老年住院冠心病患者生活质量危险因素及其与运动耐量的相关性

Risk factors of quality of life and its correlation with exercise tolerance in elderly inpatients with coronary heart disease

【摘要】目的 探讨影响老年住院冠心病(CHD)患者生活质量的危险因素,并分析其与运动耐量的相关性。方法 回顾性分析2022年1月至2023年10月于南京医科大学第一附属医院住院治疗的285例老年CHD患者的临床资料。患者入院后通过《冠心病心脏康复基层指南(2020年)》、健康状况调查表对运动耐量与生活质量进行评估,比较不同运动耐量老年住院CHD患者生活质量评分,并通过Spearman等级相关系数分析运动耐量与生活质量间的相关性。同时收集老年住院CHD患者各项临床资料信息,比较不同临床特征患者生活质量评分,并采取多变量logistic回归分析明确影响老年住院CHD患者生活质量的危险因素。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、χ²检验及方差分析。结果 不同运动耐量老年住院CHD患者生活质量评分存在显著差异,其中＞7METs的患者生活质量评分显著高于5～7代谢当量(METs)和＜5METs的患者,而5～7METs的患者生活质量评分显著高于＜5METs的患者,差异均有统计学意义(均P＜0.05)。老年住院CHD患者运动耐量与生活质量各维度及总分间均呈正相关(P＜0.05)。不同年龄、美国纽约心脏病协会(NYHA)心功能分级、CHD病程、文化程度、合并慢性疾病数量、月收入、运动耐量、血运重建的老年住院CHD患者生活质量评分比较,差异均有统计学意义(均P＜0.05)。经多变量logistic回归分析证实,年龄≥70岁(OR=1.930,95%CI 1.189～3.133)、NYHA心功能分级Ⅲ～Ⅳ级(OR=1.230,95%CI 1.028～1.472)、CHD病程≥5年(OR=3.102,95%CI 1.475～6.524)、文化程度初中(OR=2.287,95%CI 1.174～4.455)、合并慢性疾病数量3种及以上(OR=1.577,95%CI 1.015～2.450)、月收入＜2000元/月(OR=2.149,95%CI 1.374～3.361)、运动耐量≤7METs(OR=3.775,95%CI 1.159～12.296)、未行血运重建(OR=3.987,95%CI 1.178～13.492)为影响老年住院CHD患者生活质量的危险因素(均P＜0.05)。结论 老年住院CHD患者运动耐量与生活质量呈现出明显相关性,年龄≥70岁、NYHA心功能分级Ⅲ～Ⅳ级、CHD病程≥5年、文化程度初中、合并慢性疾病数量≥3种、月收入＜2000元/月、运动耐量≤7METs、未行血运重建为影响老年住院CHD患者生活质量的危险因素。临床应加强这些因素的管理,以提升患者生活品质。

基金项目:国家自然科学基金青年科学基金(82000319)

【Abstract】Objective To investigate the risk factors of quality of life in elderly inpatients with coronary heart disease (CHD) and to explore its correlation with exercise tolerance. Methods A retrospective analysis was made of the clinical data of 285 elderly CHD patients hospitalized in the First Affiliated Hospital of Nanjing Medical University from January 2022 to October 2023. On admission, exercise tolerance and quality of life were evaluated using the 《Basic Guidelines for Coronary Heart Disease Rehabilitation (2020)》 and health status questionnaire. The quality of life scores of elderly CHD inpatients with different exercise tolerance were compared, and the correlation between exercise tolerance and quality of life was analyzed by Spearman′s correlation coefficient. At the same time, the patients′ clinical data and information were collected, and their quality of life scores with different clinical characteristics were compared. Multivariate logistic regression analysis was used to identify the risk factors affecting the quality of life of elderly CHD inpatients. SPSS statistics 22.0 was used for statistical analysis. Data comparison between two groups was performed using t test,χ² test or analysis of variance depending on data type. Results There were significant differences in the quality of life scores of the elderly CHD inpatients with different exercise tolerance. The quality of life scores of patients with > 7 metabolic equivalents ( METs) was significantly higher than those of patients with 5-7 METs and < 5 METs, while the quality of life scores of patients with 5-7 METs was significantly higher than those of patients with < 5 METs, and the difference was statistically significant (P<0.05). The exercise tolerance was positively correlated with all dimensions of quality of life and total score in elderly CHD inpatients (P<0.05). Quality of life scores of elderly CHD inpatients differed with age, New York Heart Association (NYHA) cardiac function grade, CHD duration, education level, number of chronic diseases, monthly income, exercise tolerance and revascularization, and the differences were statistically significant (P<0.05 for all). Multivariate logistic regression analysis confirmed that age ≥70 years (OR=1.930,95%CI 1.189-3.133), NYHA class Ⅲ/Ⅳ (OR=1.230,95%CI 1.028-1.472), CHD duration ≥5 years (OR=3.102,95%CI 1.475-6.524), junior high school education (OR=2.287,95%CI 1.174-4.455), ≥3 chronic diseases (OR=1.577,95%CI 1.015-2.450), monthly income <2 000 yuan (OR=2.149,95%CI 1.374-3.361), exercise tolerance ≤7 METs (OR=3.775,95%CI 1.159-12.296), and no revascularization (OR=3.987,95%CI 1.178-13.492) were the risk factors affecting the quality of life of elderly CHD inpatients (P<0.05 for all). Conclusion Exercise tolerance is significantly correlated with quality of life in elderly CHD inpatients. Age ≥70 years, NYHA class Ⅲ/Ⅳ, CHD course ≥5 years, junior high school education, three or more comorbid chronic diseases, monthly income <2 000 yuan, exercise tolerance ≤7 METs, and no revascularization were risk factors affecting the quality of life of elderly CHD inpatients. The management of these factors should be strengthened clinically to improve patients′ quality of life.

This work was supported by the National Natural Science Foundation of China for Young Scholars (82000319).