429例老年慢性阻塞性肺疾病患者衰弱发展轨迹及影响因素研究

doi:10.3877/cma.j.issn.1674-6902.2026.02.019

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (02) : 309 -314. doi: 10.3877/cma.j.issn.1674-6902.2026.02.019

论著

429例老年慢性阻塞性肺疾病患者衰弱发展轨迹及影响因素研究

郑玲¹^,², 杨海艳¹, 程燕³, 夏彬雪², 刘洪会², 胡红¹, 严茂文¹, 王天露¹, 杨玉婷¹, 熊洪¹^,^†(

)

¹646000　泸州，西南医科大学附属医院呼吸与危重症医学科
²646000　泸州，西南医科大学护理学院
³646000　泸州，西南医科大学附属医院急诊医学科

收稿日期:2025-12-17 出版日期:2026-04-25
通信作者: 熊洪
基金资助:
四川省护理科研计划(H22010)

Study on the development trajectory and influencing factors of frailty in 429 elderly patients with chronic obstructive pulmonary disease

Ling Zheng¹^,², Haiyan Yang¹, Yan Cheng³, Binxue Xia², Honghui Liu², Hong Hu¹, Maowen Yan¹, Tianlu Wang¹, Yuting Yang², Hong Xiong¹^,^†()

¹Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
²College of Nursing, Southwest Medical University, Luzhou 646000, China
³Department of Emergency Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China

Received:2025-12-17 Published:2026-04-25
Corresponding author: Hong Xiong

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引用本文：

郑玲, 杨海艳, 程燕, 夏彬雪, 刘洪会, 胡红, 严茂文, 王天露, 杨玉婷, 熊洪. 429例老年慢性阻塞性肺疾病患者衰弱发展轨迹及影响因素研究[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(02): 309-314.

Ling Zheng, Haiyan Yang, Yan Cheng, Binxue Xia, Honghui Liu, Hong Hu, Maowen Yan, Tianlu Wang, Yuting Yang, Hong Xiong. Study on the development trajectory and influencing factors of frailty in 429 elderly patients with chronic obstructive pulmonary disease[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(02): 309-314.

目的

探讨老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者衰弱发展轨迹及多维度影响因素。

方法

选取2024年1月至2025年9月我院收治的429例老年COPD患者为对象。采用衰弱筛查量表(frailty screening scale, FSS)判断患者入院时(T0)、随访1个月(T1)、3个月(T2)、6个月(T3)衰弱程度。根据潜类别增长模型(latent class growth modeling, LCGM)识别衰弱发展轨迹，分为平缓205例C1组、上升70例C2组、下降154例C3组。采用单因素分析和多元Logistic回归模型分析不同轨迹的影响因素。

结果

T0时衰弱者327例(76.22%)，T3时衰弱者346例(80.65%)。T0、T1、T2、T3时相衰弱评分相关系数为0.553~0.685(P<0.01)。C1组衰弱评分4个时相点变化幅度小，截距2.68，平均斜率0.077；C2组衰弱评分随时间逐渐升高，截距0.97，平均斜率0.262；C3组衰弱评分逐渐降低，截距4.36，平均斜率－0.257。单因素分析显示，年龄、BMI、民族、文化程度、病程、用药种类、独居、握力在不同轨迹组间差异有统计学意义(P<0.05)。多元Logistic回归分析显示，与C1组相比，BMI>24(OR＝6.957，95%CI：1.434~33.760，P＝0.016)、病程3~6年(OR＝0.335，95%CI：0.154~0.728，P＝0.006)、疾病进展恐惧(OR＝1.066，95%CI：1.014~1.121，P＝0.012)、有认知障碍(OR＝1.068，95%CI：1.003~1.137，P＝0.039)是进入C2组的影响因素；与C1组相比，年龄≥80岁(OR＝2.277，95%CI：1.164~4.455，P＝0.016)、独居(OR＝6.031，95%CI：1.981~18.357，P＝0.002)、握力(OR＝1.051，95%CI：1.015~1.089，P＝0.006)是进入C3组的影响因素。随访6个月，生存414例(96.50%)，死亡15例(3.50%)，其中C2组病死率8.57%高于C1组2.44%和C3组2.60%。

结论

老年COPD患者衰弱发展存在平缓、上升、下降三种轨迹。BMI、病程、疾病进展恐惧、认知障碍、独居、握力及年龄是不同衰弱轨迹的多维度影响因素。动态监测衰弱轨迹有助于早期识别高危人群并实施个体化干预。

关键词: 肺疾病，慢性阻塞性, 衰弱轨迹, 潜在类别, 影响因素

Objective

To investigate the development trajectory and influencing factors of frailty in elderly patients with chronic obstructive pulmonary disease (COPD).

Methods

A total of 429 elderly COPD patients admitted to our hospital from January 2024 to September 2025 were selected as the study subjects. The frailty screening scale (FSS) was used to assess frailty at admission (T0), 1 month (T1), 3 months (T2), and 6 months (T3) of follow-up. Latent class growth modeling (LCGM) was applied to identify frailty development trajectories, resulting in three groups: a stable group (C1, 205 cases), an increasing group (C2, 70 cases), and a decreasing group (C3, 154 cases). Univariate analysis and multivariate logistic regression were used to analyze the influencing factors of different trajectories.

Results

At T0, 327 patients (76.22%) were frail, and at T3, 346 patients (80.65%) were frail. The correlation coefficients for frailty scores across T0, T1, T2, and T3 ranged from 0.553 to 0.685 (P<0.01). In the C1 group, the frailty score showed little change over the four time points, with an intercept of 2.68 and an average slope of 0.077. In the C2 group, the frailty score gradually increased over time, with an intercept of 0.97 and an average slope of 0.262. In the C3 group, the frailty score gradually decreased, with an intercept of 4.36 and an average slope of -0.257. Univariate analysis showed statistically significant differences in age, BMI, ethnicity, education level, disease duration, number of medication types, living alone, and grip strength among the different trajectory groups (P<0.05). Multivariate logistic regression showed that compared with the C1 group, BMI >24 (OR=6.957, 95%CI: 1.434~33.760, P=0.016), disease duration of 3~6 years (OR=0.335, 95%CI: 0.154~0.728, P=0.006), fear of progression (OR = 1.066, 95% CI: 1.014~1.121, P=0.012), and cognitive impairment (OR=1.068, 95% CI: 1.003~1.137, P=0.039) were factors associated with being in the C2 group. Compared with the C1 group, age ≥ 80 years (OR=2.277, 95%CI: 1.164~4.455, P=0.016), living alone (OR=6.031, 95%CI: 1.981~18.357, P=0.002), and grip strength (OR=1.051, 95%CI: 1.015~1.089, P=0.006) were factors associated with being in the C3 group. After 6 months of follow-up, 414 patients (96.50%) survived and 15 (3.50%) died, with a mortality rate of 8.57% in the C2 group, which was higher than that in the C1 group (2.44%) and the C3 group (2.60%).

Conclusion

The development of frailty in elderly COPD patients follows three distinct trajectories: stable, increasing, and decreasing. BMI, disease duration, fear of progression, cognitive impairment, living alone, grip strength, and age are influencing factors for different frailty trajectories. Dynamic monitoring of frailty trajectories may help identify high-risk individuals early and facilitate personalized interventions.

Key words: Chronic obstructive pulmonary disease, Frailty trajectory, Latent class, Influencing factors

表1 老年COPD患者衰弱得分的潜类别增长模型拟合结果

类　别	AIC	BIC	aBIC	Entropy	BLRT(P)	潜类别概率(%)
1	4 942.571	4 975.063	4 949.676			100.00
2	4 345.116	4 397.915	4 356.661	0.870	0.000	30.54/69.46
3	4 113.442	4 186.548	4 129.427	0.845	0.000	47.79/16.32/35.90
4	3 517.751	3 611.164	3 538.176	0.999	0.000	22.84/44.29/4.43/28.44
5	3 467.370	3 581.091	3 492.236	0.972	0.000	4.43/22.84/44.29/5.13/23.31

表1 老年COPD患者衰弱得分的潜类别增长模型拟合结果

类　别	AIC	BIC	aBIC	Entropy	BLRT(P)	潜类别概率(%)
1	4 942.571	4 975.063	4 949.676			100.00
2	4 345.116	4 397.915	4 356.661	0.870	0.000	30.54/69.46
3	4 113.442	4 186.548	4 129.427	0.845	0.000	47.79/16.32/35.90
4	3 517.751	3 611.164	3 538.176	0.999	0.000	22.84/44.29/4.43/28.44
5	3 467.370	3 581.091	3 492.236	0.972	0.000	4.43/22.84/44.29/5.13/23.31

表2 老年COPD患者不同时相衰弱变化及相关性

时　相	衰弱[n(%)]	衰弱前期[n(%)]	无衰弱[n(%)]	衰弱评分[M(P₂₅, P₇₅)]	相关系数
时　相	衰弱[n(%)]	衰弱前期[n(%)]	无衰弱[n(%)]	衰弱评分[M(P₂₅, P₇₅)]	T0	T1	T2
T0	327(76.22)	85(19.81)	17(3.96)	3(2 ，4)	1.000
T1	332(77.39)	95(22.14)	2(0.47))	2(1 ，3)	0.642^a	1.000
T2	341(79.49)	88(20.51)	0(0.00)	2(1 ，3)	0.685^a	0.671^a	1.000
T3	346(80.65)	82(19.11)	1(0.23)	3(2 ，4)	0.661^a	0.553^a	0.560^a

表2 老年COPD患者不同时相衰弱变化及相关性

时　相	衰弱[n(%)]	衰弱前期[n(%)]	无衰弱[n(%)]	衰弱评分[M(P₂₅, P₇₅)]	相关系数
时　相	衰弱[n(%)]	衰弱前期[n(%)]	无衰弱[n(%)]	衰弱评分[M(P₂₅, P₇₅)]	T0	T1	T2
T0	327(76.22)	85(19.81)	17(3.96)	3(2 ，4)	1.000
T1	332(77.39)	95(22.14)	2(0.47))	2(1 ，3)	0.642^a	1.000
T2	341(79.49)	88(20.51)	0(0.00)	2(1 ，3)	0.685^a	0.671^a	1.000
T3	346(80.65)	82(19.11)	1(0.23)	3(2 ，4)	0.661^a	0.553^a	0.560^a

图1 每组COPD患衰弱变化轨迹注：T0为入院时；T1为1个月；T2为3个月；T3为6个月；C1为平缓组、C2为上升组、C3为下降组

表3 每组COPD患者衰弱发展轨迹单因素分析

临床资料	C1(n＝205)	C2(n＝70)	C3(n＝154)	统计量	P值
年龄[n(%)]				16.166^a	0.003
60~69	82(40.00)	39(55.71)	46(29.87)
70~79	83(40.49)	21(30.00)	63(40.91)
≥80	40(19.51)	10(14.29)	45(29.22)
BMI[n(%)]				12.809^a	0.012
<18.5	47(22.93)	9(12.86)	41(26.62)
18.5~24	152(74.15)	53(75.71)	107(69.48)
>24	6(2.93)	8(11.43)	6(3.90)
民族[n(%)]				8.745^a	0.013
汉族	203(99.02)	66(94.29)	153(99.35)
其他	2(0.98)	4(5.71)	1(0.65)
文化程度[n(%)]				14.508^a	0.024
小学及以下	153(74.63)	52(74.29)	105(68.18)
初中	44(21.46)	13(18.57)	34(22.08)
高中或中专/大专	8(3.90)	5(7.14)	8(5.29)
大专及以上	0(0.00)	0(0.00)	7(4.55)
病程[n(%)]				20.185^a	0.001
1~2年	39(19.02)	29(41.43)	29(18.83)
3~6年	111(54.15)	25(35.71)	71(46.10)
>6年	55(26.83)	16(22.86)	54(35.06)
用药种类[n(%)]				6.199^a	0.045
<3类	114(55.61)	49(70.00)	81(52.60)
≥3类	91(44.39)	21(30.00)	73(47.40)
独居[n(%)]	6(2.93)	5(7.14)	14(9.09)	6.325^a	0.042
握力[kg，M(P₂₅，P₇₅)]	12.8(10.9，17.4)	15.9(11.2，22.5)	12.3(9.5，17.9)	9.450^b	0.000

表3 每组COPD患者衰弱发展轨迹单因素分析

临床资料	C1(n＝205)	C2(n＝70)	C3(n＝154)	统计量	P值
年龄[n(%)]				16.166^a	0.003
60~69	82(40.00)	39(55.71)	46(29.87)
70~79	83(40.49)	21(30.00)	63(40.91)
≥80	40(19.51)	10(14.29)	45(29.22)
BMI[n(%)]				12.809^a	0.012
<18.5	47(22.93)	9(12.86)	41(26.62)
18.5~24	152(74.15)	53(75.71)	107(69.48)
>24	6(2.93)	8(11.43)	6(3.90)
民族[n(%)]				8.745^a	0.013
汉族	203(99.02)	66(94.29)	153(99.35)
其他	2(0.98)	4(5.71)	1(0.65)
文化程度[n(%)]				14.508^a	0.024
小学及以下	153(74.63)	52(74.29)	105(68.18)
初中	44(21.46)	13(18.57)	34(22.08)
高中或中专/大专	8(3.90)	5(7.14)	8(5.29)
大专及以上	0(0.00)	0(0.00)	7(4.55)
病程[n(%)]				20.185^a	0.001
1~2年	39(19.02)	29(41.43)	29(18.83)
3~6年	111(54.15)	25(35.71)	71(46.10)
>6年	55(26.83)	16(22.86)	54(35.06)
用药种类[n(%)]				6.199^a	0.045
<3类	114(55.61)	49(70.00)	81(52.60)
≥3类	91(44.39)	21(30.00)	73(47.40)
独居[n(%)]	6(2.93)	5(7.14)	14(9.09)	6.325^a	0.042
握力[kg，M(P₂₅，P₇₅)]	12.8(10.9，17.4)	15.9(11.2，22.5)	12.3(9.5，17.9)	9.450^b	0.000

表4 老年COPD患者衰弱发展轨迹多元Logistic回归分析

类　别	预测变量	分类	B	SE	Wald	P值	OR	95%CI
C2 vs. C1	截距		0.497	2.479	0.040	0.841	1.644
	BMI分级	>24	1.940	0.806	5.793	0.016	6.957	1.434~33.760
	病程	3~6年	－1.094	0.396	7.625	0.006	0.335	0.154~0.728
	疾病进展恐惧		0.064	0.026	6.314	0.012	1.066	1.014~1.121
	MMSE分级	有认知障碍	0.066	0.032	4.263	0.039	1.068	1.003~1.137
C3 vs. C1	截距		－0.835	2.042	0.167	0.682	0.434
	年龄	80岁及以上	0.823	0.342	5.778	0.016	2.277	1.164~4.455
	独居		1.797	0.568	10.010	0.002	6.031	1.981~18.357
	握力		0.050	0.018	7.688	0.006	1.051	1.015~1.089

表4 老年COPD患者衰弱发展轨迹多元Logistic回归分析

类　别	预测变量	分类	B	SE	Wald	P值	OR	95%CI
C2 vs. C1	截距		0.497	2.479	0.040	0.841	1.644
	BMI分级	>24	1.940	0.806	5.793	0.016	6.957	1.434~33.760
	病程	3~6年	－1.094	0.396	7.625	0.006	0.335	0.154~0.728
	疾病进展恐惧		0.064	0.026	6.314	0.012	1.066	1.014~1.121
	MMSE分级	有认知障碍	0.066	0.032	4.263	0.039	1.068	1.003~1.137
C3 vs. C1	截距		－0.835	2.042	0.167	0.682	0.434
	年龄	80岁及以上	0.823	0.342	5.778	0.016	2.277	1.164~4.455
	独居		1.797	0.568	10.010	0.002	6.031	1.981~18.357
	握力		0.050	0.018	7.688	0.006	1.051	1.015~1.089

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Study on the development trajectory and influencing factors of frailty in 429 elderly patients with chronic obstructive pulmonary disease

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Study on the development trajectory and influencing factors of frailty in 429 elderly patients with chronic obstructive pulmonary disease