Chao Chia-Ter, Hung Kuan-Yu
Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.
Kaohsiung J Med Sci. 2023 Apr;39(4):318-325. doi: 10.1002/kjm2.12664. Epub 2023 Mar 3.
Frailty is the incremental accumulation of minute defects that progressively impair health and performance. Frailty is commonly observed in older adults; however, secondary frailty may also occur in patients with metabolic disorders or major organ failure. In addition to physical frailty, several distinct types of frailty have been identified, including oral, cognitive, and social frailty, each of which is of practical importance. This nomenclature suggests that detailed descriptions of frailty can potentially advance relevant researches. In this narrative review, we first summarize the clinical value and plausible biological origin of frailty, as well as how to appropriately assess it using physical frailty phenotypes and frailty indexes. In the second part, we discuss the issue of vascular tissue as a relatively underappreciated organ whose pathologies contribute to the development of physical frailty. Moreover, when vascular tissue undergoes degeneration, it exhibits vulnerability to subtle injuries and manifests a unique phenotype amenable to clinical assessment prior to or accompanying physical frailty development. Finally, we propose that vascular frailty, based on an extensive set of experimental and clinical evidence, can be considered a new frailty type that requires our attention. We also outline potential methods for the operationalization of vascular frailty. Further studies are required to validate our claim and sharpen the spectrum of this degenerative phenotype.
衰弱是微小缺陷的渐进性累积，会逐渐损害健康和功能。衰弱在老年人中很常见；然而，继发性衰弱也可能发生在患有代谢紊乱或主要器官衰竭的患者中。除了身体衰弱外，还发现了几种不同类型的衰弱，包括口腔、认知和社会衰弱，每种衰弱都具有实际重要性。这种命名法表明，对衰弱的详细描述可能会推动相关研究。在这篇叙述性综述中，我们首先总结了衰弱的临床价值和可能的生物学起源，以及如何使用身体衰弱表型和衰弱指数对其进行适当评估。在第二部分中，我们讨论了血管组织这一相对未被充分认识的器官的问题，其病理学促成了身体衰弱的发展。此外，当血管组织发生退化时，它会表现出对细微损伤的易感性，并在身体衰弱发展之前或伴随身体衰弱发展时表现出一种适合临床评估的独特表型。最后，基于大量的实验和临床证据，我们提出血管衰弱可被视为一种需要我们关注的新的衰弱类型。我们还概述了血管衰弱可操作化的潜在方法。需要进一步的研究来验证我们的主张，并明确这种退化表型的范围。
