尿毒症患者首次血液透析前后抑郁评估及相关因素分析
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摘要
目的探讨尿毒症患者首次血液透析前后抑郁的状况及其影响因素。方法应用汉密尔顿抑郁量表和自制一般资料调查表对177例尿毒症患者进行问卷调查,同时检测患者实验室指标并进行分析。结果透析前1周35.0%的患者有不同程度抑郁症状,透析后1周11.9%的患者有抑郁症状;透析前后抑郁评分分别为(14.96±8.37)、(6.52±3.81)分,差异有统计学意义(t=16.267,P<0.01)。有合并症与无合并症患者抑郁评分,差异有统计学意义(t=-2.528,P=0.013);而患者不同性别、年龄、文化程度、原发病种类,是否吸烟、饮酒的抑郁评分差异无统计学意义(P>0.05)。3组研究对象血肌酐(Cr)、血尿素氮(BUN)、空腹血糖(GLU)、清蛋白(Alb)、总胆固醇(TC)水平,差异有统计学意义(P<0.01)。Spearman相关分析显示,GLU、Cr、BUN的水平与抑郁评分呈正相关,TC、Alb水平与抑郁评分呈负相关,差异有统计学意义(P<0.01)。结论应重视对血液透析患者抑郁状况的评估。
Objective To investigate the depression status and its influencing factors in the patients with uremia before and after the first time hemodialysis.Methods A total of 177 patients with uremia conducted the questionnaire investigation by using the Hamilton Depression Scale and self-made general information questionnaire.Meanwhile,the laboratory indexes were detected and analyzed.Results At one week before dialysis,35% of the patients had different degrees of depression symptoms,11.9% of the patients had depressive symptoms at 1 week after dialysis;the depression scores before and after dialysis were(14.96±8.37)points and(6.52±3.81)points respectively,the difference was statistically significant(t=16.267,P<0.01).The depression score had statistical difference between the patients with complications and patients without complications(t=-2.528,P=0.013);while the depression scores had no statistical difference among the patients with different sexes,ages,cultural levels,types of original diseases,whether smoking and drinking(P<0.01).The Spearman correlation analysis showed that the levels of GLU,Cr and BUN were positively correlated with the depression score,while the levels of TC and Alb were negatively correlated with the depression score,the difference was statistically significant(P<0.01).Conclusion The evaluation of depression status in hemodialysis patients should be emphasized.
Objective To investigate the depression status and its influencing factors in the patients with uremia before and after the first time hemodialysis.Methods A total of 177 patients with uremia conducted the questionnaire investigation by using the Hamilton Depression Scale and self-made general information questionnaire.Meanwhile,the laboratory indexes were detected and analyzed.Results At one week before dialysis,35% of the patients had different degrees of depression symptoms,11.9% of the patients had depressive symptoms at 1 week after dialysis;the depression scores before and after dialysis were(14.96±8.37)points and(6.52±3.81)points respectively,the difference was statistically significant(t=16.267,P<0.01).The depression score had statistical difference between the patients with complications and patients without complications(t=-2.528,P=0.013);while the depression scores had no statistical difference among the patients with different sexes,ages,cultural levels,types of original diseases,whether smoking and drinking(P<0.01).The Spearman correlation analysis showed that the levels of GLU,Cr and BUN were positively correlated with the depression score,while the levels of TC and Alb were negatively correlated with the depression score,the difference was statistically significant(P<0.01).Conclusion The evaluation of depression status in hemodialysis patients should be emphasized.
引文
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[13]李钦君,张长岭,张曙光,等.持续性不卧床腹膜透析患者焦虑和抑郁状态及其相关因素探究[J].中国血液净化,2012,11(6):756-757.
[14]RM J C R.Quality of life of patients on haemodialysis for end-stage renal disease[J].J Adva Nurs,2005,51(6):577-586.
[15]HUANG T L,LEE C T.Low serum albumin and high ferritin levels in chronic hemodialysis patients with major depression[J].Psychiatry Res,2007,152(2):277-280.
[16]MONTINARO V,LAFFALDANO G P.Emotional symptoms,quality of life and cytokine profile in hemodialysis patients[J].Clin Nephrol,2010,73(1):36-43.
[17]MANN J J.The serotonergic system in mood disorders and suicidal behaviour[J].Philos Trans R Soc London B Biol Sci,2013,368(1615):86-91.
[18]沈宗霖,程宇琪,叶靖,等.有无自杀意念抑郁症患者血脂水平与P300的相关性[J].中国神经精神疾病杂志,2015(7):435-438.
[19]JIANG W,ALEXANDER J,CHRISTOPHER E,et al.Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure[J].Arch Int Med,2001,161(15):1849.
[2]KING-WING M T,KAM-TAO L P.Depression in dialysis patients[J].Nephrology,2016,21(8):639-646.
[3]FARROKHI F,ABEDI N,BEYENE J,et al.Association between depression and mortality in patients receiving long-term dialysis:a systematic review and meta-analysis[J].Am J Kidney Dis,2014,63(4):623-635.
[4]GYAMLANI G,BASU A,GERACI S,et al.Depression,screening and quality of life in chronic kidney disease[J].Am J Med Sci,2011,342(3):186-191.
[5]ARAUJO S M,DE-BRUIN V M,DAHER E F,et al.Risk factors for depressive symptoms in a large population on chronic hemodialysis[J].Int Urol Nephrol,2012,44(4):1229-1235.
[6]陈小帆,朱春平,王饶萍,等.维持性血液透析患者焦虑和抑郁状态与合并症相关性调查[J].中国中西医结合肾病杂志,2016,17(6):534-536.
[7]KALENDER B,CORAPCIOGLU A C,KOROGLU G.Associationofdepressionwithmarkersof nutrition and inflammation in chronic kidney disease and end-stage renal disease[J].Nephron Clin Pract,2006,102(3/4):V139.
[8]GILDENGERS A G,WHYTE E M,DRAYER R A,et al.Medical burden in late-life bipolar and major depressive disorders[J].Am J Geriatr Psychiatry,2008,16(3):194-200.
[9]王静.血液透析患者抑郁状态及其相关因素分析[J].国际检验医学杂志,2015,36(10):1414-1415.
[10]POMPILI M,LESTER D,INNAMORATI M,et al.Quality of life and suicide risk in patients with diabetes mellitus[J].Psychosomatics,2009,50(1):16-23.
[11]DE LA ROCA-CHIAPAS J M,HERNNDEZGONZLEZ M,CANDELARIO M,et al.Association between depression and higher glucose levels in middleaged Mexican patients with diabetes[J].Rev Invest Clin,2013,65(3):209-213.
[12]WATERS R P,RIVALAN M,BANGASSER D A,et al.Evidence for the role of corticotropin-releasing factor in major depressive disorder[J].Neur Biob Rev,2015,58:63.
[13]李钦君,张长岭,张曙光,等.持续性不卧床腹膜透析患者焦虑和抑郁状态及其相关因素探究[J].中国血液净化,2012,11(6):756-757.
[14]RM J C R.Quality of life of patients on haemodialysis for end-stage renal disease[J].J Adva Nurs,2005,51(6):577-586.
[15]HUANG T L,LEE C T.Low serum albumin and high ferritin levels in chronic hemodialysis patients with major depression[J].Psychiatry Res,2007,152(2):277-280.
[16]MONTINARO V,LAFFALDANO G P.Emotional symptoms,quality of life and cytokine profile in hemodialysis patients[J].Clin Nephrol,2010,73(1):36-43.
[17]MANN J J.The serotonergic system in mood disorders and suicidal behaviour[J].Philos Trans R Soc London B Biol Sci,2013,368(1615):86-91.
[18]沈宗霖,程宇琪,叶靖,等.有无自杀意念抑郁症患者血脂水平与P300的相关性[J].中国神经精神疾病杂志,2015(7):435-438.
[19]JIANG W,ALEXANDER J,CHRISTOPHER E,et al.Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure[J].Arch Int Med,2001,161(15):1849.