2025 年第 7 期 第 20 卷

老年不稳定型心绞痛患者并发衰弱的危险因素及对预后的影响

Risk factors of frailty in elderly patients with unstable angina pectoris and its effect on prognosis

作者：陈英王统彩

英文作者：Chen Ying Wang Tongcai

单位：内蒙古自治区人民医院老年医学中心，呼和浩特010000

英文单位：Geriatric Center Inner Mongolia Autonomous Region People′s Hospital Hohhot 010000 China

关键词：不稳定型心绞痛；衰弱；危险因素；预测模型；预后

英文关键词：Unstableangina;Frailty;Riskfactors;Predictionmodel;Prognosis

• 摘要：

• 目的 探讨老年不稳定型心绞痛（UA）患者并发衰弱的危险因素及对预后的影响。方法 选取2021年1月至2023年12月内蒙古自治区人民医院收治的老年UA患者255例，根据是否并发衰弱分为衰弱组和非衰弱组，并随访1年统计主要不良心血管事件（MACE）发生率。收集老年UA患者临床资料，通过多因素Logistic回归方法分析老年UA患者并发衰弱的危险因素并构建列线图模型；Hosmer-Lemeshow检验评估模型拟合优度；受试者工作特征（ROC）曲线计算曲线下面积评价模型预测能力；C指数评价模型区分能力；校准曲线评价模型一致性；决策曲线评价模型的净效益；Kaplan-Meier生存曲线比较衰弱组与非衰弱组MACE发生率。结果 255例老年UA患者衰弱发生率为45.1%（115/255）。年龄、加拿大心血管病学会（CCS）分级Ⅲ～Ⅳ级、多病共存、多重用药、睡眠障碍、日常生活能力降低、营养风险、心肌肌钙蛋白T（cTnT）为老年UA患者并发衰弱的独立危险因素（均P＜0.05）。基于上述独立危险因素构建列线图模型，Hosmer-Lemeshow检验P＞0.05。ROC曲线和模型评价显示，该列线图模型预测老年UA患者并发衰弱的曲线下面积为0.891，一致性指数为0.891；校准曲线和决策曲线显示，列线图模型的预测概率与理想曲线贴合，阈值概率＞0.11时临床净获益＞0。Kaplan-Meier生存曲线显示，衰弱组MACE发生率高于非衰弱组（P＜0.05）。结论 年龄、CCS分级、多病共存、多重用药、睡眠障碍、日常生活能力降低、营养风险、cTnT是老年UA患者并发衰弱的危险因素，且对预后产生了显著不良影响，基于危险因素构建的列线图预测模型对老年UA患者并发衰弱的具有较高的预测价值、区分能力、一致性及临床适用性。

• Objective  To investigate the risk factors of frailty in elderly patients with unstable angina pectoris (UA) and its effect on prognosis. Methods A total of 255 elderly patients with UA admitted to Inner Mongolia Autonomous Region People′s Hospital from January 2021 to December 2023 were selected. According to the presence or absence of frailty, the patients were divided into frailty group and non-frailty group, and the incidence of major adverse cardiovascular events (MACE) was recorded during 1-year follow-up. The clinical data of elderly UA patients were collected, and the risk factors for frailty in elderly UA patients were analyzed by multivariate Logistic regression method and a nomogram model was constructed. The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model. Receiver operating characteristic (ROC) curve was used to calculate the area under the curve to evaluate the predictive ability of the model. C-index was used to evaluate the discrimination ability of the model. The calibration curve was used to evaluate the consistency of the model. The decision curve was used to evaluate the net benefit of the model. The Kaplan-Meier survival curve was used to compare the incidence of MACE between the frailty group and the non-frailty group. Results The incidence of frailty in 255 elderly patients with UA was 45.1% (115/255). Age, Canadian Cardiovascular Society (CCS) grade Ⅲ-Ⅳ, comorbidity, polypharmacy, sleep disorders, decreased activities of daily living, nutritional risk and cardiac troponin T (cTnT) were independent risk factors for frailty in elderly patients with UA (all P＜0.05). A nomogram model was constructed based on the above independent risk factors, and the Hosmer-Lemeshow test showed P＞0.05. ROC curve and model evaluation showed that the area under the curve of the nomogram model for predicting frailty in elderly UA patients was 0.891, and the consistency index was 0.891. The calibration curve and decision curve showed that the prediction probability of the nomogram model fitted the ideal curve, and the net clinical benefit was greater than 0 when the threshold probability was greater than 0.11. The Kaplan-Meier survival curve showed that the incidence of MACE in the frail group was higher than that in the non-frail group (P＜0.05). Conclusion Age, CCS classification, comorbidity, polypharmacy, sleep disorders, reduced activities of daily living, nutritional risk, and cTnT are risk factors for frailty in elderly UA patients, which have a significant adverse impact on the prognosis. The nomogram prediction model based on risk factors has high predictive value, discrimination ability, consistency and clinical applicability for elderly UA patients complicated with frailty.