老年COPD患者获得性衰弱风险预测模型构建-现代医学

老年COPD患者获得性衰弱风险预测模型构建

单位：南京医科大学第一附属医院/江苏省人民医院老年呼吸科, 江苏南京 210029

分类号：R563

出版年·卷·期（页码）：2025·53·第五期（772-778）

摘要：

目的： 探讨老年慢性阻塞性肺疾病(COPD)患者的获得性衰弱现状，明确其危险因素，以构建预测模型。方法： 回顾性分析本院2021年1月至2024年4月住院治疗的215例老年COPD患者的临床资料，根据是否发生获得性衰弱分为获得性衰弱组(n=102)和非获得性衰弱组(n=113)。比较两组一般资料以及临床相关指标，进一步纳入多因素Logistic回归分析，以构建预测模型。Hosmer-Lemeshow 用以检验评估模型拟合优度，绘制受试者工作特征(ROC)曲线以评估该预测模型的价值。结果： 共纳入215例老年COPD患者，获得性衰弱发生率为47.44%(102/215)。非获得性衰弱组在闭目单脚站立测试(CST)、6 min步行距离(6MWD)、老年人运动功能量表(GLFS)、第1秒用力呼气容积(FEV₁)以及用力肺活量(FVC)检查指标上的表现优于获得性衰弱组，差异有统计学意义(P＜0.05)。多因素Logistic回归分析结果显示，年龄、体育活动等级量表(PARS-3)评分、共病情况、睡眠障碍、COPD病程、营养风险、降钙素原(PCT)、C反应蛋白(CRP)以及中性粒细胞与淋巴细胞比值(NLR)是老年COPD患者获得性衰弱的独立影响因素(P＜0.05)。根据以上影响因素构建预测模型，其Homer-Lemeshow检验拟合优度(χ²=9.047, P=0.483)显示校准度良好；AUC=0.817(0.729~0.905)，灵敏度为 0.784，特异度为 0.818。结论： 老年COPD患者并发获得性衰弱会显著降低其运动能力，影响其呼吸功能；基于临床、实验室相关指标构建的风险预测模型有助于临床护理人员对高风险患者进行及时干预，从而改善患者的功能状态和生活质量。

Objective: To investigate the current status of acquired weakness in elderly patients with chronic obstructive pulmonary disease(COPD), identify its risk factors, and develop a predictive model. Methods: A retrospective analysis was conducted on the clinical data of 215 elderly COPD patients hospitalized in our hospital from January 2021 to April 2024. Patients were divided into a acquired frailty group(n=102) and a non-acquired frailty group(n=113) based on the presence of acquired frailty. The general characteristics and clinical-related indicators were compared between the two groups, and factors which had statistic significance were incorporated into multivariate Logistic regression analysis to construct a predictive model. The Hosmer-Lemeshow test was used to assess the goodness-of-fit of the model, and the receiver operating characteristic(ROC) curve was plotted to evaluate the predictive value of the model. Results: Among the 215 elderly COPD patients, the prevalence of acquired frailty was 47.44%(102/215). The non-acquired frailty group showed significantly better performance in closed-eyed standing test(CST), 6-minute walking distance(6MWD), geriatric locomotive function scale(GLFS), forced expiratory volume in 1 second(FEV₁, and forced vital capacity(FVC) compared to the acquired frailty group(P<0.05). Multivariate Logistic regression analysis identified age, physical activity rank scale (PARS-3), comorbidities, sleep disorder, COPD duration, nutritional risk, procalcitonin(PCT), C-reactive protein(CRP), and neutrophil-to-lymphocyte ratio(NLR) as independent risk factors for acquired frailty in elderly COPD patients(P<0.05). A predictive model was constructed based on these influencing factors. The Hosmer-Lemeshow test indicated good calibration (χ²=9.047, P=0.483). The AUC was 0.817(95%CI 0.729-0.905), with a sensitivity of 0.784, and a specificity of 0.818. Conclusion: Acquired frailty can significantly reduce physical performance and adversely affect respiratory function in elderly COPD patients. The risk prediction model based on clinical and laboratory indicators facilitates early identification of high-risk patients, enabling timely interventions by clinical care providers to improve patients' functional status and quality of life.

参考文献：

[1] 叶世贤，赵东兴，苏冠升,等.呼吸康复对慢性阻塞性肺疾病患者的疗效及影响预后的危险因素分析:回顾性研究[J].中国康复医学杂志，2024，39(11):1581-1587.
[2] 张明月，田玉梅，高娥,等.慢性阻塞性肺疾病患者居家肺康复维持现状及影响因素研究[J].中华护理杂志，2024，59(17):2077-2083.
[3] 李莉，王蕾，张丽,等.衰弱增加慢性阻塞性肺疾病急性加重期老年患者院内死亡风险:一项真实世界研究[J].中国循证医学杂志，2024，24(6):652-657.
[4] 黄慧，杨敬源，杨星,等.贵州农村老年人可逆认知衰弱与日常生活功能受损、住院、跌倒的关联研究[J].现代预防医学，2023，50(21):3924-3929.
[5] 张文，刘林峰，曹俊,等.老年慢性阻塞性肺疾病患者病耻感与衰弱的相关性研究[J].中国慢性病预防与控制，2024，32(3):216-220.
[6] 陶阳，郭洪花，张彩虹.慢性阻塞性肺疾病相关性衰弱发病机制及营养干预的研究进展[J].中国全科医学，2021，24(6):684-689.
[7] 李惊鸿，黄欢欢，谢颖,等.369例重庆社区高血压老年患者衰弱与营养不良共病现状及影响因素分析[J].护理学报，2021，28(22):70-74.
[8] 黄雅璇,梅培培.老年COPD稳定期患者病情急性加重再入院的影响因素及预测价值研究[J].现代医学,2024,52(9):1379-1385.
[9] 王凤燕，张冬莹，梁振宇,等.面向全科医生的《慢性阻塞性肺疾病诊治指南(2021年修订版)》解读[J].中国全科医学，2021，24(29):3660-3663，3677.
[10] 杨丽峰，杨洋，张春梅,等.老年人衰弱评估量表的编制及信效度检验[J].中华护理杂志，2017，52(1):49-53.
[11] 许群，王镆，赵崇乐.光照环境运动强度与女大学生季节性情感障碍的关系[J].中国学校卫生，2020，41(9):1403-1405.
[12] TSENG T H，CHEN H C，WANG L Y，et al.Effects of exercise training on sleep quality and heart rate variability in middle-aged and older adults with poor sleep quality:a randomized controlled trial[J].J Clin Sleep Med，2020，16(9):1483-1492.
[13] WU Y，ZHU Y，FENG Y，et al.Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutrition-al Risk Screening 2002[J].Br J Nutr，2020，124(12):1293-1302.
[14] LI Z，GE J，FENG J，et al.Less social support for patients with COVID-19:comparison with the experience of nurses[J].Front Psychiatry，2021，12:554435.
[15] PALHANO-FONTES F，BARRETO D，ONIAS H，et al.Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression:a randomized placebo-controlled trial[J].Psychol Med，2019，49(4):655-663.
[16] PENG X，ZHOU T，WU H，et al.Effects of weight-bearing dance aerobics on lower limb muscle morphology，strength and functional fitness in older women[J].PeerJ，2024，12:e17606.
[17] ROMERO D，BLANCO-ALMAZÁN D，GROENENDAAL W，et al.Predicting 6-minute walking test outcomes in patients with chronic obstructive pulmonary disease without physical performance measures[J].Comput Methods Programs Biomed，2022，225:107020.
[18] KOBAYASHI T，MORIMOTO T，SHIMANOE C，et al.Development of a simple screening tool based on the 5-question geriatric locomotive function scale for locomotive syndrome[J].J Orthop Sci，2022，27(4):913-920.
[19] 黄娟，刘家昌，方明,等.慢性阻塞性肺疾病急性加重期患者EOS、PCT水平变化及临床意义[J].中国老年学杂志，2022，42(22):5490-5492.
[20] 程敏,刘芹,甘皓月,等.不同干预措施对ICU获得性衰弱患者应用效果的网状Meta分析[J].现代医学,2024,52(6):884-891.
[21] 王雪辉，裴瑶琳.中国老年人的衰弱与健康——基于RuLAS调查数据的实证研究[J].人口与发展，2020，26(4):43-50，34.
[22] 谢红梅，蒋运兰，彭寒梅,等.老年慢性阻塞性肺疾病患者衰弱现状及影响因素的Meta分析[J].护理学杂志，2022，37(21):27-31.
[23] 王宜顺，赵春芝.睡眠质量在老年COPD患者久坐行为与衰弱间的中介作用[J].护理学杂志，2024，39(9):41-44.
[24] 刘文艳，吴炜炜.老年睡眠障碍与衰弱的相关性研究进展[J].中国康复理论与实践，2020，26(12):1435-1438.
[25] 宋刚，韩培英，张慧聪,等.清肺化痰、降逆平喘方在慢性阻塞性肺疾病急性加重期治疗中的作用及对外周血PCT、CRP、IL-6和免疫功能的影响[J].中华中医药学刊，2024，42(8):85-89.

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