Development of a Frailty Index for Patients with Coronary Artery Disease

OBJECTIVES: To construct a brief frailty index for older patients with coronary artery disease (CAD) undergoing coronary angiography that includes physical, cognitive, and psychosocial criteria and accurately predicts future disability and decline in health‐related quality of life (HRQL). DESIGN: Prospective cohort. SETTING: An urban tertiary care hospital in Alberta, Canada. PARTICIPANTS: Three hundred seventy‐four patients aged 60 and older (73% male) undergoing cardiac catheterization for CAD between October 2003 and May 2007. MEASUREMENTS: Potential frailty criteria examined at baseline (before the procedure) included measures of balance, gait speed, cognition, self‐reported health, body mass index (BMI), depressive symptoms, and living alone. The outcomes assessed over 1 year were dependency in activities of daily living (ADLs) and HRQL. RESULTS: The five best‐fitting criteria from regression analyses for ADL decline were poor balance (risk ratio (RR)=2.4, 95% confidence interval (CI)=1.4–4.0), abnormal BMI (RR=1.8, 95% CI=1.1–3.0), impaired Trail‐Making Test Part B performance (RR=2.3, 95% CI=1.3–4.2), depressive symptoms (RR=1.8, 95% CI=1.1–3.1), and living alone (RR=2.2, 95% CI=1.3–3.8). Using the five criteria as separate variables or as a summary frailty index yielded identical areas under the receiver operating characteristic curve (0.76, 95% CI=0.66–0.84). Patients with three or more criteria (vs none) were at statistically significant greater risk for increased disability (RR=10.4, 95% CI=4.4–24.2) and decreased HRQL (RR=4.2, 95% CI=2.3–7.4) after 1 year. CONCLUSION: This brief frailty index including physical, cognitive, and psychosocial criteria was predictive of increased disability and decreased HRQL at 1 year in older patients with CAD undergoing angiography. This index may have applications for clinicians and researchers but requires further validation.     

Sleep–Wake Disturbances and Frailty in Community-Living Older Persons

OBJECTIVES: To evaluate the association between sleep–wake disturbances and frailty.
DESIGN: Cross-sectional.
SETTING: New Haven, Connecticut.
PARTICIPANTS: Three hundred seventy-four community-living persons aged 78 and older.
MEASUREMENTS: Frailty was based on the Fried phenotype, and sleep–wake disturbances were defined as daytime drowsiness, based on an Epworth Sleepiness Scale (ESS) score of 10 or greater, and as subthreshold and clinical insomnia, based on Insomnia Severity Index (ISI) scores of 8 to 14 and greater than 14, respectively.
RESULTS: Mean age was 84.3; 87 (23.8%) participants were drowsy, 122 (32.8%) had subthreshold insomnia, 38 (10.2%) had clinical insomnia, and 154 (41.2%) were frail. There was a significant association between drowsiness and frailty, with unadjusted and adjusted odds ratios (ORs) of 3.79 (95% confidence interval (CI)=2.29–6.29) and 3.67 (95% CI=2.03–6.61), respectively. In contrast, clinical insomnia was significantly associated with frailty in the unadjusted analysis (OR=2.77, 95% CI=1.36–5.67) but not the adjusted analysis (OR=1.93, 95% CI=0.81–4.61)), and subthreshold insomnia was not associated with frailty in the unadjusted or adjusted analysis.
CONCLUSION: In older persons, sleep–wake disturbances that present with daytime drowsiness, but not insomnia, are independently associated with frailty. Because drowsiness is potentially remediable, future studies should determine whether there is a temporal relationship between drowsiness and frailty, with the ultimate goal of informing interventions to reverse or prevent the progression of frailty.     

高血压患者颈动脉亚临床病变与动态脉压指数及相关危险因素研究

目的探讨动态脉压指数（24h ambulatory pulse pressure index,24hAPPI）对原发性高血压（essentialhypertension,EH）患者颈动脉亚临床病变的影响。方法对255例EH患者进行动态血压监测（ambulatory blood pressure monitoring,ABPM）和颈动脉超声检查。所有患者分为3组：A组（PPI≤0.40）、B组（PPI：0.40～0.49）和C组（PPI≥0.50）。结果颈动脉斑块积分及颈动脉内膜中层厚度（intima media thickness,IMT）随着PPI的增加而增加,24hAPP、24hAPPI以及斑块的严重程度（颈动脉斑块积分）与IMT间呈相关性。多因素Logistic回归分析表明,24hAPP、24hAPPI、吸烟、高血压病程是颈动脉亚临床病变独立的预测指标。结论颈动脉斑块积分及颈动脉IMT随着PPI的增加而增加,24hPPI与动态PPI、斑块的严重程度与IMT间有相关性。24hAPP、24hAPPI、吸烟、高血压病程是颈动脉亚临床病变独立的预测指标。     

高脂血症患者血浆致动脉粥样硬化指数与血栓形成危险因子的相关性

目的 研究高脂血症患者血浆致动脉粥样硬化指数与同型半胱氨酸、尿酸等血栓形成危险因子的相关性.方法 采用标准方法测定100例高脂血症患者和109例正常血脂对照者血脂及血同型半胱氨酸、尿酸、凝血因子Ⅶ、11-脱氢血栓素B2、6-酮-前列腺素F1α等血栓形成危险因子,根据甘油三酯与高密度脂蛋白胆固醇比值的对数转换值计算血浆致动脉粥样硬化指数值,用多元线性回归分析血浆致动脉粥样硬化指数、同型半胱氨酸、尿酸与其它血栓形成危险因子之间的相关性.结果 高脂血症组体质指数、血浆致动脉粥样硬化指数、血糖、低密度脂蛋白胆固醇、凝血因子Ⅶ、6-酮-前列腺素F1α及非高密度脂蛋白胆固醇显著升高 (P<0.01),11-脱氢血栓素B2水平显著降低(P<0.01);血浆致动脉粥样硬化指数与体质指数、血糖、甘油三酯、尿酸、非高密度脂蛋白胆固醇、凝血因子Ⅶ及同型半胱氨酸呈正相关(P<0.05),与高密度脂蛋白胆固醇呈负相关(r=-0.726,P<0.01);同型半胱氨酸与年龄、血压、尿酸呈正相关(P<0.01);尿酸与甘油三酯、体质指数及11-脱氢血栓素B2呈正相关(P<0.05或P<0.01);同型半胱氨酸、尿酸及体质指数与高密度脂蛋白胆固醇呈负相关(P<0.01).结论 高脂血症患者血浆致动脉粥样硬化指数、6-酮-前列腺素F1α、非高密度脂蛋白胆固醇和凝血因子FⅦ等显著高于正常血脂对照组,总胆固醇、甘油三酯与多项血栓形成危险因子相关.血浆致动脉粥样硬化指数与肥胖、高血压、同型半胱氨酸, 尿酸及血脂参数呈一定相关性,能够更加准确地评估血脂代谢综合征发生的危险度,当血浆致动脉粥样硬化指数升高时,应引起临床重视.     

动态动脉硬化指数研究进展

动脉硬化是高血压心血管并发症的独立危险因素,动态动脉硬化指数作为新的动脉硬化评价指标,近年来引起了广泛的研究。其受到年龄、血压和夜间血压下降等因素的影响,可重复性为中等水平,正常值范围有待进一步研究确认。其与脉搏波传导速度等传统动脉硬化指标中等程度相关,同时与肾功能损伤、血管损伤和心脏损伤等高血压靶器官损伤相关,临床上能一定程度预测心血管疾病和脑卒中等高血压并发症的发生风险。     

原发性高血压患者动态动脉硬化指数与颈动脉粥样硬化的相关性

目的 探讨原发性高血压患者动态动脉硬化指数与颈动脉粥样硬化的相关性.方法 124例原发性高血压患者和70例健康对照者,根据颈动脉超声检查,将原发性高血压患者按内膜中膜厚度≥0.9 mm者分为颈动脉硬化组,内膜中膜厚度<0.9 mm者分为无颈动脉硬化组.通过24 h动态血压监测,分析血压参数特点,计算动态动脉硬化指数.结果 原发性高血压患者颈动脉内膜中膜厚度、颈动脉斑块积分明显高于健康对照者(1.178±0.214 mm和0.806±0.356比3.17±2.44 mm和1.02±1.51,P<0.01),原发性高血压患者和健康对照者动态动脉硬化指数值分别为0.56±0.14和0.41±0.12(P<0.01);颈动脉硬化组和无颈动脉硬化组动态动脉硬化指数分别为0.59±0.12和0.50±0.11(P<0. 05) ,动态动脉硬化指数与内膜中膜厚度呈正相关(r=0.325,P<0.01).结论 原发性高血压患者动态动脉硬化指数与颈动脉粥样硬化关系密切.     

习惯性鼾症患者动态血压监测及其临床意义

对４２例习惯性鼾症伴高血压患者进行动态血压监测和晨晚间血浆血管紧张素Ⅰ、血管紧张素Ⅱ测定。结果显示鼾症组夜间血压较白昼无明显降低，昼诳节律消失。晨间ＡｎｇⅠ 和ＡｎｇⅡ比晚间增高。与对照组比较动态血压多项参数和因浆ＡｎｇⅠ、Ａdisplay status     

Prevalence and 10‐Year Outcomes of Frailty in Older Adults in Relation to Deficit Accumulation

OBJECTIVES: To evaluate the prevalence and 10‐year outcomes of frailty in older adults in relation to deficit accumulation. DESIGN: Prospective cohort study. SETTING: The National Population Health Survey of Canada, with frailty estimated at baseline (1994/95) and mortality follow‐up to 2004/05. PARTICIPANTS: Community‐dwelling older adults (N=2,740, 60.8% women) aged 65 to 102 from 10 Canadian provinces. During the 10‐year follow‐up, 1,208 died. MEASUREMENTS: Self‐reported health information was used to construct a frailty index (Frailty Index) as a proportion of deficits accumulated in individuals. The main outcome measure was mortality. RESULTS: The prevalence of frailty increased with age in men and women (correlation coefficient=0.955–0.994, P<.001). The Frailty Index estimated that 622 (22.7%, 95% confidence interval (CI)=21.0–24.4%) of the sample was frail. Frailty was more common in women (25.3%, 95% CI=23.2–27.5%) than in men (18.6%, 95% CI=15.9–21.3%). For those aged 85 and older, the Frailty Index identified 39.1% (95% CI=31.3–46.9%) of men as frail, compared with 45.1% (95% CI=39.7–50.5%) of women. Frailty significantly increased the risk of death, with an age‐ and sex‐adjusted hazard ratio for the Frailty Index of 1.57 (95% CI=1.41–1.74). CONCLUSION: The prevalence of frailty increases with age and at any age lessens survival. The Frailty Index approach readily identifies frail people at risk of death, presumably because of its use of multiple health deficits in multidimensional domains.     

踝臂指数与缺血性脑卒中的关系

目的探讨踝臂指数与缺血性脑卒中的关系。方法连续入选上海和北京地区10所医院的内科住院患者,测量踝臂指数并进行资料收集,对年龄在35~97岁之间的4 780例有效数据进行统计学处理。结果缺血性脑卒中组平均年龄明显高于非脑卒中组(70.29±10.01岁比65.89±11.87岁,P<0.001),且踝臂指数≤0.9的患者所占比例也明显高于非脑卒中组(34.6%比20.9%,P<0.001)。校正相关危险因素后,踝臂指数≤0.9组发生缺血性脑卒中的可能性是踝臂指数>0.9组的1.55倍(95%可信区间为1.314~1.817)。将正常踝臂指数分为五层与踝臂指数≤0.9组相比,缺血性脑卒中患病危险随踝臂指数的升高而降低。结论低踝臂指数增加缺血性脑卒中的风险,踝臂指数可用于评估缺血性脑卒中的患病危险。     

食管胃静脉曲张破裂出血患者死亡危险因素分析

背景：食管胃静脉曲张破裂出血（EVB）是肝硬化门静脉高压的常见并发症,再出血死亡率高.目的：分析EVB患者入院第1个月内的死亡危险因素.方法：回顾性分析2009年5月～2010年1月101例EVB患者的临床和实验室资料,多因素Logistic回归分析筛选独立死亡危险因素并构建Logistic回归模型,以该模型预测患者的死亡风险并与实际情况行一致性检验.结果：EVB患者入院第1个月内的死亡率为38.6%.存活组和死亡组患者的血红蛋白、白蛋白、血胆固醇、血钠、血氯、血钾、白细胞计数、凝血酶原时间、总胆红素、ALT、血尿素氮、血肌酐、Child-Pugh 评分、出血量、腹水和肝性脑病程度差异均有统计学意义（P＜0.05）.多因素Logistic回归分析示血钠、白细胞计数和Child-Pugh评分是EVB的独立死亡危险因素,以此建立的Logistic回归模型预测死亡的敏感性和特异性分别为69.2%和93.5%,一致性检验κ值为0.653.结论：低钠血症、白细胞计数和Child-Pugh评分是EVB患者入院第1个月内的独立死亡危险因素,以此建立的Logistic回归模型可用于EVB患者死亡风险的预测,且与实际情况的一致性良好.     

Ⅱ型糖尿病患者的动态血压观察

对３１例Ⅱ型糖尿病患者（其中糖尿病肾病组１６例，糖尿病无肾病组１５例）进行２４ｈ动态血压观察。结果提示：Ⅱ型糖尿病不论有否合并肾病，２４ｈ平均收缩压（２４ｈＳＢＰ）、白昼平均收缩压（ｄＳＢＰ）、夜间平均收缩压（ｎＳＢＰ）均显著高于对照组（Ｐ均＜０．０１）；糖尿病肾病组的ｎＳＢＰ／ｄＳＢＰ和ｎＤＢＰ／ｄＤＢＰ均显著高于对照组（Ｐ均＜０．０１）；糖尿病肾病组的ｎＳＢＰ、ｎＳＢＰ／ｄＳＢＰ和ｎＤＢＰ／ｄＤＢｐ均显著高于糖尿病无肾病组（Ｐ均＜０．０５）。Ⅱ型糖尿病患者ＡＢＰＭ主要表现为收缩期血压增高，而且在糖尿病肾病患者中，夜间血压下降不明显，失去了血压的正常昼夜节律变化。结果提示血压超负荷时间延长可能是糖尿病肾病发生和发展的因素之一。