Walston Jeremy, McBurnie Mary Ann, Newman Anne, Tracy Russell P, Kop Willem J, Hirsch Calvin H, Gottdiener John, Fried Linda P
Johns Hopkins Medical Institutions, Baltimore, Md, USA.
Arch Intern Med. 2002 Nov 11;162(20):2333-41. doi: 10.1001/archinte.162.20.2333.
The biological basis of frailty has been difficult to establish owing to the lack of a standard definition, its complexity, and its frequent coexistence with illness.
To establish the biological correlates of frailty in the presence and absence of concurrent cardiovascular disease and diabetes mellitus.
Participants were 4735 community-dwelling adults 65 years and older. Frail, intermediate, and nonfrail subjects were identified by a validated screening tool and exclusion criteria. Bivariate relationships between frailty level and physiological measures were evaluated by Pearson chi2 tests for categorical variables and analysis of variance F tests for continuous variables. Multinomial logistic regression was performed to evaluate multivariable relationships between frailty status and physiological measures.
Of 4735 Cardiovascular Health Study participants, 299 (6.3%) were identified as frail, 2147 (45.3%) as intermediate, and 2289 (48.3%) as not frail. Frail vs nonfrail participants had increased mean +/- SD levels of C-reactive protein (5.5 +/- 9.8 vs 2.7 +/- 4.0 mg/L), factor VIII (13 790 +/- 4480 vs 11 860 +/- 3460 mg/dL), and, in a smaller subset, D dimer (647 +/- 1033 vs 224 +/- 258 ng/mL) (P< or =.001 for all, chi2 test for trend). These differences persisted when individuals with cardiovascular disease and diabetes were excluded and after adjustment for age, sex, and race.
These findings support the hypothesis that there is a specific physiological basis to the geriatric syndrome of frailty that is characterized in part by increased inflammation and elevated markers of blood clotting and that these physiological differences persist when those with diabetes and cardiovascular disease are excluded.
由于缺乏标准定义、其复杂性以及常与疾病并存，衰弱的生物学基础难以确立。
确定在合并和不合并心血管疾病及糖尿病的情况下衰弱的生物学相关因素。
参与者为4735名65岁及以上的社区居住成年人。通过经过验证的筛查工具和排除标准确定衰弱、中间状态和非衰弱受试者。对于分类变量，通过Pearson卡方检验评估衰弱水平与生理指标之间的双变量关系；对于连续变量，通过方差分析F检验进行评估。进行多项逻辑回归以评估衰弱状态与生理指标之间的多变量关系。
在4735名心血管健康研究参与者中，299人（6.3%）被确定为衰弱，2147人（45.3%）为中间状态，2289人（48.3%）为非衰弱。与非衰弱参与者相比，衰弱参与者的C反应蛋白平均±标准差水平升高（5.5±9.8 vs 2.7±4.0 mg/L）、因子VIII升高（13790±4480 vs 11860±3460 mg/dL），在较小的亚组中，D二聚体也升高（647±1033 vs 224±258 ng/mL）（所有P<或=.001，趋势卡方检验）。排除患有心血管疾病和糖尿病的个体并对年龄、性别和种族进行调整后，这些差异仍然存在。
这些发现支持以下假设，即衰弱这一老年综合征存在特定的生理基础，其部分特征为炎症增加和凝血标志物升高，并且在排除糖尿病和心血管疾病患者后，这些生理差异仍然存在。
