抑郁症对老年慢性肾病患者营养状态研究

Effects of depression on nutritional status of elderly patients with kidney disease

目的探讨抑郁症对老年慢性肾病患者营养状态的影响。方法选取自2016年9月至2017年9月南京医科大学第一附属医院老年肾科收治的110例老年慢性肾病(CKD)患者为研究对象。根据健康问卷抑郁量表(PHQ-9),将所有患者分为抑郁组(n=70)和非抑郁症组(n=40),比较两组患者血清蛋白(Alb)、血红蛋白(Hb)、三头肌部皮褶厚度(TSF)及上臂肌围(AMC)等营养指标;采用微型营养评估量表(MNA)评估两组患者的整体营养状况,比较不同抑郁程度患者MNA评分及营养不良率,分析老年CKD伴抑郁症患者PHQ-9评分与营养状态指标相关性。结果抑郁症组Alb、Hb、TSF和AMC等营养状态指标均低于非抑郁症组,两组比较,差异均有统计学意义(P<0.05);抑郁症组整体营养状态较非抑郁症组差,抑郁症组营养不良率高于非抑郁症组,两组比较,差异均有统计学意义(P<0.05);随着抑郁程度加重,患者MNA评分降低,营养不良率增加,两组比较,差异均有统计学意义(P<0.05);CKD合并抑郁症患者PHQ-9评分与ALb、Hb、TSF、AMC、MNA评分均呈负相关。结论抑郁可影响CKD患者的营养状态,抑郁程度越高,发生营养不良的风险越大,应及时监测并给予合理的干预措施。

Objective To investigate the effects of depression on nutritional status of elderly patients with kidney disease.Methods Aretrospective study was performed on 110 cases of elderly patients with chronic kidney disease（ CKD） who were admitted from September 2016 to September 2017. According to Patient Health Questionnaire（ PHQ-9）,patients were divided into the depression group（ n = 70） and the not depression group（ n = 40）. The nutritional status indexes such as serum albumin（ Alb）,hemoglobin（ Hb）,triceps skinfold thickness（ TSF） and upper arm muscle circumference（ AMC） were compared between the two groups; the mininutritional assessment scale（ MNA） was used to evaluate the overall nutritional status of the two groups,the MNA score and malnutrition rate of the patients with different depression levels were compared,and the correlation between PHQ-9 score and nutritional status indexes of elderly patients with kidney disease and depression were analyzed. Results The serum levels of Alb,Hb,TSF and AMC in the depression group were lower than those in the not depression group（ P〈0. 05）. The overall nutritional status in the depression group was poorer than that in the not depression group,and the malnutrition rate was higher than that in the not depression group（ P〈0. 05）. With the aggravation of depression,the MNA score was reduced and malnutrition rate was increased（ P〈0. 05）. Correlation analysis showed that the PHQ-9 score was negatively correlated with the levels of Alb,Hb,TSF,AMC and MNA score in elderly patients with kidney disease and depression. Conclusion Depression can affect the nutritional status of elderly patients with kidney disease.With the aggravation of depression,the risk of malnutrition increases,therefore,the patients should be given the timely monitoring and appropriate interventions.