老年慢性心力衰竭患者肌少症的筛查及干预研究

目的 筛查老年慢性心力衰竭(CHF)住院患者中肌少症的发生率,评价运动训练及营养支持结合标准心衰治疗对老年CHF患者肌少症及心功能的改善情况.方法 收集2018年1月-2020年2月于杭州市第三人民医院住院治疗的老年CHF患者200例,进行肌少症筛查.比较CHF合并与不合并肌少症患者心功能、肌少症指标的差异.将筛选出的...

Screening and intervention of sarcopoenia in elderly patients with chronic heart failure

  Objective  To screen the incidence of sarcopoenia in elderly inpatients with chronic heart failure (CHF) and to evaluate the effect of exercise training and nutritional support in combination with standard heart-failure treatment on the improvement in sarcopoenia and cardiac function in elderly inpatients with CHF.  Methods  Two hundred elderly inpatients with CHF who were in the Hangzhou Third People's Hospital from January 2018 to February 2020 were collected to be screened for sarcopoenia. The differences of cardiac function, sarcopoenia, in the 200 selected patients were observed. The selected patients with CHF combined with sarcopoenia were randomly divided into control (standard heart-failure treatment, 33 cases) and observation (exercise training+nutritional support+standard heart-failure treatment, 33 cases) groups. After two months of treatment, the improvement in sarcopoenia and cardiac function were compared between the two groups.  Results  (1) The incidence of sarcopoenia in elderly inpatients with CHF was 33%. (2) In patients with CHF complicated with sarcopoenia and those who without sarcopoenia, NT-proBNP levels were (1 559.59±485.95) pg / mL vs. (1 362.60±336.75) pg / mL, the LVEFs were (45.56±4.25) % vs. (46.98±3.12) %, and the proportions of cardiac function Ⅲ were 37(56.06%) vs. 53(39.55%), the difference was statistically significant respectively. (3) After treatment, between two groups, the 6 min walking distance, appendicular muscle mass, grip strength, and GDF-11 level of the observation group were all higher; GDF-15 level was lower in the observation group (all P < 0.05). The LVEF and NYHA cardiac-function grading in the observation group also improved compared with that of the control group (all P < 0.05). (4) Multiple linear-regression analysis showed that the GDF-15 level was inversely correlated with appendicular muscle mass and 6 min walking distance (β=-0.449, -0.708, all P < 0.05), GDF-11 level was positively correlated with appendicular muscle mass and grip strength (β=0.537, 0.759, all P < 0.05).  Conclusion  Sarcopoenia has a high incidence in elderly inpatients with CHF. Exercise training and nutritional support combined with standard heart-failure treatment can improve sarcopoenia and cardiac function in elderly patients with CHF complicated with sarcopoenia. GDF-15 and GDF-11 can be used as clinical-observation indices in patients with sarcopoenia.