维持性血液透析患者焦虑状态及其对生活质量的影响

Anxiety disorder and it impacts on life quality in patients with maintenance hemodialysis

目的分析维持性血液透析(maintenance hemodialysis,MHD)患者焦虑状态及其影响因素,探讨焦虑情绪对生活质量的影响。方法选取MHD三个月以上并且愿意参加本项调查的中国医科大学附属第一医院血液净化中心的102例患者作为调查对象。采用汉密顿焦虑量表(hamilton anxiety scale,HAMA)评估患者的焦虑状态,应用SF-36量表评价患者的生活质量。分析MHD患者焦虑情绪与性别、年龄、文化程度、职业、婚姻状况、透析时间、月透析次数及部分实验室指标的关系,探讨焦虑情绪对患者生活质量的影响。结果60.78%的患者处于不同程度的焦虑状态。性别、职业对焦虑情绪有显著影响(P<0.05);HAMA得分与血全段甲状旁腺素(intact parathyroid hormone,iPTH)呈正相关(r=0.384,P<0.01);焦虑情绪对生理功能(physical function,PF)、生理职能(role physical,RP)、一般健康(general health,GH)、精力(vitality,VT)、社会功能(social function,SF)、情感职能(role emotional,RE)、心理健康(mental health,MH)、躯体健康总评(physical component summary,PCS)、精神健康总评(mental component summary,MCS)有显著影响(P<0.01)。结论MHD患者焦虑情绪发生率高;女性、无业、血iPTH高的患者焦虑情绪发生率高;焦虑情绪可导致患者生活质量显著下降。

Objective To evaluate the anxiety disorder and it impacts on life quality in patients with maintenance hemodialysis.Methods We recruited 102 patients with end stage renal disease undergoing hemodialysis for more than 3 months in this dialysis center.Patients＇ anxiety status was evaluated by Hamilton Anxiety Scale （HAMA）,and their life quality was assessed by SF-36 scales.Based on HAMA score,patients were then divided into 2 groups：40 patients having HAMA score 0-14 in group A （no anxiety disorder）,and 62 patients with HAMA score higher than 14 in group B （clinical anxiety disorder）.Univariate analysis was performed to determine the effects of the variables including age,gender,marital satisfaction,employment status,education,dialysis status and biochemistry parameters on mental status,to evaluate the psychosocial impact of anxiety disorder on life quality of the patients.Result The data that 62 of the 102 patients were in group B indicate 60.78% of these patients with anxiety disorder.Univariate analysis demonstrated that gender and employment status contributed negative effects on mental status （P0.05）.Clinical correlation analysis showed that intact parathyroid hormone （iPTH） positively correlated with HAMA score （r =0.384,P=0.000）.Anxiety disorder had a significantly negative effects on physical function （PF）,role physical （RP）,general health （GH）,vitality （VT）,social function （SF）,role emotional （RE）,mental health （MH）,physical component summary （PCS） and mental component summary （MCS） （P0.01）.Conclusions The prevalence rate of anxiety disorder in patients with maintenance hemodialysis was relatively high.Female,unemployment and high iPTH level are the risk factors for anxiety disorder.Anxiety disorder can lead to a significant drop in life quality in patients with maintenance hemodialysis.