356例非透析慢性肾衰竭患者抑郁情况及生命质量的分析研究
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摘要
目的评估非透析慢性肾衰竭患者的抑郁情况和生命质量,分析二者的相关关系及其影响因素。方法选取2017年5月至2018年3月在重庆市三峡中心医院、重庆市云阳县人民医院、重庆市梁平区人民医院、重庆市江津区中医院就诊的并明确诊断为慢性肾衰竭且没有进行过透析的356例患者;采用Beck抑郁量表评估患者的抑郁情况,慢性肾衰竭生命质量量表(QLICD-CRF2.0)评估患者的生命质量情况。结果 356例非透析慢性肾衰竭患者抑郁发生率为45.22%;生命质量方面,抑郁组患者生理功能、心理功能、社会功能的评分均低于非抑郁组;反映症状的特异性模块的评分高于非抑郁组(P均<0.05);抑郁情况与生命质量的二分类Logistic回归分析结果显示:职业(OR=1.753,95%CI:1.352～2.273)、住院次数(OR=1.221,95%CI:1.007～1.480)、体现症状体征的特异性模块(OR=1.034,95%CI:1.011～1.058)、心理功能(OR=0.922,95%CI:0.902～0.942)、教育状况(OR=0.597,95%CI:0.394～0.906)、家庭人均年收入(OR=0.514,95%CI:0.346～0.765)是抑郁发生的独立危险因素。结论非透析慢性肾衰竭患者的抑郁发生率较高,抑郁组患者的生命质量低于非抑郁组,职业、住院次数、特异性模块、心理功能、教育状况和家庭人均年收入影响着非透析慢性肾衰竭患者的生命质量。
Objective To evaluate the prevalence of depression and quality of life and their correlation in non-dialysis patients with chronic renal failure and analyze the factors affecting the occurrence of depression in these patients.Methods This study was conducted among 356 non-dialysis patients with chronic renal failure(including both inpatients and outpatients) from 4 general hospitals in Chongqing during the period from May,2017 to March,2018.Beck Depression Inventory-Ⅱ(BDI-Ⅱ) was used to assess the patient's depression,and the quality of life the patients was assessed using Quality of Life Instrument for Chronic Disease-Chronic Renal Failure(QLICD-CRF2.0).Results The incidence of depression was45.22% in the 356 patients with chronic renal failure without dialysis.The patients with depression had significantly lower quality of life scores(including the physiological function,psychological function,social function and total scores),but had significantly higher scores in the specific modules of response symptoms than those without depression(P<0.05).Binary logistic regression analysis of depression and quality of life showed that occupation(OR=1.753,95% CI:1.352-2.273),hospitalization frequency(OR=1.221,95% CI:1.007-1.480),specific modules(OR=1.034,95% CI:1.011-1.058),psychological function(OR=0.922,95% CI:0.902-0.942),education level(OR=0.597,95% CI:0.394-0.906),and annual income of the family(OR=0.514,95% CI:0.346-0.765) were all independent risk factors for the occurrence of depression in these patients.Conclusion The incidence of depression is high in non-dialysis patients with chronic renal failure.The patients with depression have lower quality of life scores than those without depression.Occupation,hospitalization frequency,specific modules,psychological function,education level and annual income of the family may affect the quality of life among the non-dialysis patients.
Objective To evaluate the prevalence of depression and quality of life and their correlation in non-dialysis patients with chronic renal failure and analyze the factors affecting the occurrence of depression in these patients.Methods This study was conducted among 356 non-dialysis patients with chronic renal failure(including both inpatients and outpatients) from 4 general hospitals in Chongqing during the period from May,2017 to March,2018.Beck Depression Inventory-Ⅱ(BDI-Ⅱ) was used to assess the patient's depression,and the quality of life the patients was assessed using Quality of Life Instrument for Chronic Disease-Chronic Renal Failure(QLICD-CRF2.0).Results The incidence of depression was45.22% in the 356 patients with chronic renal failure without dialysis.The patients with depression had significantly lower quality of life scores(including the physiological function,psychological function,social function and total scores),but had significantly higher scores in the specific modules of response symptoms than those without depression(P<0.05).Binary logistic regression analysis of depression and quality of life showed that occupation(OR=1.753,95% CI:1.352-2.273),hospitalization frequency(OR=1.221,95% CI:1.007-1.480),specific modules(OR=1.034,95% CI:1.011-1.058),psychological function(OR=0.922,95% CI:0.902-0.942),education level(OR=0.597,95% CI:0.394-0.906),and annual income of the family(OR=0.514,95% CI:0.346-0.765) were all independent risk factors for the occurrence of depression in these patients.Conclusion The incidence of depression is high in non-dialysis patients with chronic renal failure.The patients with depression have lower quality of life scores than those without depression.Occupation,hospitalization frequency,specific modules,psychological function,education level and annual income of the family may affect the quality of life among the non-dialysis patients.
引文
[1]万崇华,李晓梅,杨峥,等.慢性病患者生命质量测评与应用[M].北京:科学出版社,2015:359-373.WAN C H,LI X M,YANG Z,et al.Evaluation and application of quality of life in patients with chronic diseases[M].Beijing:Science Press,2015:359-373.
[2]ZHANG L,WANG F,WANG L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,379(9818):815-822.DOI:10.1016/S0140-6736(12)60033-6.
[3]罗华丽,蒋先洪,文津,等.重庆市永川区成人慢性肾脏病流行病学调查[J].重庆医学,2014,43(29):3937-3940.DOI:10.3969/j.issn.1671-8348.2014.29.031.LUO H L,JIANG X H,WEN J,et al.Epidemiology investigation of chronic kidney disease among adults in Yongchuan of Chongqing[J].Chongqing Med,2014,43(29):3937-3940.DOI:10.3969/j.issn.1671-8348.2014.29.031.
[4]赵德龙.维持性血液透析患者流行病学调查及生存预后相关性分析[D].北京:中国人民解放军医学院,2016.ZHAO D L.Epidemiology and prognosis analysis of maintenance hemodialysis patients[D].Beijing:Medical College of The Chinese People's Liberation Army,2016.
[5]黄新萍.慢性病患者生命质量测定量表体系之慢性肾衰竭量表QLICD-CRF的研制与应用[D].昆明:昆明医科大学,2012.HUANG X P.Development and application of the quality of life instrument for patients with chronic renal failure(QLIC-CRF)[D].Kunming:Kunming Medical University,2012.
[6]王振,苑成梅,黄佳,等.贝克抑郁量表第2版中文版在抑郁症患者中的信效度[J].中国心理卫生杂志,2011,25(6):477-478.DOI:10.3969/j.issn.1000-6729.2011.06.014.WANG Z,YUAN C M,HUANG J,et al.Reliability and validity of the Chinese version of Beck Depression Inventory-Ⅱamong depression patients[J].Chin Mental Health J,2011,25(6):476-479.DOI:10.3969/j.issn.1000-6729.2011.06.014.
[7]叶瑞繁,耿庆山,陈剑,等.医院焦虑抑郁量表与Beck抑郁问卷在综合医院门诊病人中评定抑郁的比较[J].中国临床心理学杂志,2013,21(1):48-50,173.DOI:10.16128/j.cnki.1005-3611.2013.01.036.YE R F,GENG Q S,CHEN J,et al.Comparison of HADSand BDI for detecting depression in general hospital outpatiens[J].Chin J Clin Psychol,2013,21(1):48-50,173.DOI:10.16128/j.cnki.1005-3611.2013.01.036
[8]马登艳,张颖君,王宇,等.1~4期慢性肾脏病患者抑郁情绪现状调查及分析[J].中华现代护理杂志,2016,22(4):458-462.DOI:10.3760/cma.j.issn.1674-2907.2016.04.004.MA D Y,ZHANG Y J,WANG Y,et al.Depressive emotions investigation and analysis for stage 1-4 chronic kidney disease[J].Chin J Mod Nurs,2016,22(4):458-462.DOI:10.3760/cma.j.issn.1674-2907.2016.04.004.
[9]凌河,王小琴,韩四萍,等.非透析慢性肾脏病患者合并抑郁、焦虑的前瞻性观察研究[J].临床肾脏病杂志,2017,17(3):136-142.DOI:10.3969/j.issn.1671-2390.2017.03.002.LING H,WANG X Q,HAN S P,et al.Association of depressive and anxiety symptoms with adverse events in chronic kidney disease patients without dialysis:a prospective observational study[J].J Clin Nephrol,2017,17(3):136-142.DOI:10.3969/j.issn.1671-2390.2017.03.002.
[10]王宗谦,卢新星.终末期肾病患者抑郁程度与生存质量各个维度之间的关系[J].吉林大学学报(医学版),2013,39(3):615-619.DOI:10.7694/jldxyxb20130340.WANG Z Q,LU X X.Relationship between depression degrees and dimensionalities of survival quality of patients with end-stage renal disease[J].J Jilin Univ(Sci Ed),2013,(3):615-619.DOI:10.7694/jldxyxb20130340.
[11]张洪凤,张桂霞,陈晓莉,等.社会支持对慢性肾脏病患者焦虑、抑郁情绪的影响[J].蚌埠医学院学报,2016,41(2):259-262.DOI:10.13898/j.cnki.issn.1000-2200.2016.02.041.ZHANG H F,ZHANG G X,CHEN X L,et al.Effects of social support on anxiety and depression in patients with chronic kidney disease[J].J Bengbu Med Coll,2016,41(2):259-262.DOI:10.13898/j.cnki.issn.1000-2200.2016.02.041.
[12]曹爽.慢性肾脏病合并抑郁障碍研究进展[J].国际泌尿系统杂志,2016,36(4):638-640.DOI:10.3760/cma.j.issn.1673-4416.2016.04.050.CAO S.Research progress of chronic kidney disease combined with depressive disorder[J].Int J Urol Nephrol,2016,36(4):638-640.DOI:10.3760/cma.j.issn.1673-4416.2016.04.050.
[13]HEDAYATI S S,MINHAJUDDIN A T,AFSHAR M,et al.Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis,hospitalization,or death[J].JAMA,2010,303(19):1946-1953.DOI:10.1001/jama.2010.619.
[14]黎夏,魏登军.慢性肾病患者住院医疗费用负担分析[J].公共卫生与预防医学,2015,26(6):64-67.LI X,WEI D J.Distribution and influence factors of medical expenditure in inpatients with chronic kidney disease[J].J Public Health Preventive Med,2015,26(6):64-67.
[15]李良志,刘雷,何先红,等.重庆市万州区慢性肾衰竭患者就医状况调查及分析[J].四川医学,2012,33(8):1477-1479.DOI:10.3969/j.issn.1004-0501.2012.08.082.LI L Z,LIU L,HE X H,et al.Investigation and analysis on medical condition of Chongqing Wanzhou district patients with chronic renal failure[J].Sichuan Med J,2012,33(8):1477-1479.DOI:10.3969/j.issn.1004-0501.2012.08.082.
[16]方鹏骞,周亚旭.我国慢性肾病医疗保险管理策略分析[J].中国卫生经济,2018,37(2):39-41.DOI:10.7664/CHE20180210.FANG P Q,ZHOU Y X.Policy analysis of Chinese chronic kidney disease medical insurance[J].Chin Health Econ,2018,37(2):39-41.DOI:10.7664/CHE 20180210.
[17]邬碧波,贺云岚,王璐,等.建议将慢性肾脏病管理纳入国家基本公共卫生服务项目[EB/OL].http://www.shszx.gov.cn/node2/node5368/node5376/node5389/u1ai97485.html.WU B B,HE Y L,WANG L,et al.Suggestion:Integrating chronic kidney disease management into the national basic public health service project.[EB/OL].http://www.shszx.gov.cn/node2/node5368/node5376/node5389/u1ai97485.html.
[18]梅长林,邬碧波.医防结合构建慢性肾脏病三级防治新体系[J].第二军医大学学报,2018,39(1):1-5.DOI:10.16781/j.0258-879x.2018.01.0001.MEI C L,WU B B.A new three-level prevention and treatment system for chronic kidney disease by combining medicine with prevention[J].Acad J 2nd Mil Med Univ,2018,39(1):1-5.DOI:10.16781/j.0258-879x.2018.01.0001.
[2]ZHANG L,WANG F,WANG L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,379(9818):815-822.DOI:10.1016/S0140-6736(12)60033-6.
[3]罗华丽,蒋先洪,文津,等.重庆市永川区成人慢性肾脏病流行病学调查[J].重庆医学,2014,43(29):3937-3940.DOI:10.3969/j.issn.1671-8348.2014.29.031.LUO H L,JIANG X H,WEN J,et al.Epidemiology investigation of chronic kidney disease among adults in Yongchuan of Chongqing[J].Chongqing Med,2014,43(29):3937-3940.DOI:10.3969/j.issn.1671-8348.2014.29.031.
[4]赵德龙.维持性血液透析患者流行病学调查及生存预后相关性分析[D].北京:中国人民解放军医学院,2016.ZHAO D L.Epidemiology and prognosis analysis of maintenance hemodialysis patients[D].Beijing:Medical College of The Chinese People's Liberation Army,2016.
[5]黄新萍.慢性病患者生命质量测定量表体系之慢性肾衰竭量表QLICD-CRF的研制与应用[D].昆明:昆明医科大学,2012.HUANG X P.Development and application of the quality of life instrument for patients with chronic renal failure(QLIC-CRF)[D].Kunming:Kunming Medical University,2012.
[6]王振,苑成梅,黄佳,等.贝克抑郁量表第2版中文版在抑郁症患者中的信效度[J].中国心理卫生杂志,2011,25(6):477-478.DOI:10.3969/j.issn.1000-6729.2011.06.014.WANG Z,YUAN C M,HUANG J,et al.Reliability and validity of the Chinese version of Beck Depression Inventory-Ⅱamong depression patients[J].Chin Mental Health J,2011,25(6):476-479.DOI:10.3969/j.issn.1000-6729.2011.06.014.
[7]叶瑞繁,耿庆山,陈剑,等.医院焦虑抑郁量表与Beck抑郁问卷在综合医院门诊病人中评定抑郁的比较[J].中国临床心理学杂志,2013,21(1):48-50,173.DOI:10.16128/j.cnki.1005-3611.2013.01.036.YE R F,GENG Q S,CHEN J,et al.Comparison of HADSand BDI for detecting depression in general hospital outpatiens[J].Chin J Clin Psychol,2013,21(1):48-50,173.DOI:10.16128/j.cnki.1005-3611.2013.01.036
[8]马登艳,张颖君,王宇,等.1~4期慢性肾脏病患者抑郁情绪现状调查及分析[J].中华现代护理杂志,2016,22(4):458-462.DOI:10.3760/cma.j.issn.1674-2907.2016.04.004.MA D Y,ZHANG Y J,WANG Y,et al.Depressive emotions investigation and analysis for stage 1-4 chronic kidney disease[J].Chin J Mod Nurs,2016,22(4):458-462.DOI:10.3760/cma.j.issn.1674-2907.2016.04.004.
[9]凌河,王小琴,韩四萍,等.非透析慢性肾脏病患者合并抑郁、焦虑的前瞻性观察研究[J].临床肾脏病杂志,2017,17(3):136-142.DOI:10.3969/j.issn.1671-2390.2017.03.002.LING H,WANG X Q,HAN S P,et al.Association of depressive and anxiety symptoms with adverse events in chronic kidney disease patients without dialysis:a prospective observational study[J].J Clin Nephrol,2017,17(3):136-142.DOI:10.3969/j.issn.1671-2390.2017.03.002.
[10]王宗谦,卢新星.终末期肾病患者抑郁程度与生存质量各个维度之间的关系[J].吉林大学学报(医学版),2013,39(3):615-619.DOI:10.7694/jldxyxb20130340.WANG Z Q,LU X X.Relationship between depression degrees and dimensionalities of survival quality of patients with end-stage renal disease[J].J Jilin Univ(Sci Ed),2013,(3):615-619.DOI:10.7694/jldxyxb20130340.
[11]张洪凤,张桂霞,陈晓莉,等.社会支持对慢性肾脏病患者焦虑、抑郁情绪的影响[J].蚌埠医学院学报,2016,41(2):259-262.DOI:10.13898/j.cnki.issn.1000-2200.2016.02.041.ZHANG H F,ZHANG G X,CHEN X L,et al.Effects of social support on anxiety and depression in patients with chronic kidney disease[J].J Bengbu Med Coll,2016,41(2):259-262.DOI:10.13898/j.cnki.issn.1000-2200.2016.02.041.
[12]曹爽.慢性肾脏病合并抑郁障碍研究进展[J].国际泌尿系统杂志,2016,36(4):638-640.DOI:10.3760/cma.j.issn.1673-4416.2016.04.050.CAO S.Research progress of chronic kidney disease combined with depressive disorder[J].Int J Urol Nephrol,2016,36(4):638-640.DOI:10.3760/cma.j.issn.1673-4416.2016.04.050.
[13]HEDAYATI S S,MINHAJUDDIN A T,AFSHAR M,et al.Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis,hospitalization,or death[J].JAMA,2010,303(19):1946-1953.DOI:10.1001/jama.2010.619.
[14]黎夏,魏登军.慢性肾病患者住院医疗费用负担分析[J].公共卫生与预防医学,2015,26(6):64-67.LI X,WEI D J.Distribution and influence factors of medical expenditure in inpatients with chronic kidney disease[J].J Public Health Preventive Med,2015,26(6):64-67.
[15]李良志,刘雷,何先红,等.重庆市万州区慢性肾衰竭患者就医状况调查及分析[J].四川医学,2012,33(8):1477-1479.DOI:10.3969/j.issn.1004-0501.2012.08.082.LI L Z,LIU L,HE X H,et al.Investigation and analysis on medical condition of Chongqing Wanzhou district patients with chronic renal failure[J].Sichuan Med J,2012,33(8):1477-1479.DOI:10.3969/j.issn.1004-0501.2012.08.082.
[16]方鹏骞,周亚旭.我国慢性肾病医疗保险管理策略分析[J].中国卫生经济,2018,37(2):39-41.DOI:10.7664/CHE20180210.FANG P Q,ZHOU Y X.Policy analysis of Chinese chronic kidney disease medical insurance[J].Chin Health Econ,2018,37(2):39-41.DOI:10.7664/CHE 20180210.
[17]邬碧波,贺云岚,王璐,等.建议将慢性肾脏病管理纳入国家基本公共卫生服务项目[EB/OL].http://www.shszx.gov.cn/node2/node5368/node5376/node5389/u1ai97485.html.WU B B,HE Y L,WANG L,et al.Suggestion:Integrating chronic kidney disease management into the national basic public health service project.[EB/OL].http://www.shszx.gov.cn/node2/node5368/node5376/node5389/u1ai97485.html.
[18]梅长林,邬碧波.医防结合构建慢性肾脏病三级防治新体系[J].第二军医大学学报,2018,39(1):1-5.DOI:10.16781/j.0258-879x.2018.01.0001.MEI C L,WU B B.A new three-level prevention and treatment system for chronic kidney disease by combining medicine with prevention[J].Acad J 2nd Mil Med Univ,2018,39(1):1-5.DOI:10.16781/j.0258-879x.2018.01.0001.
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