维持性血液透析患者抑郁、睡眠质量与疲乏的相关性及中介效应分析
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摘要
目的了解维持性血液透析患者抑郁、睡眠质量与疲乏的现状及3者之间的相关性及中介效应。方法采用一般资料调查表、抑郁自评量表、慢性病治疗功能评估-疲劳量表、阿森斯失眠量表对在北京3家三级及三级以上医院血液净化中心进行维持性血液透析治疗的209名患者进行调查。相关性分析采用Spearman相关系数分析,中介效应采用线性回归分析。结果维持性血液透析患者抑郁发生率为40.2%,睡眠障碍发生率为77.5%,疲劳量表得分范围为8～52分,中位数为38.00(32.00,44.00)。统计分析结果显示,抑郁评分与疲乏评分呈负相关(r=-0.590,P<0.001);睡眠质量评分与疲乏评分呈负相关(r=-0.404,P<0.001);睡眠质量评分与抑郁评分呈正相关(r=0.416,P<0.001)。抑郁评分对疲乏评分有负向预测作用(β=-0.621,P<0.001),对睡眠质量评分有正向预测作用(β=0.214,P<0.001);加入睡眠质量评分后,抑郁评分对疲乏评分的效应减少,β值由-0.621变为-0.552,提示睡眠质量在抑郁和疲乏的关系中起到部分中介效应。结论改善维持性血液透析患者的疲乏,不仅要关注其抑郁的发生,同时要关注其睡眠质量,改善抑郁和睡眠障碍是改善疲乏的重要措施。
Objective To understand the status of depression, sleep quality and fatigue in maintenance hemodialysis(MHD) patients as well as the correlation and mediation effects between the three symptoms.Methods The general data questionnaire, Self-rating Depression Scale, Functional Assessment of Chronic Illness Therapy-Fatigue, and Athen's Insomnia Scale were used to investigate 209 MHD patients in 3 top level hospitals. Correlation analysis was performed using Spearman correlation coefficient analysis, and mediating effect was analyzed by linear regression analysis. Results The incidence of depression and sleep disorder in the MHD patients were 40.2% and 77.5% respectively, and the score of fatigue scale was 8-52 points [median38.00(32.00, 44.00)]. Statistical analysis showed that depression score was negatively correlated with fatigue score(r=-0.590, P<0.001), sleep quality score was negatively correlated with fatigue score(r=-0.404, P<0.001), and sleep quality score was positively correlated with depression score(r=0.416, P<0.001). The depression score had a negative predictive effect on fatigue score(β =-0.621, P<0.001), and a positive predictive effect on sleep quality score(β=0.214, P<0.001). After adding sleep quality score, the effect of depression scores on fatigue scores decreased and the beta value changed from-0.621 to-0.552, suggesting that sleep quality plays a partial mediating role in the relationship between depression and fatigue. Conclusions Improving fatigue in MHD patients should focus on the presence of depression as well as the quality of sleep.Improving depression and sleep disorders are the important measures to decrease fatigue.
Objective To understand the status of depression, sleep quality and fatigue in maintenance hemodialysis(MHD) patients as well as the correlation and mediation effects between the three symptoms.Methods The general data questionnaire, Self-rating Depression Scale, Functional Assessment of Chronic Illness Therapy-Fatigue, and Athen's Insomnia Scale were used to investigate 209 MHD patients in 3 top level hospitals. Correlation analysis was performed using Spearman correlation coefficient analysis, and mediating effect was analyzed by linear regression analysis. Results The incidence of depression and sleep disorder in the MHD patients were 40.2% and 77.5% respectively, and the score of fatigue scale was 8-52 points [median38.00(32.00, 44.00)]. Statistical analysis showed that depression score was negatively correlated with fatigue score(r=-0.590, P<0.001), sleep quality score was negatively correlated with fatigue score(r=-0.404, P<0.001), and sleep quality score was positively correlated with depression score(r=0.416, P<0.001). The depression score had a negative predictive effect on fatigue score(β =-0.621, P<0.001), and a positive predictive effect on sleep quality score(β=0.214, P<0.001). After adding sleep quality score, the effect of depression scores on fatigue scores decreased and the beta value changed from-0.621 to-0.552, suggesting that sleep quality plays a partial mediating role in the relationship between depression and fatigue. Conclusions Improving fatigue in MHD patients should focus on the presence of depression as well as the quality of sleep.Improving depression and sleep disorders are the important measures to decrease fatigue.
引文
[1]Horigan AE.Fatigue in hemodialysis patients:a review of current knowledge[J].J Pain Symptom Manage,2012,44(5):715-724.
[2]Zyga S,Alikari V,Sachlas A,et al.Assessment of Fatigue in End Stage Renal Disease Patients Undergoing Hemodialysis:Prevalence and Associated Factors[J].Med Arch,2015,69(6):376-380.
[3]Danquah FV,Zimmerman L,Diamond PM,et al.Frequency,severity,and distress of dialysis-related symptoms reported by patients on hemodialysis[J].Nephrol Nurs J,2010,37(6):627-638.
[4]Zalai D,Bohra M.Fatigue in chronic kidney disease:Definition,assessment and treatment[J].CANNT Journal,2016,26(1):39-44.
[5]刘正翠,游励红,肖红波,等.维持性血液透析患者症状群的确立及其与生活质量的相关性研究[J].中国血液净化,2018,17(11):748-752.
[6]Horigan AE,Schneider SM,Docherty S,et al.The experience and self-management of fatigue in patients on hemodialysis[J].Nephrol Nurs J,2013,40(2):113-122.
[7]Yong DS,Kwok AO,Wong DM,et al.Symptom burden and quality of life in end-stage renal disease:a study of179 patients on dialysis and palliative care[J].Palliat Med,2009,23(2):111-119.
[8]Jhamb M,Pike F,Ramer S,et al.Impact of Fatigue on Outcomes in the Hemodialysis(HEMO)Study[J].Am JNephrol,2011,33(6):515-523.
[9]Zung WW.A SELF-RATING DEPRESSION SCALE[J].Arch Gen Psychiatry,1965,12:63-70.
[10]Yellen SB,Cella DF,Webster K,et al.Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy(FACT)measurement system[J].J Pain Symptom Manage,1997,13(2):63-74.
[11]Demyttenaere K,De Fruyt J,Stahl SM.The many faces of fatigue in major depressive disorder[J].Int J Neuropsychopharmacol,2005,8(1):93-105.
[12]Farragher JF,Polatajko HJ,Jassal SV.The Relationship Between Fatigue and Depression in Adults With EndStage Renal Disease on Chronic In-Hospital Hemodialysis:A Scoping Review[J].J Pain Symptom Manage,2017,53(4):783-803.
[13]Mucsi I,Molnar MZ,Rethelyi J,et al.Sleep disorders and illness intrusiveness in patients on chronic dialysis[J].Nephrol Dial Transplant,2004,19(7):1815-1822.
[14]张晓英,许娴,邓胜兰.维持性血透患者疲乏状况及其与睡眠质量、社会支持的关系[J].中国中西医结合肾病杂志,2014,(6):504-506.
[15]Pai MF,Hsu SP,Yang SY,et al.Sleep disturbance in chronic hemodialysis patients:the impact of depression and anemia[J].Ren Fail,2007,29(6):673-677.
[2]Zyga S,Alikari V,Sachlas A,et al.Assessment of Fatigue in End Stage Renal Disease Patients Undergoing Hemodialysis:Prevalence and Associated Factors[J].Med Arch,2015,69(6):376-380.
[3]Danquah FV,Zimmerman L,Diamond PM,et al.Frequency,severity,and distress of dialysis-related symptoms reported by patients on hemodialysis[J].Nephrol Nurs J,2010,37(6):627-638.
[4]Zalai D,Bohra M.Fatigue in chronic kidney disease:Definition,assessment and treatment[J].CANNT Journal,2016,26(1):39-44.
[5]刘正翠,游励红,肖红波,等.维持性血液透析患者症状群的确立及其与生活质量的相关性研究[J].中国血液净化,2018,17(11):748-752.
[6]Horigan AE,Schneider SM,Docherty S,et al.The experience and self-management of fatigue in patients on hemodialysis[J].Nephrol Nurs J,2013,40(2):113-122.
[7]Yong DS,Kwok AO,Wong DM,et al.Symptom burden and quality of life in end-stage renal disease:a study of179 patients on dialysis and palliative care[J].Palliat Med,2009,23(2):111-119.
[8]Jhamb M,Pike F,Ramer S,et al.Impact of Fatigue on Outcomes in the Hemodialysis(HEMO)Study[J].Am JNephrol,2011,33(6):515-523.
[9]Zung WW.A SELF-RATING DEPRESSION SCALE[J].Arch Gen Psychiatry,1965,12:63-70.
[10]Yellen SB,Cella DF,Webster K,et al.Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy(FACT)measurement system[J].J Pain Symptom Manage,1997,13(2):63-74.
[11]Demyttenaere K,De Fruyt J,Stahl SM.The many faces of fatigue in major depressive disorder[J].Int J Neuropsychopharmacol,2005,8(1):93-105.
[12]Farragher JF,Polatajko HJ,Jassal SV.The Relationship Between Fatigue and Depression in Adults With EndStage Renal Disease on Chronic In-Hospital Hemodialysis:A Scoping Review[J].J Pain Symptom Manage,2017,53(4):783-803.
[13]Mucsi I,Molnar MZ,Rethelyi J,et al.Sleep disorders and illness intrusiveness in patients on chronic dialysis[J].Nephrol Dial Transplant,2004,19(7):1815-1822.
[14]张晓英,许娴,邓胜兰.维持性血透患者疲乏状况及其与睡眠质量、社会支持的关系[J].中国中西医结合肾病杂志,2014,(6):504-506.
[15]Pai MF,Hsu SP,Yang SY,et al.Sleep disturbance in chronic hemodialysis patients:the impact of depression and anemia[J].Ren Fail,2007,29(6):673-677.