Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT 06520-8025, USA.
J Gerontol A Biol Sci Med Sci. 2010 Apr;65(4):407-13. doi: 10.1093/gerona/glp181. Epub 2009 Nov 23.
Developing interventions to prevent frailty in older adults is a priority as it increases the risk for disability, institutionalization, and death. Single chronic inflammatory diseases are known to increase the risk of frailty. Identification of comorbid inflammatory diseases that synergistically might heighten this risk would provide further insight into therapeutic approaches to prevent frailty. The study aims were to characterize whether there are specific inflammatory disease pairs that are associated with frailty and to determine whether the risk of frailty is affected by synergistic interactions between these inflammatory diseases.
Data were from the Women's Health and Aging Studies I and II and complementary cohorts of community-dwelling women aged 70-79 years from Baltimore, Maryland (n = 620). Multivariable logistic regression analyses were performed to evaluate the relationships between these diseases and frailty.
Among the frail (11.3%), 15.2% had both depressive symptoms and anemia and 14.5% had pulmonary disease and anemia. The risk of frailty was synergistically increased in those with depressive symptoms and anemia (adjusted risk ratios = 11.93, 95% confidence interval [CI] 4.10-34.76) and those with pulmonary disease and anemia (risk ratios = 5.57, 95% CI 2.14-14.48), compared with those without either disease in each pair. The attributable proportions of frail cases due to interaction between the diseases of each pair were 0.56 (95% CI 0.07-1.05) and 0.61 (95% CI 0.18-1.05), respectively.
Synergistic interactions between specific inflammatory diseases may heighten the risk of frailty. These findings suggest that a common etiologic pathway may exist among co-occurring inflammatory diseases and that their improved comanagement may be an approach to reducing frailty.
开发干预措施以预防老年人虚弱是当务之急，因为它会增加残疾、住院和死亡的风险。已知单一的慢性炎症性疾病会增加虚弱的风险。识别协同作用可能会增加这种风险的合并炎症性疾病将为预防虚弱的治疗方法提供进一步的见解。本研究的目的是确定是否存在与虚弱相关的特定炎症性疾病对，以及这些炎症性疾病之间的协同相互作用是否会影响虚弱的风险。
数据来自巴尔的摩市马里兰州 70-79 岁的社区居住女性的妇女健康和衰老研究 I 和 II 以及补充队列（n=620）。采用多变量逻辑回归分析评估这些疾病与虚弱之间的关系。
在虚弱（11.3%）的人群中，15.2%的人同时有抑郁症状和贫血，14.5%的人同时有肺部疾病和贫血。同时患有抑郁症状和贫血的患者（调整后的风险比=11.93，95%置信区间[CI] 4.10-34.76）和同时患有肺部疾病和贫血的患者（风险比=5.57，95%CI 2.14-14.48）的虚弱风险呈协同增加，与每对疾病中没有任何一种疾病的患者相比。由于每对疾病之间的相互作用导致虚弱病例的归因比例分别为 0.56（95%CI 0.07-1.05）和 0.61（95%CI 0.18-1.05）。
特定炎症性疾病之间的协同相互作用可能会增加虚弱的风险。这些发现表明，共同发生的炎症性疾病之间可能存在共同的发病机制，改善其共同管理可能是减少虚弱的一种方法。
