脑白质异常与慢性肾病患者抑郁状态的临床相关性分析

Clinical Correlation Analysis of White Matter Lesions and Depressive State in Patients with Chronic Kidney Disease

目的:研究脑白质异常与慢性肾病患者抑郁状态的临床关系。方法:选择314例慢性肾病患者作为研究对象,评估所有患者的PHQ-9抑郁症筛查量表评分,结合患者的MRI影像结果,分析慢性肾病患者脑白质异常的发生率、持续代谢紊乱相关症状发生率、脑白质发生情况与患者抑郁状态的相关关系,以及脑白质异常对持续代谢紊乱相关症状与抑郁鉴别的临床价值。结果:CDK分期1~5期患者例数分别为55例、73例、69例、57例、60例,各组间患者的年龄、性别构成无统计学差异(P>0.05)。CDK分期1~5期患者出现有抑郁评分4分以上的分别有7(12.73%)、10(13.70%)、12(17.39%)、15(26.32%)、21(35.00%),各组间比率有统计学差异(P<0.05);CDK分期1~5期患者出现脑白质异常的分别有4(7.27%)、11(15.07%)、12(17.39%)、13(22.81%)、18(30.00%),各组间比率有统计学差异(P<0.05);CDK分期1~5期患者出现代谢紊乱的分别有2(3.64%)、4(5.48%)、11(15.94%)、19(33.33%)、18(30.00%),各组间比率有统计学差异(P<0.05)。相关性检测结果显示,抑郁状态与脑白质异常及代谢紊乱均呈显著正相关(P<0.05)。单纯性代谢紊乱与代谢紊乱合并抑郁的脑白质异常率有显著性差异(P<0.05);脑白质病程度与代谢紊乱合并抑郁呈显著正相关(P<0.05)。结论:慢性肾病晚期(CDK4期和5期)患者高发抑郁和脑白质异常,并且脑白质异常与患者抑郁发生有显著正相关,对慢性肾病晚期有脑白质异常的患者应注意代谢紊乱症状下可能合并抑郁。

Objective:To study the clinical relationship between white matter lesions and depressive state in patients with chronic kidney disease.Methods:314 patients with chronic kidney disease were selected as the research object to evaluate PHQ-9 depression screening scale scores for all patients.Combined with the results of MRI image,the incidence of cerebral white matter lesions in patients with chronic kidney disease,the incidence of symptoms related to continuous metabolic disorders,the correlation of cerebral white mass occurrence and the state of depression,and the clinical value of cerebral white matter abnormalities in the identification of symptoms related to continuous metabolic disorders and depression were analyzed.Results:The number of patients with CDK stage 1 to 5 was 55,73,69,57,60,respectively,and there was no statistical difference in age and gender among the groups(P>0.05).There were 7(12.73%),10(13.70%),12(17.39%),15(26.32%)and 21(35.00%)patients with CDK stage 1 to 5 with depression score above 4 points,respectively,and there were statistically significant differences among groups(P<0.05).There were 4(7.27%),11(15.07%),12(17.39%),13(22.81%)and 18(30.00%)patients with CDK stage 1 to 5 with white matter lesions,respectively,and there were statistically significant differences among groups(P<0.05).There were 2(3.64%),4(5.48%),11(15.94%),19(33.33%),18(30.00%)patients with CDK stage 1 to 5 with metabolic disorders,respectively,and there were statistically significant differences among groups(P<0.05).The results of correlation test showed that depressive state was positively correlated with cerebral white matter lesions and metabolic disorders(P<0.05).There was significant difference in the rate of white matter lesions between simple metabolic disorder and metabolic disorder complicated with depression(P<0.05).There was a significant positive correlation between the degree of leukoencephalopathy and metabolic disorders complicated with depression(P<0.05).Conclusion:Patients with advanced chronic kidney disease(CDK4 and CDK5)have high incidence of depression and white matter lesions,and white matter lesions have significant positive correlation with the occurrence of depression in patients.Patients with late chronic kidney disease and white matter lesions should pay attention to the possibility of depression under the symptoms of metabolic disorders.