认知功能、肌肉减少症和炎症与虚弱密切相关：弗雷明汉队列研究。
Cognitive Function, Sarcopenia, and Inflammation Are Strongly Associated with Frailty: A Framingham Cohort Study.
机构信息
University of California at Los Angeles, Los Angeles.
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor.
出版信息
Am J Med. 2021 Dec;134(12):1530-1538. doi: 10.1016/j.amjmed.2021.07.012. Epub 2021 Aug 28.
BACKGROUND
Frailty is an important contributor to morbidity and mortality in chronic liver disease. Understanding the contributors to frailty has the potential to identify individuals at risk for frailty and may potentially provide targets for frailty-modifying interventions. We evaluated the relationship among cognitive function, inflammation, and sarcopenia and frailty.
METHODS
Using cohorts from the Framingham Heart Study (2011-2014), we evaluated for factors associated with frailty. Exposures included cognitive tests (combined Trails A/B test, Animal Naming Test, and combined Digit Span Forward/Backward test), inflammation (interleukin-6 and tumor necrosis factor receptor II), and sarcopenia (creatinine-to-cystatin C ratio). We performed linear and logistic regression to identify the relationship between these exposures and the Liver Frailty Index (LFI).
RESULTS
The study population (N = 1208) had a median age of 70 years, was 56% female, and 48.5% had evidence of liver disease. The combined Trails A/B test (β 0.05, P < .001), creatinine-to-cystatin C (β -0.17, P = .006), and both inflammatory markers, interleukin-6 levels (β 0.16, P = .002) and tumor necrosis factor receptor II (β 0.21, P = .04), were independently associated with the LFI. Using an LFI cutoff of ≥4.5 to define frailty, Trails A/B (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.07-1.37), Animal Naming Test (OR 0.64, 95% CI 0.42-0.97), sarcopenia (OR 0.10, 95% CI 0.01-0.73), and interleukin-6 (OR 4.99, 95% CI 1.03-15.53) were all associated with frailty. Although liver disease did not modify the relationship between the LFI and the Trails A/B test, interleukin-6 was significantly associated with the LFI only in the presence of liver disease.
CONCLUSIONS
Cognitive performance, inflammation, and sarcopenia, each highly prevalent in cirrhosis, are associated with the LFI in this population-based study of persons without cirrhosis. Further research is warranted for interventions aiming to prevent frailty by tailoring their approach to the patient's underlying risk factors.
背景
衰弱是慢性肝病患者发病率和死亡率的重要原因。了解衰弱的原因有可能确定衰弱的高危人群，并可能为衰弱的干预提供目标。我们评估了认知功能、炎症和肌肉减少症与衰弱之间的关系。
方法
我们使用弗雷明汉心脏研究（2011-2014 年）的队列，评估与衰弱相关的因素。暴露因素包括认知测试（Trails A/B 测试、动物命名测试和数字跨度正向/反向测试的组合）、炎症（白细胞介素-6 和肿瘤坏死因子受体 II）和肌肉减少症（肌酐与胱抑素 C 的比值）。我们进行线性和逻辑回归，以确定这些暴露因素与肝脏衰弱指数（LFI）之间的关系。
结果
研究人群（N=1208）的中位年龄为 70 岁，56%为女性，48.5%有肝脏疾病证据。Trails A/B 测试的综合结果（β 0.05，P<0.001）、肌酐与胱抑素 C 的比值（β -0.17，P=0.006）和两种炎症标志物，白细胞介素-6 水平（β 0.16，P=0.002）和肿瘤坏死因子受体 II（β 0.21，P=0.04）均与 LFI 独立相关。使用 LFI 临界值≥4.5 来定义衰弱，Trails A/B（比值比[OR]1.21，95%置信区间[CI]1.07-1.37）、动物命名测试（OR 0.64，95%CI 0.42-0.97）、肌肉减少症（OR 0.10，95%CI 0.01-0.73）和白细胞介素-6（OR 4.99，95%CI 1.03-15.53）均与衰弱相关。虽然肝脏疾病并没有改变 LFI 与 Trails A/B 测试之间的关系，但白细胞介素-6 仅在存在肝脏疾病时才与 LFI 显著相关。
结论
在这项非肝硬化人群的基于人群的研究中，认知表现、炎症和肌肉减少症在肝硬化中均很常见，与 LFI 相关。需要进一步研究针对患者潜在危险因素的干预措施，以防止衰弱。
Zotero 插件