中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (10): 658-662.doi: 10.3969/j.issn.1671-4091.2018.10.003

• 临床研究 • 上一篇    下一篇

维持性血液透析患者抑郁与透析相关临床生化指标间的关系研究

石艳1,张明昊2,姚曦1   

  1. 1. 重庆市第九人民医院肾脏内科
    2. 重庆医科大学实验教学管理中心
  • 收稿日期:2018-05-14 修回日期:2018-07-23 出版日期:2018-10-12 发布日期:2018-10-12
  • 通讯作者: 姚曦156543868@qq.com E-mail:156543868@qq.com
  • 基金资助:

    重庆市卫生计生委2017ZBXM019 号项目；重庆市科委cstc2015shmszx120069号项目

The relationship between depression and dialysis-related clinical and biochemical parameters in maintenance hemodialysis patients

  • Received:2018-05-14 Revised:2018-07-23 Online:2018-10-12 Published:2018-10-12

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摘要： 【摘要】目的通过横断面调查研究，探讨维持性血液透析(maintenance hemodialysis, MHD)患者抑郁与透析相关临床生化指标间的关系。方法采用便利抽样法，选取符合入选条件的MHD 患者80 例，使用贝克抑郁量表(Beck Depression Inventory, BDI)评估其抑郁程度，并收集其近1 个月来透析相关临床指标、抑郁评估当次的透析相关生化指标。根据BDI 结果将MHD 患者分为抑郁组和非抑郁组，使用卡方检验和独立样本t 检验比较两组基线特质及透析相关临床生化指标的差异。使用Logistic 回归分析寻找MHD 患者抑郁发生的保护性和危险性因素。结果符合入选条件并完成研究的患者共75 例，其中抑郁组53 例，非抑郁组22 例，抑郁的检出率高达70.67%。2 组患者年龄、透析龄、性别、教育程度和病因并无统计学意义(P﹥0.05)。非抑郁组MHD 患者透析前血小板(t=3.466，P=0.001)、血总蛋白(t=2.462, P=0.016)、血白蛋白(t=2.833, P=0.006)、血肌酐值(t=2.547, P=0.013)、血钙值(t=2.938, P=0.004)和身体质量指数(body mass index, BMI)(t=2.582，P=0.012)均显著高于抑郁组患者，而碱性磷酸酶(t=-2.742，P=0.008)、spKt/V 值(t=-2.127，P=0.037)和透析间期血压[收缩压(t=-4.385，P﹤0.001)、舒张压(t=-3.168，P=0.002)]则显著低于抑郁组患者(P﹤0.05)。进一步Logjistic 回归显示透析间期平均收缩压升高(OR=1.272，95% CI：1.031～1.568，P=0.025)是影响患者抑郁发生的独立危险性因素，而透析前血白蛋白(OR=0.552，95% CI：0.332～0.919，P=0.022)、血肌酐(OR=0.994，95% CI：0.990～0.999，P=0.018)、血钙(OR ﹤0.001，95% CI：0～0.054, P=0.006)和BMI 值(OR=0.383, 95% CI：0.189～0.777, P=0.008)水平升高为独立保护性因素。结论MHD 患者中抑郁的发生率很高，透析前高血白蛋白、血肌酐、血钙和BMI 值是其抑郁发生的独立保护性因素，而透析间期收缩压的升高则是抑郁发生的独立危险性因素。

关键词: 维持性血液透析患者, 抑郁, 透析相关临床生化指标

Abstract: 【Abstract】Objective To investigate the relationship between depression and dialysis- related clinical and biochemical parameters in maintenance hemodialysis (MHD) patients by using a cross- sectional study. Methods A total of 80 MHD patients compliant with the inclusion criteria and selected by the convenience sampling method were enrolled in this study. Their depression degree was evaluated by the Beck depression inventory (BDI), and their dialysis-related clinical and biochemical parameters in the recent one month were collected. They were then divided into depression group and non-depression group according to the BDI results. Chi-square test and independent-sample t test were used to compare the baseline characteristics and dialysis-related clinical and biochemical parameters between the two groups. Logistic regression was used to analyze the protective and risk factors for depression. Results A total of 75 patients completed the trial, including 53 cases in depression group and 22 cases in non- depression group, with the depression morbidity of 70.67%. There were no differences in age, dialysis vintage, gender, educational level and disease cause between the two groups (P>0.05). In non-depression group before dialysis, blood platelet (t=3.466, P=0.001), serum total protein (t=2.462, P=0.016), albumin (t=2.833, P=0.006), creatinine (t=2.547, P=0.013), calcium (t=2.938, P=0.004) and body mass index (BMI, t=2.582, P=0.012) were significantly higher than those in depression group, and alkaline phosphatase (t=-2.742, P=0.008), spKt/V (t=-2.127, P=0.037) systolic blood pressure (t=-4.385, P<0.001) and diastolic blood pressure (t=-3.168, P=0.002) were significantly lower than those in depression group. Logistic regression showed that higher interdialytic systolic blood pressure (OR=1.272, 95% CI: 1.031～1.568, P=0.025) was the independent risk factor for depression in MHD patients, and higher predialytic serum albumin (OR=0.552, 95% CI: 0.332～0.919, P = 0.022), creatinine (OR = 0.994, 95% CI: 0.990～0.999, P = 0.018), calcium (OR<0.001, 95% CI: 0～0.054, P = 0.006) and BMI (OR = 0.383, 95% CI:
0.189 ～0.777, P=0.008) were the independent protective factors for depression in MHD patients. Conclusion The prevalence of depression was higher in MHD patients. Interdialytic systolic blood pressure was the independent risk factor for depression in MHD patients, while higher predialytic serum albumin, creatinine, calcium and BMI were the protective factors for depression in MHD patients.

Key words: maintenance hemodialysis patients, depression, dialysis-related clinical and biochemical parameters