[Related factors of sarcopenia in hospitalized elderly patients with coronary heart disease].

Objective: To explore the incidence and clinical characteristics of sarcopenia in hospitalized elderly patients with coronary heart disease and search for the related factors. Methods: This study was a single-center observational study. According to the inclusion criteria, elderly patients hospitalized with coronary heart disease from Peking Union Medical College Hospital between December 2017 and December 2018 were enrolled. The patients were divided into sarcopenic group and non-sarcopenic group according to the diagnostic criteria of the Asian Working Group for Sarcopenia. Activities of daily living of the patients were assessed (including ADL and IADL) . Comorbidity of the patients was evaluated by the Charlson comorbidity index (CCI). Long-term medication use of the patients was recorded to assesse whether there was polypharmacy. The nutritional status of the patients was examined by the mini nutritional assessment-short form (MNA-SF). The full tandem stance time of the patients was evaluated. The history of falls over the previous year, urinary incontinence, and living conditions of the patients were also recorded. Multivariate logistic regression was used to analyze the related factors for sarcopenia of elderly patients with coronary heart disease. Results: A total of 364 patients were enrolled in the study. The patients were aged 65-96 (74.6±6.5) years and there were 218 (59.9%) male patients. There were 264 cases of stable coronary heart disease and 100 cases of acute coronary syndrome. The median number of long-term used medication was 7. One hundred and fifty-two (41.8%) patients were complicated with type 2 diabetes, 38 (10.4%) patients were complicated with anxiety/depression, and 98 (26.9%) patients had the history of falls over the previous year. Eighty-two (22.5%) patients were complicated with urinary incontinence, 12 patients (3.3%) were complicated with malnutrition and 33 patients (9.2%) were living alone. There were 81 (22.3%) sarcopenic patients and 283 (77.7%) non-sarcopenic patients among all the hospitalized elderly patients with coronary heart disease. The sarcopenic patients were more older, with lower body mass index(BMI)(both P<0.001), higher CCI and more long-term used medication (both P<0.05), higher proportions of malnutrition, urinary incontinence, history of falls, and living alone (all P<0.05) compared to non-sarcopenic patients. ADL and IADL scores of sarcopenic patients were significantly lower than those of non-sarcopenic patients (both P<0.001). There was also a higher proportion of unable to accomplish full tandem stance among sarcopenic patients compared to non-sarcopenic patients (P<0.001). Moreover, higher hs-CRP level (P=0.047) , lower albumin level (P=0.004) and significantly lower prealbumin level (P<0.001) were observed in sarcopenic patients compared to non-sarcopenic patients. Stepwise multivariate binomial logistic regression analysis revealed that male (OR=5.036, 95%CI 1.782-14.230, P=0.002), low BMI (OR=0.883, 95%CI 0.796-0.980, P=0.019), as well as low prealbumin level (OR=0.990, 95%CI 0.980-1.000, P=0.045) were related factors for sarcopenia among elderly patients with coronary heart disease. Conclusions: Sarcopenia is a geriatric condition commonly seen in hospitalized elderly patients with coronary heart disease. Male, low BMI, and low prealbumin level were the factors related to sarcopenia for older adults with coronary heart disease.目的： 探讨住院老年冠心病患者合并肌少症的情况及其相关因素。 方法： 该研究为单中心观察性研究。按入排标准连续入选2017年12月至2018年12月在北京协和医院老年医学科及心内科住院治疗的老年冠心病患者，根据患者是否患有肌少症分为冠心病合并肌少症组和冠心病不合并肌少症组。肌少症的诊断采用2014年亚洲肌少症工作组标准。评估入院患者的日常生活活动能力[日常生活活动能力评分（ADL）、日常生活活动评分（IADL）]。应用Charlson共病指数（CCI）对患者的共存疾病程度进行评估。核查患者长期服用药物，评估是否存在多重用药。采用简易营养评估量表（MNA-SF）筛查入选患者的营养状况。测试患者全足距站立时间。评估患者近1年内跌倒史、是否合并尿失禁以及居住情况。采用多因素logistic回归模型分析住院老年冠心病患者合并肌少症的相关因素。 结果： 最终入选住院老年冠心病患者364例，其中男性218例（59.9%），年龄65~96（74.6±6.5）岁。入选患者中稳定性冠心病264例，急性冠状动脉综合征（ACS）患者100例。入选患者的中位长期服用药物种类为7种，152例（41.8%）患者合并2型糖尿病，38例（10.4%）患者合并焦虑/抑郁，98例（26.9%）患者近1年内有跌倒史，82例（22.5%）患者合并尿失禁，12例（3.3%）患者合并营养不良，33例（9.2%）患者为独居。入选患者中患有肌少症者81例（22.3%），作为冠心病合并肌少症组；无肌少症者283例（77.7%），作为冠心病不合并肌少症组。与冠心病不合并肌少症组比较，冠心病合并肌少症组患者年龄更大、体重指数（BMI）较低（P均<0.001），CCI更高、长期用药种类更多（P均<0.05），合并营养不良、尿失禁、近1年内跌倒史、独居的比例更高（P均<0.05），ADL、IADL得分较低（P均<0.001），不能完成全足距测试者比例更高（P<0.001），超敏C反应蛋白水平较高（P=0.047），白蛋白水平较低（P=0.004），前白蛋白水平较低（P<0.001）。多因素logistic回归分析结果显示，男性（OR=5.036，95%CI 1.782~14.230，P=0.002）、低BMI（OR=0.883，95%CI 0.796~0.980，P=0.019）以及低前白蛋白水平（OR=0.990，95%CI 0.980~1.000，P=0.045）是住院老年冠心病患者合并肌少症的相关因素。 结论： 住院老年冠心病患者合并肌少症者较多，男性、低BMI以及低前白蛋白水平是住院老年冠心病患者合并肌少症的相关因素。.