ABSTRACT
Objective:To investigate the therapeutic effect of comprehensive geriatric assessment(CGA) in elderly patients with chronic heart failure(CHF) complicated with sarcopenia, and to provide a theoretical reference for clinical application.Methods:This study was a prospective randomized controlled study. 110 elderly CHF patients with myopenia admitted to the Third People's Hospital of Hefei from January 2019 to February 2022 were selected. Using the random number table method, 56 cases were divided into an observation group and 54 cases into a control group. Before treatment, the control group of patients underwent a selective single assessment based on the hospital's requirements and the patient's actual situation, including a fall risk assessment, nutritional risk screening checklist assessment, and routine medication to improve cardiac function and prognosis; Before treatment, the patients in the observation group were assessed with CGA, including the assessment of physical function, mental and psychological status, multiple drug management, pain, Sleep disorder, and social environment. According to the assessment results, individual diagnosis and treatment plans were formulated, implemented, and dynamically adjusted. The two groups were treated for 12 weeks. The general information, treatment compliance, B-type brain natriuretic peptide (BNP) level, left ventricular Ejection fraction (LVEF), 6 min walking distance (6MWD), arm strength of upper limbs and 6 m walking speed, clinical efficacy and prognosis of the two groups were compared before and after treatment. The measurement data is represented by xˉ± s, group t-tests are used for inter group comparison, and paired t-tests are used for intra group comparison before and after treatment; Counting data is represented as an example (%), and inter group comparisons are made using χ 2 test, non parametric rank sum test was used for inter group comparison of hierarchical data. Results:There was no statistically significant difference in gender, age, course of CHF, smoking, alcohol consumption, number of comorbidities, cardiac function grading, and treatment compliance between the two groups of patients (all P>0.05), indicating comparability. Before treatment, there was no statistically significant difference in plasma BNP, LVEF, 6MWD, upper limb grip strength, and 6-meter walking speed between the two groups of patients (all P>0.05); After treatment, the BNP of both groups of patients was lower than before treatment and the observation group was lower than the control group. LVEF, 6MWD, upper limb grip strength, and 6-meter walking speed were all higher than before treatment and the observation group was higher than the control group [(343.45±34.95) ng/L vs (387.09±46.96) ng/L, (49.61±7.11)% vs (42.94±5.72)%, (348.92±37.73) m vs (297.74±43.48) m, (22.64±3.82) kg vs (19.48±3.88) kg, (0.97±0.10) m/s vs (0.83±0.12) m/s], The differences were statistically significant ( t-values were 5.51, -5.40, -6.60, -4.31, -6.60, all P<0.001). After 12 weeks of treatment, there was no statistically significant difference in clinical efficacy between the two groups of patients ( P=0.216), but the overall poor prognosis rate in the follow-up observation group was lower than that in the control group [7.14%(4/56) vs 22.22% (12/54)], and the difference was statistically significant (χ 2=5.03, P=0.025). Conclusions:Developing, implementing, and dynamically adjusting the individualized treatment plan involving CGA can improve the prognosis of elderly CHF patients with sarcopenia, help improve cardiac function, increase grip strength and somatic function, and reduce the risk of major adverse cardiovascular events ,all-cause mortality in elderly patients with CHF combined with sarcopeni and has certain clinical application value.
ABSTRACT
Objective To analyze serum calcium and phosphorus levels and its related factors of clinical type 2 diabetes mellitus (T2DM) with overt diabetic kidney disease (T2-dDKD).Methods Ninety cases of T2DM patients according to K/DOQI Recommendations in 2007 were selected as the study subjects.Based on the patients' 2 times mean urinary albumin/creatinine ratio (ACR),these people were divided into three groups,namely Normal albuminuria group (30 patients,ACR＜30 mg/gCr),Microalbuminuria group (30 patients,ACr =30-300 mg/gCr),Macroalbuminuria group (30 patients,ACR＞300 mg/gCr).Thirty cases of healthy at the same period were selected as the Control group.Serum calcium,phosphorus,hs-CRP,IL-6,HbA1c were detected.And glomerular filtration rate (eGFR) was calculated.Results The eGFR in Normal albuminuria group was more higher than other groups (P＜0.05),the eGFR of Microalbuminuria group was significantly lower than other groups (P＜0.05).Subgroups of T2DM with different albuminuria presence and severity,duration was also different between the groups,the more albumin in urine,the longer its duration.The contents of HbA1c in the groups of varying degrees of albuminuria increased as urinary albumin aggravation (HbA1c was (8.87±2.44) ％,(9.27±2.74)％,(11.04±2.86)％ respectively,P＜0.05),but there was not statistically significant between Microalbuminuria group ((9.27±2.74)％) and Normal albuminuria group ((8.87±2.44) ％).Compared with Control group,in subgroups of T2DM,serum calcium was decreased((2.22±0.19) mmol/L,(2.16±0.14) mmol/L,(2.13±0.18) mmol/L,and the Contorl group was (2.32±0.11)mmol/L,P＜0.05),and serum phosphorus ((1.16±0.31) mmol/L,(1.42±0.52) mmol/L,(1.98±0.58)mmol/L,and the Control group was (1.08±0.28) mmol/L),hs-CRP ((4.82±0.89) mmol/L,(8.46± 2.85)mmol/L,(13.09±3.49) mmol/L,and the Control group was (2.46±0.48) mmol/L),IL-6((10.32±4.19)pg/L,(14.78±4.34) pg/L,(16.67±6.62) pg/L,and the Control group was (7.03±2.15) pg/L) were increased(P＜0.05).In subgroups of T2DM,hs-CRP was significantly increased with the increase of the serum albumin((4.82±0.89) mmol/L,(8.46±2.85) mmol/L,(13.09±3.49) mmol/L,P＜0.05),there were no statistical significance about blood phosphorus among Macroalbuminuria group (1.98±0.58) mmol/L),control group((1.08±0.28) mmol/L),normal albuminuria group((1.16±0.31) mmol/L) and albumin urinary group (1.42±0.52) mmol/L).Serum phosphorus in Microalbuminuria group were positively correlated with hs-CRP,IL-6,HbA1c (r =0.431,0.384,0.517 respectively,P＜0.05).Serum phosphorus in Macroalbuminuria group were positively correlated with hs-CRP,IL-6,HbA1c (r=0.825,0.622,0.683 respectively,P＜0.01),but negatively with eGFR(r=0.600,P＜0.01).Conclusion Serum phosphorus metabolism is abnormal in patients with diabetic nephropathy,hs-CRP,IL-6,and HbA1c are the related factors influencing the progression of serum phosphorus in patients with diabetic nephropathy.