中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (06): 410-414.doi: 10.3969/j.issn.1671-4091.2023.06.003

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血清FT3水平、睡眠和焦虑状态：1项中介效应分析研究

李茂雪   隆沐阳   刘 云   钟小仕   刘 岩   

  1. 550004 贵阳，1贵州医科大学临床医学院 
    510220 广州，2暨南大学附属广州红十字会医院肾内科
    422000 邵阳，3邵阳市中心医院肾内科
  • 收稿日期:2023-01-09 修回日期:2023-04-01 出版日期:2023-06-12 发布日期:2023-06-12
  • 通讯作者: 刘岩 E-mail:rabbityan127@163.com

Serum FT3 levels, sleep, and anxiety status in maintenance hemodialysis patients: a mediation effect analysis study

LI Mao-xue,LONG Mu-yang,LIU Yun,ZHONG Xiao-shi，LIU Yan   

  1. 1Department of Medicine Science,Guizhou Medical University,Guiyang 550004,China; 2Department of Nephrology,Guangzhou Red Cross Hospital , Jinan University, Guangzhou 510220,China; 3Department of Nephrology,The Central Hospital of Shaoyang,Shaoyang 422000,China
  • Received:2023-01-09 Revised:2023-04-01 Online:2023-06-12 Published:2023-06-12
  • Contact: 550004 贵阳，1贵州医科大学临床医学院； 510220 广州，2暨南大学附属广州红十字会医院肾内科 E-mail:rabbityan127@163.com

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摘要： 目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者焦虑状态和血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)的关系。 方法 单中心横断面研究。纳入2021年9月在暨南大学附属广州红十字会医院血液净化中心行MHD的患者。收集受试者的人口学、临床资料和问卷资料，测定透析前血常规、血清生化指标和血清FT3，根据汉密尔顿焦虑量表(Hamilton anxiety scale，HAMA)评分将患者分为非焦虑状态组(总分＜7分)和焦虑状态组(总分≥7分)，比较2组的临床特征，应用二元Logistic回归评价与MHD患者焦虑状态相关的因素，使用易侕(empower stats 3.0)软件分析变量间的因果中介效应。 结果 共纳入120例MHD患者，其中焦虑状态组66例，非焦虑状态组54例，spearman相关分析提示血清FT3水平与睡眠评分呈负相关(r=-0.277，P=0.002)。在校正相关混杂因素后，多因素二元Logistic回归显示血清低FT3水平和焦虑状态相关(OR=3.167，95% CI：1.144～8.772，P=0.027)；将睡眠评分纳入时，FT3和焦虑状态的独立关联消失(OR=0.842，95% CI：0.812～8.051，P= 0.109)。中介效应分析显示血清FT3和焦虑状态的关联中，有47.6%的效应占比是通过睡眠的变化达成的(P=0.004)。 结论 MHD患者血清 FT3 水平与睡眠质量、焦虑三者之间存在密切联系，在血清FT3和焦虑状态的关联中，有47.6%的效应是通过睡眠的变化达成的。

关键词: 维持性血液透析, 血清低游离三碘甲状腺原氨酸, 焦虑, 睡眠

Abstract: Objective  To investigate the relationship between serum FT3 level and anxiety state in maintenance hemodialysis (MHD) patients.  Methods  This was a single-center and cross-sectional study. Patients who underwent MHD in our center in September 2021 were enrolled. Demographic data, routine blood biochemical examination, and serum free triiodothyronine (FT3) before dialysis sessions were tested, and the anxiety status of the patients was evaluated by the Hamilton Anxiety Scale (HAMA). According to the anxiety scale score, patients were divided into the without anxiety status group (total score＜7 points) and with anxiety status group (total score≥7 points). Multivariate binary Logistic regression was used to analyze the independent factors associated with anxiety risk, and software (Empower Stats 3.0) was used to analyze causal mediating effects among variables.  Results  A total of 120 MHD patients were enrolled in this study, including 66 patients in the anxiety status group and 54 patients in the control group. Spearman analyses showed that the levels of serum FT3 negatively correlated with the sleep score (r=-0.277, P=0.002). Multivariate binary logistic regression analysis showed that low serum FT3 level in MHD patients in our center was independent associated with anxiety status (OR=3.167，95% CI：1.144～8.772, P=0.027), but when sleep score was included in the models, the association between the serum FT3 and anxiety status disappeared (OR=0.842，95% CI：0.812～8.051, P=0.109). Mediation analysis showed that 47.6% of the effect of serum FT3 on anxiety state was mediated through sleep disturbance (P=0.004).

Key words: Maintenance hemodialysis, Serum low free triiodothyronine, Anxiety, Sleep

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