中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (02): 77-81.doi: 10.3969/j.issn.1671-4091.2014.02.004

• 临床研究 • 上一篇    下一篇

腹膜透析患者抑郁与炎症状态、营养不良和心血管疾病相关分析

李哲1 ,裴华颖1*, 董捷2 ,吴晓磊1 ,卢素玉1, 殷小文1 ,傅淑霞1   

  1. 1. 河北医科大学大学第二医院肾内科 2. 北京大学第一医院肾内科
  • 收稿日期:2013-12-06 修回日期:2013-12-10 出版日期:2014-02-12 发布日期:2014-02-12
  • 通讯作者: 裴华颖 huayingpei@163.com E-mail:huayingpei@163.com

The association of depression with malnutrition, inflammation and cardiovascular disease in peritoneal dialysis patients

  • Received:2013-12-06 Revised:2013-12-10 Online:2014-02-12 Published:2014-02-12

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摘要： 目的：探讨腹透患者抑郁与炎症状态、营养不良和心血管疾病的关系。方法：腹膜透析大于3个月的患者120例，填写Zung自评抑郁量表（SDS）及生活质量量表（SF-36），SDS标准分≥50为抑郁。记录患者一般情况及生化指标，根据患者是否ALb≤35g/L,CRP≥8mg/L，曾发生过心血管事件赋值并分组。结果：1.抑郁的发生率为55.83%，男性占34.33%，女性占65.67%。抑郁组女性偏多，透析时间偏长，血浆Alb及Hb水平、残余肾功能普遍偏低，血浆CRP水平、心血管事件的发生偏高；与非抑郁组比较均有统计学差异（P<0.05）。抑郁组患者生活质量各维度得分普遍偏低，与非抑郁组相比存在显著差异（P=0.002）。2.二元Logistic回归分析显示，残余肾功能和赋值分组情况与抑郁呈显著相关（B=-0.460,OR=0.631,P=0.002及P=0.008)。3.多元线性回归显示，残余肾功能、性别和赋值分组情况是生活质量的独立危险因素（P<0.05）结论：腹透患者中抑郁患病率较高，具有ALb≤35g/L和/或CRP≥8mg/L和/或心血管事件等危险因素越多，患者越易发生抑郁，抑郁程度越严重。

关键词: 腹膜透析, 抑郁, 炎症状态, 营养不良, 心血管疾病

Abstract: Objective The objective of this study was to explore the association of depression with inflammation, malnutrition and cardiovascular disease in peritoneal dialysis (PD) patients. Methods One hundred and twenty patients undergoing peritoneal dialysis over three months were enrolled in this study. We used the Zung self-rating depression scale (SDS) to assess the severity of depression, and the SF-36 questionnaire to assess quality of life. Clinical data, cardiovascular disease, and laboratory results were collected. Patients were divided into groups based on cardiovascular events and the values of Alb (<35g/L) and CRP (＞ 8mg/L) Results ① In peritoneal dialysis patients, the prevalence of depression (SDS score ≥50) was 55.83%. The prevalence of depression was higher in females (44 cases, 65.67%) than in males (23 cases, 34.33%), and was higher in the PD patients with longer dialysis age (average 28 months, 17～60 months), lower serum albumin (33.78±4.03 g/L), lower hemoglobin (102.60±15.18 g/L), less residual renal function (average 0.78 ml/ min, 0.00～2.53 ml/min), higher serum CRP (average 2.7 mg/L, 2.1～8.0 mg/L), and higher rate of cardiovascular event (29.85%), than in those with higher serum albumin (36.48±2.84)g/L), higher hemoglobin (112.26± 10.07 g/L), more residual renal function (average 1.25 ml/min, 0.00～1.50 ml/min), lower serum CRP (average 2.4 mg/L, 1.85～3.20 mg/L), and lower rate of cardiovascular event (9.43%). These parameters were statistically significant (P＜0.05) between PD patients with depression and those without depression. In PD patients with depression, the scores of quality of life were lower in every dimension than in those without depression (P=0.002).②Binary logistic regression analysis demonstrated that depression was significantly correlated with residual renal function (B=-0.434, OR=0.648, P=0.045) and assignment of group (P=0.008). (c) Multivariate linear regression analyses showed that residual renal function (B=1.975, P=0.009), gender (B=6.955, P=0.003), and assignment of group (B=- 3.669, P=0.009) were the independent risk factors for quality of life. Conclusion The prevalence of depression was higher in PD patients, especially in those with Alb ≤35g/L, CRP ≥8mg/L, and cardiovascular diseases.

Key words: Peritoneal dialysis, Depression, Inflammation, Malnutrition, Cardiovascular disease