维持性血液透析患者抑郁症发病相关因素调查分析

Depression characteristics and its related factors in patients of maintenance hemodialysis

目的:探讨维持性血液透析(maintenance hemodialysis,MHD)患者抑郁症的发生及相关因素,为防治MHD患者抑郁症提供依据。方法:调查东南大学附属中大医院148例MHD患者抑郁症发病状况,分析MHD患者抑郁症发生相关因素。用主观综合性营养评估(subjective global assessment,SGA)量表评估MHD患者营养状态,分析营养状态与抑郁症之间关系。结果:148例MHD患者中108例有抑郁症,抑郁组与非抑郁组婚姻及工作状况,个人收入及医疗费用支出比,心血管并发症,动静脉内瘘次数,C-反应蛋白、血红蛋白及白蛋白水平比较差异有统计学意义(P=0.005 9、P=0.015 7、P=0.000 1、P=0.045 1、P=0.042 3、P=0.027 7、P=0.043 0、P=0.001 3、P=0.047 2);抑郁组与非抑郁组SGA评分比较差异有统计学意义(P<0.05),SGA评分与汉密顿抑郁量表(Hamilton depression,HAMD)评分呈正相关(r=0.749,P<0.001)。结论:MHD患者抑郁症发病率高于普通人群;婚姻障碍、退休及工作环境差、低收入、医疗费用支出过高、动静脉内瘘成形手术次数多、心脑血管并发症、贫血与低血清白蛋白、微炎症状态是MHD患者抑郁症发病主要危险因素;抑郁组SGA评分明显高于非抑郁组,SGA评分越高,抑郁症程度越重。

Objective： To investigate the prevalence of depression in patients of maintenance hemodialysis and analyse the related factors of depression,provide evidence for reduce the prevalence of depression in maintenance hemodialysis patients.Methods： One hundred and forty-eight patients of Zhongda Hospital Affiliated to Southeast University undergoing hemodialysis were assessed to investigate the prevalence of depression and it′s related factors.All patients were assessed by the subjective synthetic assessment（SGA） to investigate the effect of nutritional assessment on depression.Results： In this study,one hundred and eight patients had depression with the incidence of 72.9%.There were significant differences in marital status,working conditions,personal income,medical expenses,cardiovascular complications,C-reactive protein,hemoglobin and albumin levels between the depression group and the non-depression group（P=0.005 9,P=0.015 7,P=0.000 1,P=0.045 1,P=0.042 3,P=0.027 7,P=0.043 0,P=0.001 3,P=0.047 2）.The SGA score of depression group was significantly higher than that of non-depression group（P0.05）.The correlation between the SGA score and the HAMD score was positive（r=0.749,P0.001）.Conclusions： The prevalence of depression in maintenance hemodialysis patients was significantly higher than that in the general population.Marriage barriers,retirement and poor working environment,low-income,higher medical expenses,multiple arteriovenous fistula surgery,cardiovascular complications,anemia,low serum albumin and micro-inflammatory state are the risk factors of depression.The SGA score is significantly higher in depression patients than that in non-depression patients.The higher SGA score,the more severity of depression.