基于倾向评分匹配法研究改善慢性肾脏病患者睡眠及抑郁状态的方法

Improve sleep and depression in patients with chronic kidney disease On propensity score matching method

目的:基于倾向评分匹配法探讨综合护理干预及加用针灸治疗改善透析前慢性肾脏病(CKD)患者睡眠及抑郁状态的疗效。方法:选取236例肾科门诊随访的CKD患者,使用匹兹堡睡眠质量量表(PSQI)及Beck抑郁自评量表调查其睡眠质量及抑郁状态,筛选出存在睡眠障碍者给予综合护理随访干预,其中自愿接受针灸治疗者纳入针灸治疗组,其他患者为对照组。以患者一般资料、PSQI评分、BDI评分、实验室指标及估算的肾小球滤过率(eGFR)作为协变量,按1∶1比例进行倾向评分匹配,重新筛选出各协变量均匹配的对照组及针灸治疗组,持续随访6个月,每间隔3个月对上述指标进行评估,分析两组患者经干预后睡眠质量、抑郁状态及eGFR指标的改善效果。结果:经倾向评分匹配后,针灸治疗组及对照组各28例患者,两组患者基线资料比较,差异无统计学意义(P>0.05)。对照组经随访干预3个月后BDI评分较基线水平明显升高,差异有统计学意义(P<0.05),随访至6个月时略有下降,与基线比较,差异无统计学意义(P>0.05);PSQI评分及eGFR水平随访干预期间比较,差异无统计学意义(P>0.05)。针灸治疗组经随访干预3个月及6个月后,PSQI及BDI评分均较基线水平有显著下降,差异有统计学意义(P<0.05),但eGFR水平比较,差异无统计学意义(P>0.05)。两组间干预效果比较,随访3个月及6个月时针灸治疗组的PSQI评分均显著低于对照组,差异有统计学意义(P<0.05),但BDI评分及eGFR水平比较,差异无统计学意义(P>0.05)。针灸治疗组干预3个月及6个月后患者PSQI及BDI评分较基线值的下降幅度明显高于对照组,差异有统计学意义(P<0.05),但两组患者随访期间eGFR变化值无统计学差异(P>0.05)。结论:经倾向评分匹配后分析,单纯通过综合护理随访不能有效改善未透析的CKD患者睡眠障碍及抑郁状态,但结合针灸治疗后可达到持续改善效果。

Objective To investigate the effect of comprehensive nursing intervention and acupuncture therapy on sleep quality and depression in patients with pre-dialysis chronic kidney disease(CKD)base on the propensity score matching method.Method 236 cases in our hospital renal outpatient follow-up of CKD patients were selected,using the Pittsburgh sleep quality scale(PSQI)and Beck depression self rating scale(BDI)to investigate their sleep quality and depression status,Patients with sleep disorders were screened out and given comprehensive nursing follow-up intervention,among them,those who voluntarily received acupuncture treatment were included into the acupuncture treatment group,and the other patients were the control group.In patients with general information,PSQI score,BDI score,laboratory indexes and estimated glomerular filtration rate(eGFR)as a covariate,according to the proportion of 1∶1 propensity score matching,to select the covariate matched control group and acupuncture treatment group,continuous follow-up of 6 months,each interval of 3 months to evaluate these indicators,analysis of the two groups before and after the intervention,depression,sleep quality status and changes of eGFR.Results After propensity score matching,there were 28 patients in the acupuncture treatment group and the control group,and the baseline data of the two groups were comparable(P>0.05).The BDI score of the control group was significantly increased after 3 months of follow-up intervention(P<0.05),and slightly decreased after 6 months of follow-up,with no significant difference from the baseline(P>0.05).There was no significant change in PSQI score or eGFR level during follow-up intervention(P>0.05).After 3 months and 6 months follow-up,PSQI and BDI scores in the acupuncture treatment group were significantly lower than the baseline level(P<0.05),but there was no significant change in eGFR level(P>0.05).Compared with the intervention effect between the two groups,the PSQI score of the acupuncture treatment group was significantly lower than that of the control group at the follow-up of 3 months and 6 months(P<0.05),but there was no significant difference in BDI score and eGFR level(P>0.05).The decrease of PSQI and BDI scores in the acupuncture treatment group was significantly higher than that in the control group after 3 months and 6 months intervention(P<0.05).However,there was no significant difference in eGFR between the two groups during the follow-up period(P>0.05).Conclusion After the analysis of propensity score matching,the comprehensive nursing follow-up alone could not effectively improve the sleep disorder and depression state of non-dialysis CKD patients,but the continuous improvement effect could be achieved after acupuncture treatment.