时间平均的焦虑抑郁积分预测腹膜透析患者的死亡率

Time-averaged depression and anxiety scores for the prediction of mortality in patients on peritoneal dialysis

目的探讨透析开始时,以及长期随访中的焦虑抑郁状态对腹膜透析患者死亡率的影响。研究方法本研究共纳入北京大学第一医院肾内科2002年2月至2007年2月新增腹膜透析患者240名,随访至死亡、转为血液透析、肾移植或观察终点(2008年2月)。收集患者透析开始时的人口学资料、生化参数、残余肾功能和透析充分性作为基线值。分别于透析开始,透析后1、2、3年采用Hamilton焦虑抑郁量表评估出基线和时间平均的焦虑抑郁积分。结果患者年龄(59.2±14.2)岁,40%为男性。平均随访时间(34.7±12.9)月,随访结束时64名(26.7%)患者死亡。老年、残余肾功能好和基线焦虑积分较低相关,男性、年收入水平高和基线抑郁积分较低相关(P<0.01)。单变量的COX回归分析提示,基线的焦虑/抑郁积分不是死亡的预测因子。而时间平均的焦虑/抑郁积分,无论是单变量还是多变量分析(经年龄,性别,体质量指数,糖尿病,教育程度,经济收入水平,血红蛋白,血白蛋白,肾小球滤过率,周总尿素清除率和平均动脉压校正),均显示为死亡的独立预测因子。结论时间平均的焦虑抑郁积分是腹膜透析患者死亡的独立预测因素,应在长期随访中密切关注其焦虑抑郁状态。

Objective To explore the impact of depression and anxiety at baseline and during follow-up on mortality in patients on peritoneal dialysis（PD）.Methods This study included 240 incident patients who started PD between July 2002 and February 2007.All patients were followed up until death,changing PD to hemodialysis or renal transplantation,or termination of this study in February 2008.Demographics,biochemical data and residual renal function information were collected at the baseline.The Hamilton depression and anxiety scale was repeatedly measured at baseline,and after 1,2 and 3 years to obtain baseline and time-averaged depression and anxiety scales.Results Mean age of the patients was 59.2±14.2 years,and 40% of them were males.Sixty-four（26.7%）patients died during the median follow-up period of 34.7 months.Older age and better residual renal function were correlated to the lower anxiety score,and males and higher annual income were correlated to the lower depression score（P0.01）.By COX regression analyses,time-averaged depression/anxiety scores rather than the baseline depression/anxiety scores were the independent predictors for mortality in either univariate or multivariate analyses.Conclusions Time-averaged depression and anxiety score independently predicts mortality in PD patients.Therefore,we should pay attention to the depression and anxiety symptoms during the long-term follow-up period of PD patients.