levels are an independent risk factor for cardiovascular disease (CVD) events. In this study we compared the association of fasting levels of non-high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, HDL cholesterol, and triglycerides with white blood cell (WBC) count, an inflammatory marker associated with an adverse CVD prognosis. We studied 458 asymptomatic men (46.0 +/- 7.0 years old) who presented for CVD risk stratification. WBC count (x10(9) cells/L) increased significantly across increasing tertiles of triglyceride level (tertile 1, 6.04 +/- 1.49; tertile 2 6.21 +/- 1.44; tertile 3 6.78 +/- 1.73, p <0.0001), whereas a trend of lower WBC counts was observed across increasing tertiles of HDL cholesterol (tertile 1, 6.52 +/- 1.62; tertile 2, 6.24 +/- 1.50; tertile 3, 6.21 +/- 1.61, p = 0.08). In models adjusted for age, gender, and CVD risk factor, the odds ratio for a high WBC count (quartile > or =4 vs lower 3 quartiles) was significantly higher with increasing levels of triglyceride (2.4, 95% confidence interval 1.3 to 4.8, p = 0.02). When all lipid variables were introduced in the models in addition to traditional CVD risk factors, the association between plasma triglyceride level and WBC count persisted (p = 0.04), which was not found for other lipid parameters. In conclusion, in our study, only plasma triglyceride level was independently associated with a higher WBC count.  相似文献   

6.
Despite the documented health benefits of physical activity, the mechanism whereby physical activity prevents cardiovascular disease is incompletely understood. In the present study, we investigated the relationship between white blood cell (WBC) count and cardiorespiratory fitness (V o(2)max) after adjusting for several well-known cardiovascular risk factors. Subjects who visited our health promotion center for a medical checkup and treadmill test (n=8241; age: median, 48 years; range, 16-79 years) were classified into 3 groups based on their WBC counts (group 1, 2200-5300 microL, n=2823; group 2, 5301-6500 microL, n=2709; group 3, 6501-10000 microL, n=2709). After adjusting for age, body mass index, body fat percentage, smoking history, systolic blood pressure, diastolic blood pressure, serum lipid profile, and fasting plasma glucose, V o(2)max still showed a significant association with WBC count (partial r=-0.11, P<.001). In logistic regression analyses, subjects in the highest WBC tertile showed lower V o(2)max compared with those in the lowest WBC tertile after adjusting for age and cardiovascular risk factors (odds ratio, 0.42; 95% confidence interval, 0.36-0.49 for the highest V o(2)max tertile). These results suggest that a WBC count in the normal concentration range is independently related to cardiorespiratory fitness in Korean men.  相似文献   

7.
OBJECTIVES: To explore the effect of serum uric acid level on subsequent all-cause mortality in high-functioning community-dwelling older persons. It is controversial whether high serum uric acid level is a true independent risk factor for cardiovascular and total mortality or the association is due to other confounding variables. Furthermore, it remains unclear whether the predictive value of uric acid level on mortality observed in younger cohorts can be extended to older people. DESIGN: Prospective cohort study. SETTING: A sample of community-dwelling older people. PARTICIPANTS: A cohort of 870 participants from the MacArthur Studies of Successful Aging. MEASUREMENTS: Baseline information was obtained for serum uric acid level, C-reactive protein (CRP), interleukin-6 (IL-6), prevalent medical conditions, and health behaviors. Crude and multivariate logistic regression analyses were used to examine the association between serum uric acid levels and 7-year all-cause mortality, while adjusting for potential confounders. RESULTS: In men, the multiply adjusted risk ratios for 7-year total mortality were 1.07 (95% CI=0.61-1.88) for the mid tertile of uric acid level and 1.24 (95% CI=0.70-2.20) for the top tertile. In women, the multiply adjusted risk ratios were 0.58 (95% CI=0.29-1.18) and 0.47 (95% CI=0.22-0.99), for the mid and top tertiles respectively. CRP and IL-6 were important confounders in the relationship between serum uric acid and overall mortality. CONCLUSIONS: High serum uric acid level is not independently associated with increased total mortality in high-functioning older men and women. When evaluating the association between serum uric acid and mortality, the potential confounding effect of underlying inflammation and other risk factors must be considered.  相似文献   

8.
OBJECTIVES: To test whether accelerated sarcopenia in older persons with high interleukin (IL)-6 serum levels plays a role in the prospective association between inflammation and disability found in many studies. DESIGN: Cohort study of older women with moderate to severe disability. PARTICIPANTS: Six hundred twenty older women from the Women's Health and Aging Study in whom information on baseline IL-6 serum level was available. MEASUREMENTS: Self-report of functional status, objective measures of walking performance, and knee extensor strength were assessed at baseline and over six semiannual follow-up visits. Potential confounders were baseline age, race, body mass index, smoking, depression, and medical conditions. RESULTS: At baseline, women with high IL-6 were more often disabled and had lower walking speed. After adjusting for confounders, women in the highest IL-6 tertile (IL-6>3.10 pg/mL) were at higher risk of developing incident mobility disability (risk ratio (RR) = 1.50, 95% confidence interval (CI) = 1.01-2.27), disability in activities of daily living (RR = 1.41, 95% CI = 1.01-1.98), and severe limitation in walking (RR = 1.61, 95% CI = 1.09-2.38) and experienced steeper declines in walking speed (P <.001) than women in the lowest IL-6 tertile (IL-6 < or =1.78 pg/mL). Decline in knee extensor strength was also steeper, but differences across IL-6 tertiles were not significant. After adjusting for change over time in knee extensor strength, the association between high IL-6 and accelerated decline of physical function was no longer statistically significant. CONCLUSIONS: Older women with high IL-6 serum levels have a higher risk of developing physical disability and experience a steeper decline in walking ability than those with lower levels, which are partially explained by a parallel decline in muscle strength.  相似文献   

9.
BACKGROUND: The association of white blood cell (WBC) count with all-cause and cardiovascular disease (CVD) mortality were examined in the National Integrated Project for Prospective Observation of Non-communicable Disease and Its Trends in the Aged (NIPPON DATA) 90. METHODS AND RESULTS: A total of 6,756 Japanese residents (2,773 men and 3,983 women) throughout Japan without a history of CVD were followed for 9.6 years. A Cox proportional hazards regression model was used to estimate the relative risk (RR) and 95% confidence interval (CI). We documented 576 deaths with 161 deaths from CVD. Overall, after adjusting for several confounders including age, sex, body mass index at baseline, smoking status, alcohol consumption, regular exercise, diastlic blood pressure, total cholesterol, high-density lipoprotein-cholesterol and hemoglobin A1c, a graded association between WBC count and higher risk of all-cause mortality was observed (WBC of 9,000-10,000 cells/mm(3) vs WBC of 4,000-4,900: RR =1.61, 95% CI: 1.07-2.40, p for trend =0.02). Elevated WBC count was almost significantly associated with high risk of CVD mortality (WBC of 9,000-10,000 vs WBC of 4,000-4,900: RR =1.79, 95% CI: 0.97-3.71). These associations strengthened among women. Stratified by smoking status, never-smokers with WBC counts of 9,000-10,000 had a 3.2 fold elevated risk for CVD death compared with those with WBC counts of 4,000-4,900. CONCLUSIONS: The WBC count may have potential as a predictor for all-cause mortality, particularly CVD mortality.  相似文献   

10.
BACKGROUND: Soluble E-selectin (sE-selectin) is a marker of activation of vascular endothelium. OBJECTIVE: To examine serum levels of sE-selectin in a cohort of 85 patients with early rheumatoid arthritis (RA) followed up for five years. METHODS: sE-selectin levels were assessed annually using an enzyme linked immunosorbent assay (ELISA) and related to simultaneously obtained clinical and laboratory measures. Joint inflammation was evaluated by active joint count, functional status by Health Assessment Questionnaire (HAQ), and radiographic findings in hands and feet by the Larsen method. Laboratory tests included serum C reactive protein (CRP) level, erythrocyte sedimentation rate, blood haemoglobin level, white blood cell count (WBC), and platelet count. Area under the curve (AUC) was calculated for each variable, and Jonckheere's test for ordered alternatives was applied to assess significance of association between sE-selectin AUC tertiles and other variables. Baseline sE-selectin tertiles were related to change in Larsen score and HAQ score at five years. Odds ratios (OR) with 95% confidence interval (CI) were calculated using univariate and multivariate logistic regression. RESULTS: sE-selectin levels were associated with CRP level (p=0.012), WBC (p=0.037), active joint count (p=0.019), progression of joint destruction (p=0.038), and HAQ score at five years (p=0.021), but not with extra-articular symptoms or comorbidity. Baseline sE-selectin levels in the third tertile predicted the HAQ score at five years (OR 4.18, 95% CI 1.15 to 15.22). sE-selectin levels of patients did not differ significantly from those of healthy control subjects. CONCLUSION: The degree of activation of vascular endothelium is associated with activity and outcome of early RA.  相似文献   

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