维持性血液透析患者抑郁发病率调查及其危险因素分析

Prevalence of depression and risk factors in maintenance hemodialysis patients

目的调查本中心维持性血液透析(MHD)患者抑郁发病率,探讨MHD患者抑郁发病相关的危险因素。方法 193例维持性血液透析患者被纳入此次研究。采用患者健康问卷(PHQ-9)评价患者,根据得分,将患者分为非抑郁组(PHQ-9得分<4分,n=101)及抑郁组(PHQ-9得分≥5分,n=92)。统计分析两组间患者性别,年龄,身体质量指数(BMI),婚姻情况,工作情况,吸烟,饮酒,医疗保险情况,透析月龄,透析间期体质量增加量(IWG),查尔森同病指数,sp Kt/V,血红蛋白,血清白蛋白的差异,并利用Logistic回归分析MHD患者发生抑郁的影响因素。结果 193例MHD患者中,抑郁发病率47. 6%(92例)。年龄(OR=1. 03,P=0. 038),透析月龄(OR=1. 02,P=0. 032),IWG(%)(OR=1. 71,P=0. 025),查尔森同病指数(OR=1. 78,P=0. 008),医保种类(OR=3. 27,P=0. 021),sp Kt/V(OR=0. 01,P <0. 001),血红蛋白(OR=0. 82,P <0. 001),血清白蛋白(OR=0. 87,P=0. 032)为MHD患者发生抑郁的独立危险因素。工作情况与抑郁患病率有关(P=0. 033),无业患者(OR=4. 41,P=0. 012)及退休患者(OR=3. 19,P=0. 049)的抑郁发生率均高于在职患者。结论在维持性血液透析患者中,抑郁发病率较高。增龄、存在合并症、透析时间及透析间期体质量增加及医疗费用比例的增加是抑郁发病的危险因素;有工作、透析充分性提高、贫血纠正、血清白蛋白升高是抑郁发生的保护性因素。

Objective To investigate the prevalence of depression and risk factors in maintenance hemodialysis(MHD)patients.Methods One hundred and ninety-three MHD patients were enrolled in this study.The patient health questionnaire-9(PHQ-9)was used to evaluate patients.According to the scores of PHQ-9,the patients were divided into non-depression group(n=101)and depression group(n=92).Patients with PHQ-9 score<4 points belonged to the non-depression group,while patients with PHQ-9 score≥5 points belonged to the depression group.The differences between the two groups were compared in gender,age,body mass index(BMI),marital status,work,smoking,drinking,medical insurance,month-age of hemodialysis,interdialytic weight gain(IWG),Charlson comorbidity index,spKt/V,serum albumin,and hemoglobin.Logistic regression method was used to analyze the risk factors of depression in MHD patients.Results Among the 193 patients with MHD,the incidence of depression was 47.6%(92 cases).Age(OR=1.03,P=0.038),dialysis age(OR=1.02,P=0.032),IWG(%)(OR=1.71,P=0.025),Charlson comorbidity index(OR=1.78,P=0.008),type of medical insurance(OR=3.27,P=0.021),spKt/V(OR=0.01,P<0.001),hemoglobin(OR=0.82,P<0.001),and serum albumin(OR=0.87,P=0.032)were independent risk factors for depression in patients with MHD.The work status was related to the prevalence of depression(P=0.033),and the incidence of depression among unemployed patients(OR=4.41,P=0.012)and retired patients(OR=3.19,P=0.049)was higher than that of in-service patients.Conclusion In MHD patients,the incidence of depression was high.The increase in age,complications,dialysis age,IWG,and the proportion of medical expenses were risk factors for depression,while the work status,increase of dialysis adequacy,anemia correction,and elevation of serum albumin were protective factors for depression.