脑卒中患者衰弱发生率与不良结局的系统评价-现代医学

脑卒中患者衰弱发生率与不良结局的系统评价

单位：1. 成都医学院护理学院, 四川成都 610083;
2. 成都医学院第二附属医院神经内科, 四川成都 610066

分类号：R743.3

出版年·卷·期（页码）：2023·51·第六期（823-830）

摘要：

目的：系统评价脑卒中患者衰弱发生率及与不良结局的关系。方法：计算机检索PubMed、Web of Science、SCOPUS、The Corchane Library、CINAHL、EMbase、MEDLINE、中国知网、维普、中国生物医学文献数据库、万方数据库，检索时限为建库至2022年10月。采用Stata 16.0进行Meta分析，采用Egger's法判断发表偏倚。结果：最终纳入26篇文献。Meta分析结果显示，脑卒中患者衰弱的总体发生率为40%(95%CI 30%~49%)，衰弱前期的总体发生率为45%(95%CI 34%~55%)；亚组分析结果显示，女性脑卒中患者的衰弱发生率(35%)高于男性(28%)；采用Tilburg衰弱量表进行评估时，脑卒中患者的衰弱发生率(75%)高于其他衰弱评估工具；亚洲地区脑卒中患者的衰弱发生率(48%)更高。衰弱与脑卒中患者不良结局关系：衰弱可增加脑卒中患者死亡的风险(OR=3.23，95%CI 2.13~ 4.90，P<0.01)，衰弱较非衰弱脑卒中患者认知障碍风险增加4.98倍(OR=4.98,95%CI 1.69~14.71，P<0.01)。描述性分析结果显示，衰弱可导致脑卒中患者住院时间延长，增加再住院率和抑郁风险。结论:脑卒中患者的衰弱发生率较高，而衰弱前期的发病率则更高，衰弱可能是脑卒中患者不良结局的危险因素之一。

Objective: To systematically review the incidence of frailty in stroke patients and their relationship with adverse outcomes. Methods: A comprehensive search was conducted in electronic databases, including PubMed, Web of Science, SCOPUS, The Cochrane Library, CINAHL, EMBASE, MEDLINE, CNKI, VIP, SinoMed, and Wanfang Database, from inception to October 2022. The stata 16.0 was used for Meta-analysis and Egger's method was used to determine publication bias. Results: A total of 26 studies were included. The results of Meta-analysis showed that the overall incidence of frailty in stroke patients was 40%(95%CI 30%-49%), and the overall incidence of pre-frailty was 45%(95%CI 34%-55%). The subgroup analysis showed that the incidence of frailty was higher in female(35%) than in male(28%). Using the Tilburg Frailty Scale, the incidence of frailty in stroke patients was 75%, which was higher than that of other frailty assessment tools. Stroke patients in Asia have a higher incidence of frailty(48%). Association of frailty with adverse outcomes in stroke patients:frailty increased the risk of death in stroke patients(OR=3.23, 95%CI 2.13-4.90, P<0.01), and the risk of cognitive impairment in frailty patients was increased by 4.98 times(OR=4.98, 95%CI 1.69-14.71, P<0.01). Descriptive analysis showed that frailty in stroke patients can lead to longer hospital stays, increased readmission rate, and increased risk of depression in stroke patients. Conclusion: The incidence of frailty is higher in stroke patients, with a higher incidence of frailty in the pre-frailty stage. Frailty may be a risk factor for adverse outcomes in stroke patients.

参考文献：

[1] 崔丽英,北京医师协会.神经内科[M].北京:中国医药科技出版社,2014.
[2] TSAO C W,ADAY A W,ALMARZOOQ Z I,et al.Heart disease and stroke statistics—2022 update:a report from the American Heart Association[J].Circulation,2022,145(8):e153-e639.
[3] WANG Y J,LI Z X,GU H Q,et al.China stroke statistics:an update on the 2019 report from the national center for healthcare quality management in neurological diseases,China national clinical research center for neurological diseases,the Chinese stroke association,national center for chronic and non-communicable disease control and prevention,Chinese center for disease control and prevention and institute for global neuroscience and stroke collaborations[J].Stroke Vasc Neurol,2022,7(5):415-450.
[4] WINOVICH D T,LONGSTRETH Jr W T,ARNOLD A M,et al.Factors associated with ischemic stroke survival and recovery in older adults[J].Stroke,2017,48(7):1818-1826.
[5] FRIED L P,FERRUCCI L,DARER J,et al.Untangling the concepts of disability,frailty,and comorbidity:implications for improved targeting and care[J].J Gerontol A Biol Sci Med Sci,2004,59(3):M255-M263.
[6] PINHO J,KUPPERS C,NIKOUBASHMAN O,et al.Frailty is an outcome predictor in patients with acute ischemic stroke receiving endovascular treatment[J].Age Ageing,2021,50(5):1785-1791.
[7] PILOTTO A,BRASS C,FASSBENDER K,et al.Premorbid frailty predicts short-and long-term outcomes of reperfusion treatment in acute stroke[J].J Neurol,2022,269(6):3338-3342.
[8] 樊凡,杨翠,王庆松.老年缺血性脑卒中患者衰弱状态与脑卒中后认知障碍的相关性研究[J].中华老年心脑血管病杂志,2018,20(12):1253-1257.
[9] EVANS N R,WALL J,TO B,et al.Clinical frailty independently predicts early mortality after ischaemic stroke[J].Age Ageing,2020,49(4):588-591.
[10] JOYCE N,ATKINSON T,MC GUIRE K,et al.Frailty and stroke thrombectomy outcomes—an observational cohort study[J].Age Ageing,2022,51(2):afab260.
[11] KANAI M,NOGUCHI M,KUBO H,et al.Pre-stroke frailty and stroke severity in elderly patients with acute stroke[J].J Stroke Cerebrovasc Dis,2020,29(12):105346.
[12] LI M,SONG Q,WANG S,et al.Study on the frailty-related serum markers in elderly patients with cerebral infarction[J].Chin J Geriatr,2018,37(6):641-645.
[13] MUNTHE-KASS R,AAM S,SALTVEDT I,et al.Is Frailty Index a better predictor than pre-stroke modified Rankin Scale for neurocognitive outcomes 3-months post-stroke?[J].BMC Geriatr,2022,22(1):1-8.
[14] QI B,ZHANG Z,WANG Y,et al.Correlation of swallowing experience to frailty and nutrition in old stroke inpatients[J].Chin J Rehabil Theory Pract,2020,26(11):1269-1274.
[15] SEAMON B A,SIMPSON K N.The effect of frailty on discharge location for medicare beneficiaries after acute stroke[J].Arch Phys Med Rehabil,2019,100(7):1317-1323.
[16] SONG X F,ZHANG Y,LI H,et al.Frailty and post-stroke depression in elderly patients with acute ischemic stroke[J].Chin Gen Pract,2020,23(30):3834.
[17] TAYLOR-ROWAN M,KEIR R,CUTHBERTSON G,et al.Pre-stroke frailty is independently associated with post-stroke cognition:a cross-sectional study[J].J Int Neuropsychol Soc,2019,25(5):501-506.
[18] TAYLOR-ROWAN M,CUTHBERTSON G,KEIR R,et al.The prevalence of frailty among acute stroke patients,and evaluation of method of assessment[J].Clin Rehabil,2019,33(10):1688-1696.
[19] 林伶姿,叶慧玲,吴洁媛,等.老年脑卒中患者衰弱与营养风险的相关性研究[J].国际医药卫生导报,2021,27(20):3243-3247.
[20] 林卫,苏俐莉,余天智,等.老年缺血性脑卒中后遗症患者衰弱状况调查及其危险因素分析[J].中华老年心脑血管病杂志,2021,23(5):499-502.
[21] 王立娟,李淑杏.老年脑卒中患者的虚弱状况及影响因素分析[J].临床医学研究与实践,2016,1(13):177.
[22] 王翎羽,胡小龙,王雪静,等.基于老年综合评估的衰弱指数对缺血性脑卒中患者衰弱的预测价值[J].中华现代护理杂志,2022,28(2):167-171.
[23] 夏晗月,曹倩,周丹丹.老年脑卒中患者衰弱现状及影响因素分析[J].上海护理,2022,22(1):28-32.
[24] 赵会云,张美琴.老年脑卒中偏瘫患者衰弱现状及影响因素研究[J].卫生职业教育,2020,38(1):129-132.
[25] 王颖,陶香君,董凯生,等.急性缺血性脑卒中患者衰弱与认知功能障碍的相关性[J].中国医药导报,2021,18(17):82-84,89.
[26] 杨华清.老年缺血性脑卒中患者衰弱状态与认知障碍的相关性分析[J].医药前沿,2020,10(33):55-56.
[27] NOGUCHI M,KUBO H,KANAI M,et al.Relationship between pre-stroke frailtystatus and short-term functional outcome in older patients with acute stroke a mediation analysis[J].Arch Gerontol Geriatr,2021,94(5):104370.
[28] KIM M G,GANDHI C,AZIZKHANIAN I,et al.Frailty and spontaneous intracerebral hemorrhage:does the modified frailty index predict mortality?[J].Clin Neurol Neurosurg,2020,194(4):105816.
[29] WÆHLER I S,SALTVEDT I,LYDERSEN S,et al.Association between in-hospital frailty and health-related quality of life after stroke:the Nor-COAST study[J].BMC Neurol,2021,21(1):1-12.
[30] KILKENNY M F,PHAN H T,LINDLEY R I,et al.Utility of the hospital frailty risk score derived from administrative data and the association with stroke outcomes[J].Stroke,2021,52(9):2874-2881.
[31] SCHNIEDER M,BÄHR M,KIRSCH M,et al.Analysis of frailty in geriatric patients as a prognostic factor in endovascular treated patients with large vessel occlusion strokes[J].J Clin Med,2021,10(10):2171.
[32] IMAOKA Y,KAWANO T,HASHIGUCHI A,et al.Modified frailty index predicts postoperative outcomes of spontaneous intracerebral hemorrhage[J].Clin Neurol Neurosurg,2018,175(11):137-143.
[33] ROHRMANN S.Epidemiology of frailty in older people[J].Adv Exp Med Biol,2020,978(3):21-27.
[34] BOUILLON K,BATTY G D,HAMER M,et al.Cardiovascular disease risk scores in identifying future frailty:the whitehall II prospective cohort study[J].Heart,2013,99(10):737-742.
[35] CHANG S F.Frailty is a major related factor for at risk of malnutrition in community-dwelling older adults[J].J Nurs Scholarsh,2017,49(1):63-72.
[36] OKSUZYAN A,JUEL K,VAUPEL J W,et al.Men:good health and high mortality.Sex differences in health and aging[J].Aging Clin Exp Res,2008,20(2):91-102.
[37] SAMSON L D,BOOTS A M H,FERREIRA J A,et al.In-depth immune cellular profiling reveals sex-specific associations with frailty[J].Immun Ageing,2020,17(1):1-13.
[38] GOBBENS R J,UCHMANOWICZ I.Assessing frailty with the Tilburg Frailty Indicator(TFI):a review of reliability and validity[J].Clin Interv Aging,2021,18(16):863.
[39] 欧阳敏,蹇在金.老年衰弱评估研究进展[J].中国实用内科杂志,2017,37(4):317-321.
[40] FRIED L P,TANGEN C M,WALSTON J,et al.Frailty in older adults:evidence for a phenotype[J].J Gerontol A Biol Sci Med Sci,2001,56(3):M146-M157.
[41] MORLEY J E,MALMSTROM T K,MILLER D K.A simple frailty questionnaire(FRAIL) predicts outcomes in middle aged African Americans[J].J Nutr Health Aging,2012,16(7):601-608.
[42] 吴珍珍,张瑞,常艳,等.衰弱表型和衰弱筛查量表在老年住院患者中的应用比较[J].中华护理杂志,2021,56(5):673-679.
[43] MITNITSKI A B,MOGILNER A J,ROCKWOOD K.Accumulation of deficits as a proxy measure of aging[J].ScientificWorld Journal,2001,8(1):323-336.
[44] ROCKWOOD K,SONG X,MACKNIGHT C,et al.A global clinical measure of fitness and frailty in elderly people[J].CMAJ,2005,173(5):489-495.
[45] DIEBEL L W M,ROCKWOOD K.Determination of biological age:geriatric assessment vs. biological biomarkers[J].Curr Oncol Rep,2021,23(9):1-8.
[46] DENT E,MARTIN F C,BERGMAN H,et al.Management of frailty:opportunities,challenges,and future directions[J].Lancet,2019,394(10206):1376-1386.
[47] 陈巍,刘改琴,周晓辉.老年衰弱综合征与骨代谢相关影响因素的研究进展[J].现代医学,2021,49(4):460-464.
[48] 武力,郑燕蓉,柴源.老年住院患者衰弱程度与肌肉减少症严重程度的相关性分析[J].现代医学,2020,48(5):647-651.
[49] HSIEH T J,SU S C,CHEN C W,et al.Individualized home-based exercise and nutrition interventions improve frailty in older adults:a randomized controlled trial[J].Int J Behav Nutr Phys Act,2019,16(1):1-15.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录