FRAIL量表在筛查老年冠心病伴衰弱患者中的应用价值研究
详细信息    查看全文 | 推荐本文 |
  • 英文篇名:Performance of the FRAIL Scale in Screening Frailty among Elderly Patients with Coronary Heart Disease
  • 作者:侯苹 ; 薛慧萍 ; 李永男 ; 冒鑫娥 ; 孙凯旋 ; 薛玲玲 ; 吴琳凤 ; 刘永兵
  • 英文作者:HOU Ping;XUE Huiping;LI Yongnan;MAO Xine;SUN Kaixuan;XUE Lingling;WU Linfeng;LIU Yongbing;School of Nursing,Yangzhou University;
  • 关键词:冠心病 ; FRAIL量表 ; 诊断 ; 老年人
  • 英文关键词:Coronary disease;;FRAIL Scale;;Diagnosis;;Aged
  • 中文刊名:QKYX
  • 英文刊名:Chinese General Practice
  • 机构:扬州大学护理学院;
  • 出版日期:2019-03-22 11:21
  • 出版单位:中国全科医学
  • 年:2019
  • 期:v.22;No.600
  • 基金:扬州市重点研发计划(社会发展)项目(YZ2015054);; 扬州大学学术学位研究生科研创新计划项目(XKYCX17_070)
  • 语种:中文;
  • 页:QKYX201909016
  • 页数:5
  • CN:09
  • ISSN:13-1222/R
  • 分类号:61-65
摘要
背景目前老年冠心病患者逐年增多,且衰弱与冠心病的预后密切相关,及早识别衰弱,可延长患者寿命,提高生活质量。对于衰弱有多种评估方法,目前衰弱表型较为常用,但需要进行体能评估,耗时耗力,FRAIL量表则完全基于患者自我陈述,简单易行。目的探讨FRAIL量表对老年冠心病伴衰弱患者的筛查价值,并计算最佳临界值。方法选取2017年5—12月在扬州大学附属医院心内科住院的老年冠心病患者进行调查。采用自行设计的问卷调查一般资料,采用衰弱表型、FRAIL量表进行衰弱评估。采用受试者工作特征(ROC)曲线计算FRAIL量表筛查老年冠心病患者衰弱状态的最佳临界值,分析其临床价值。共发放问卷320份,回收有效问卷308份,有效回收率为96.2%。结果 FRAIL量表筛查老年冠心病的ROC曲线下面积(AUC)为0.858[95%CI(0.811,0.906),P<0.01],最佳临界值为2分时,约登指数为0.584,灵敏度为85.9%,特异度为72.5%,阳性预测值为45.1%,阴性预测值为95.2%。FRAIL量表与衰弱表型一致性检验结果显示Kappa值为0.438,P<0.01,提示两者存在中度一致性;FRAIL量表和衰弱表型相关性分析结果显示,FRAIL量表与衰弱表型呈中度相关(r=0.668,P<0.01)。结论 FRAIL量表筛查老年冠心病伴衰弱患者的最佳临界值为2分,筛查价值较好,简单易操作且省时,可在临床进行推广。
        Background The number of elderly patients with coronary heart disease(CHD) is increasing year by year,and frailty is closely related to the prognosis of CHD.Early identification of frailty can prolong the survival time of patients and improve their quality of life.There are many methods to assess frailty,and frailty phenotype is commonly used at present.However,it requires evaluating physical fitness,which is time-consuming and inefficient.On the other hand,the FRAIL Scale is entirely based on patients' self-statement,which is simple and feasible.Objective To explore the performance of the FRAIL Scale in screening frailty in elderly patients with CHD,with the determination of its optimal cut-off value.Methods Participants were elderly patients with CHD who enrolled from Department of Cardiology,Affiliated Hospital of Yangzhou University from May to December in 2017.A self-developed Demographic Questionnaire was adopted to collect the demographic characteristics.Frailty was assessed by using both Fried frailty phenotype criteria and FRAIL Scale.ROC curve analysis was conducted to determine the optimal cut-off value of FRAIL Scale for screening frailty,and its clinical value was analyzed.308 of the 320 participants returned responsive questionnaires,obtaining a response rate of 96.2%.Results For identifying frailty,the area under the ROC curve(AUC) of the FRAIL Scale for screening elderly patients with CHD was 0.858[95%CI(0.811,0.906),P<0.01].When the optimal cut-off value was determined as 2 points,the Youden's index,sensitivity,specificity,positive predictive value and negative predictive value were 0.584,85.9%,72.5%,45.1% and 95.2%,respectively.Kappa statistic result(Kappacoefficient=0.438) showed a moderate level of agreement between the performance of FRAIL Scale and that of frailty phenotype(P<0.01).Furthermore,a moderate correlation was found between the FRAIL score and the frailty phenotype score by Pearson analysis(r=0.668,P<0.01).Conclusion The FRAIL Scale was proved to be a good tool for the identification of frailty in elderly patients with CHD when using an optimal cut-off value of 2 points.Moreover,the assessment using it is simple and time-saving,so it is worthy of wide clinical application.
引文
[1]CLEGG A,YOUNG J,ILIFFE S,et al.Frailty in elderly people[J].Lancet,2013,381(9868):752-762.DOI:10.1016/S0140-6736(12)62167-9.
    [2]曾朝霞,梁杰.老年冠心病患者合并衰弱综合征的影响因素研究[J].中国全科医学,2017,20(19):2347-2352,2357.DOI:10.3969/j.issn.1007-9572.2017.19.011.ZENG Z X,LIANG J.Associated factors for the identification of frailty syndrome in coronary heart disease in the elderly[J].Chinese General Practice,2017,20(19):2347-2352,2357.DOI:10.3969/j.issn.1007-9572.2017.19.011.
    [3]康琳,朱鸣雷,刘晓红,等.衰弱与老年人冠状动脉粥样硬化性心脏病的相关性研究[J].中华老年医学杂志,2015,34(9):951-955.DOI:10.3760/cma.J.issn.0254-9026.2015.09.006.KANG L,ZHU M L,LIU X H,et al.Correlation between frailty and coronary heart disease in the elderly[J].Chinese Journal of Geriatrics,2015,34(9):951-955.DOI:10.3760/cma.j.issn.0254-9026.2015.09.006.
    [4]AFILALO J,ALEXANDER K P,MACK M J,et al.Frailty assessment in the cardiovascular care of older adults[J].J Am CollCardiol,2014,63(8):747-762.DOI:10.1016/j.jacc.2013.09.070.
    [5]LE MAGUET P,ROQUILLY A,LASOCKI S,et al.Prevalence and impact of frailty on mortality in elderly ICU patients:a prospective,multicenter,observational study[J].Intensive Care Med,2014,40(5):674-682.DOI:10.1007/s00134-014-3253-4.
    [6]CESARI M,ABELLAN VAN KAN G,ARIOGUL S,et al.The European Union Geriatric Medicine Society(EUGMS)Working Group on《Frailty in Older Persons》[J].J Frailty Aging,2013,2(3):118-120.DOI:10.14283/jfa.2013.15.
    [7]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):M146-156.
    [8]BIENIEK J,WILCZYNSKI K,SZEWIECZEK J.Fried frailty phenotypeassessmentcomponentsasappliedtogeriatric inpatients[J].Clin Interv Aging,2016,11:453-459.DOI:10.2147/CIA.S101369.
    [9]ABELLAN VAN KAN G,ROLLAND Y,BERGMAN H,et al.The I.A.N.A Task Force on frailty assessment of older people in clinical practice[J].J Nutr Health Aging,2008,12(1):29-37.
    [10]DíAZ DE LEóN GONZáLEZ E,GUTIéRREZ HERMOSILLO H,MARTINEZ BELTRAN J A,et al.Validation of the FRAIL scale in Mexican elderly:results from the Mexican Health and Aging Study[J].Aging Clin Exp Res,2016,28(5):901-908.DOI:10.1007/s40520-015-0497-y.
    [11]GARDINER P A,MISHRA G D,DOBSON A J.Validity and responsiveness of the FRAIL scale in a longitudinal cohort study of older Australian women[J].J Am Med Dir Assoc,2015,16(9):781-783.DOI:10.1016/j.jamda.2015.05.005.
    [12]中华人民共和国国家卫生和计划生育委员会.冠状动脉粥样硬化性心脏病诊断标准[EB/OL].(2010-07-01)[2017-12-16].http://www.moh.gov.cn/zwgkzt/s9494/201007/47956.shtml.National Health and Family Planning Commission of the People's Republic of China.Diagnostic criteria for coronary atherosclerotic heart disease[EB/OL].(2010-07-01)[2017-12-16].http://www.moh.gov.cn/zwgkzt/s9494/201007/47956.shtml.
    [13]LIOU Y M,JWO C J,YAO K G,et al.Selection of appropriate Chinese terms to represent intensity and types of physical activity terms for use in the Taiwan version of IPAQ[J].J Nurs Res,2008,16(4):252-263.
    [14]中华医学会老年医学分会.老年患者衰弱评估与干预中国专家共识[J].中华老年医学杂志,2017,36(3):251-256.DOI:10.3760/cma.j.issn.0254-9026.2017.03.007.Geriatrics Branch of the Chinese Medical Association.Chinese experts consensus on evaluation and intervention for elderly patients with frailty[J].Chinese Journal of Geriatrics,2017,36(3):251-256.DOI:10.3760/cma.j.issn.0254-9026.2017.03.007.
    [15]ROCKWOOD K,HOGAN D B,MACKNIGHT C.Conceptualization and measurement of frailty in elderly people[J].Drugs Aging,2000,17(4):295-302.
    [16]尹傲冉,倪朝民,杨洁,等.脑卒中偏瘫患者步态的不对称性与平衡功能的相关性研究[J].中华物理医学与康复杂志,2014,36(3):190-193.DOI:10.3760/cma.j.issn.0254-1424.2014.03.008.YIN A R,NI C M,YANG J,et al.Gait asymmetry and balance in hemiplegic stroke survivors[J].Chinese Journal of Physical Medicine and Rehabilitation,2014,36(3):190-193.DOI:10.3760/cma.j.issn.0254-1424.2014.03.008.
    [17]LANDIS J R,KOCH G G.The measurement of observer agreement for categorical data[J].Biometrics,1977,33(1):159-174.
    [18]GO A S,MOZAFFARIAN D,ROGER V L,et al.Executive summary:heart disease and stroke statistics—2013 update:a report from the American Heart Association[J].Circulation,2013,127(1):143-152.DOI:10.1161/CIR.0b013e318282ab8f.
    [19]KANG L,ZHANG S Y,ZHU W L,et al.Is frailty associated with short-term outcomes for elderly patients with acute coronary syndrome?[J].J Geriatr Cardiol,2015,12(6):662-667.DOI:10.11909/j.issn.1671-5411.2015.06.010.
    [20]CHONGE,HOE,BALDEVARONA-LLEGOJ,etal.Frailtyandriskofadverseoutcomesinhospitalizedolder adults:a comparison of different frailty measures[J].J Am MedDirAssoc,2017,18(7):638.DOI:10.1016/j.jamda.2017.04.011.
    [21]WIDAGDO I S,PRATT N,RUSSELL M,et al.Predictive performance of four frailty measures in an older Australian population[J].Age Ageing,2015,44(6):967-972.DOI:10.1093/ageing/afv144.
    [22]RITT M,RITT J I,SIEBER C C,et al.Comparing the predictive accuracy of frailty,comorbidity,and disability for mortality:a 1-year follow-up in patients hospitalized in geriatric wards[J].Clin Interv Aging,2017,12:293-304.DOI:10.2147/CIA.S124342.
    [23]MALMSTROM T K,MILLER D K,MORLEY J E.A comparison of four frailty models[J].J Am Geriatr Soc,2014,62(4):721-726.DOI:10.1111/jgs.12735.
    [24]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.
    [25]APRAHAMIAN I,CEZAR N O C,IZBICKI R,et al.Screening for frailty with the frail scale:a comparison with the phenotype criteria[J].J Am Med Dir Assoc,2017,18(7):592-596.DOI:10.1016/j.jamda.2017.01.009.
    [26]BRAUN T,GRüNEBERG C,THIEL C.German translation,cross-cultural adaptation and diagnostic test accuracy of three frailty screening tools:PRISMA-7,FRAIL scale and Groningen Frailty Indicator[J].Z Gerontol Geriatr,2018,51(3):282-292.DOI:10.1007/s00391-017-1295-2.
    [27]DONG L,QIAO X,TIAN X,et al.Cross-cultural adaptation and validation of the frail scale in chinese community-dwelling older adults[J].J Am Med Dir Assoc,2018,19(1):12-17.DOI:10.1016/j.jamda.2017.06.011.
    [28]JUNG H W,JANG I Y,LEE Y S,et al.Prevalence of frailty and aging-related health conditions in older Koreans in rural communities:a cross-sectional analysis of the aging study of Pyeongchang rural area[J].J Korean Med Sci,2016,31(3):345-352.DOI:10.3346/jkms.2016.31.3.345.

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700