腹膜透析患者透析前后焦虑抑郁状态变化的影响因素分析

Peritoneal Dialysis Patients Before and After Dialysis Impact of Changes in Anxiety and Depression Factors

目的:探讨腹膜透析患者在透析1年后焦虑抑郁状态较透析前的变化,并分析影响其变化的因素。方法:本研究共纳入2002年2月～2007年2月新增腹透患者177名。收集患者透析开始时的人口学资料和生化参数。分别于透析前,透析后1年采用Hamilton焦虑抑郁量表评估出焦虑抑郁积分。根据透析后1年和透析前焦虑积分的差值的百分位数,将患者三等分为焦虑程度改善组,不变组和变差组。结果:患者进入透析时年龄(58.7±14.0)岁,39.5%为男性。透析1年后焦虑积分自(12.1±9.4)分下降至(8.4±6.9)分(P<0.001),抑郁积分自(9.8±6.1)分下降至(5.9±4.7)分(P<0.001)。透析1年后焦虑程度加重组的糖尿病比例,明显高于焦虑程度不变和改善组,分别为47.5%和27.1%(P<0.01),其中年收入2万以上所占比例明显低于焦虑程度不变和改善组,分别为22.1%和38.9%(P<0.05)。结论:总的说来腹透患者透析1年后焦虑抑郁程度有所改善。透析1年后焦虑程度加重者糖尿病和经济收入较低者居多。

Objective：We aimed to observe the change of depression and anxiety in patients on peritoneal dialysis during the first one year,and further explore the contributing factors.Methods：The study included 177 incident patients,starting PD between July 2002 and February 2007.The demographics and biochemical data were collected at the baseline.The Hamilton depression/anxiety scale was repeatedly measured at baseline and one year after starting peritoneal dialysis.Patients were divided into improved group,no changed group and worsen group in terms of the differences in anxiety scores between 1yr-and baseline measurement.Results：Mean age was 58.7 years,and 39.5% were male in 177 incident PD patients.The anxiety scores decreased to 8.4±6.9 from 12.1±9.4（P0.001）,and depression scores decreased to 5.9±4.7 from 9.8±6.1（P0.001）.The percentage of diabetes in worsen group was higher compared to improved/no changed group,which was 47.5% and 27.1% respectively（P0.01）.The percentage of patients with annual income higher than 20,000 in worsen group was lower compared to improved/no changed group,which was 22.1% and 38.9% respectively（P0.05）.Conclusion：The status of depression and anxiety was improved in our subjects after one year on peritoneal dialysis.However,the extent of anxiety in patients with diabetes was prone to be aggravated.Patients with relatively high income seemed to maintain a stable anxiety status.The potential mechanisms for these phenomena are to be determined.