临床研究

维持性血液透析患者衰弱与焦虑、抑郁的相关性

  • 刘洪梅 ,
  • 周华红 ,
  • 陈翔鸠 ,
  • 洪国保 ,
  • 吴雄彬 ,
  • 梁燕娟 ,
  • 李春婷 ,
  • 郑美娣 ,
  • 赖月琴 ,
  • 刘璠娜
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  • 1.暨南大学附属顺德医院肾内科 (广东 佛山 528305 )
    2.暨南大学附属第一医院肾内科 (广州 510630 )

收稿日期: 2024-05-21

  网络出版日期: 2024-09-30

基金资助

佛山市自筹经费类科技计划项目(2220001004 377);广东省普通高校重点领域专项(2021ZDZX2042);暨南大学医学联合基金自由项目(MF220211)

Association of frailty with anxiety and depression in patients on maintenance hemodialysis

  • Hongmei LIU ,
  • Huahong ZHOU ,
  • Xiangjiu CHEN ,
  • Guobao HONG ,
  • Xiongbin WU ,
  • Yanjuan LIANG ,
  • Chunting LI ,
  • Meidi ZHENG ,
  • Yueqin LAI ,
  • Fanna. LIU
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  • *.Department of Nephrology,Shunde Hospital Affiliated to Jinan University,Foshan 528305,China

Received date: 2024-05-21

  Online published: 2024-09-30

摘要

目的 了解维持性血液透析(MHD)患者衰弱的现状,并探究衰弱与焦虑、抑郁的相关性。 方法 收集2023年1月至2024年1月在暨南大学附属顺德医院肾内科接受MHD的101例患者的一般资料、临床数据和血液生化数据。采用FRAIL量表评估衰弱状况,根据其分为“衰弱组”和“非衰弱组”(包括虚弱前期和无衰弱的参与者)。同时采用GAD-7、PHQ-9量表评估焦虑、抑郁现状。使用单因素分析及logistic回归方法探究衰弱与焦虑、抑郁的相关性及其他可能的影响因素。 结果 101例MHD患者中,衰弱组29例(28.71%),非衰弱组72例(71.29%),其中抑郁42例(41.58%),焦虑25例(24.75%)。衰弱组中抑郁患病率65.52%,焦虑患病率55.17%。衰弱组和非衰弱组之间的年龄、握力值、有无运动、脑卒中及冠心病患病情况、有无焦虑抑郁、铁蛋白、CRP方面差异均有统计学意义(P < 0.01)。通过多因素回归分析发现,抑郁、焦虑、无运动,患脑卒中,高铁蛋白浓度是MHD患者衰弱的独立危险因素(P < 0.05)。 结论 MHD患者中,衰弱与抑郁、焦虑及缺乏运动密切相关,且脑卒中和高铁蛋白浓度亦是衰弱的独立危险因素。

本文引用格式

刘洪梅 , 周华红 , 陈翔鸠 , 洪国保 , 吴雄彬 , 梁燕娟 , 李春婷 , 郑美娣 , 赖月琴 , 刘璠娜 . 维持性血液透析患者衰弱与焦虑、抑郁的相关性[J]. 实用医学杂志, 2024 , 40(18) : 2612 -2617 . DOI: 10.3969/j.issn.1006-5725.2024.18.018

Abstract

Objective To investigate the current status of frailty in patients on maintenance hemodialysis (MHD), and explore the correlation of frailty with anxiety and depression. Methods General information, clinical data and blood biochemical data of 101 cases who underwent MHD in Department of Nephrology, Shunde Hospital Affiliated to Jinan University from January 2023 to January 2024 were collected. FRAIL scale was applied to evaluate the frailty of the patients, and they were accordingly classified into frailty group and non?frailty group (including pre?frail and non?frail participants). Anxiety and depression were evaluated by GAD?7 and PHQ?9 scale. Univariate analysis and logistic regression were used to explore the association of frailty with anxiety, depression and other possible influencing factors. Results Among the 101 cases, 29 cases (28.71%) were includedin frailty group and 72 cases (71.29%) in non?frailty group. There were 42 patients with depression (41.58%) and 25 with anxiety (24.75%). In the frailty group, the prevalence of depression was 65.52% and that of anxiety 55.17%。 There were significant differences in age, grip strength, exercise, stroke and coronary heart disease, anxiety and depression, ferritin and CRP between the two groups (P < 0.01). Multivariate regression analysis showed that depression, anxiety, no exercise, stroke and high ferritin concentration were independent risk factors for frailty in MHD patients (P < 0.05). Conclusion In patients on MHD, frailty is closely associated with depression, anxiety, and lack of exercise, and stroke as well as high ferritin concentration are independent risk factors for frailty。

参考文献

1 JIANG X, LI D, SHEN W, et al. In-Hospital outcomes of patients on maintenance dialysis with frailty: 10-yearresults from the US national inpatient sample database[J]. J Ren Nutr, 2020,30(6):526-534. doi:10.1053/j.jrn.2019.12.007
2 WANG J, HUANG L, XU M, et al. Study on the clinical Implications of NLR and PLR for diagnosing frailty in maintenance hemodialysis patients and their correlations with patient prognosis[J]. J Healthc Eng, 2022, 2022:1267200. doi:10.1155/2022/1267200
3 朱蓓,杭乐佳,高飞,等. 老年血液透析病人衰弱与血清瘦素及25-羟维生素D的相关性研究[J]. 实用老年医学, 2024,38(6):603-606.
4 肖宗清,董翠婷,张杰,等. 维持性血液透析患者衰弱风险预测模型的建立与验证[J]. 临床肾脏病杂志, 2024,24(4):265-270.
5 解巧丽,石瑞,王德光. 老年维持性血液透析患者衰弱发生情况及其影响因素[J]. 中华老年多器官疾病杂志, 2023,22(5):334-338.
6 黄莉娟,李蓓,王俊,等. 维持性血液透析患者衰弱发生的危险因素及运动联合营养支持小组干预的疗效观察[J]. 中国血液净化, 2022,21(4):292-295.
7 GONG W, YAO L, ZHONG X, et al. Prevalence and associated factors of frailty among Southern Chinese Han patients on haemodialysis: A multicentre, observational cross-sectional study[J]. BMJ Open, 2022,12(3):e054177. doi:10.1136/bmjopen-2021-054177
8 陈洁,李婷冶. 衰弱症临床诊治研究进展[J]. 中国老年学杂志, 2014,34(17):5019-5022. doi:10.3969/j.issn.1005-9202.2014.17.152
9 刘鲲,洪法通,汪宏. 维持性血液透析女性患者焦虑,抑郁状态调查及其对生活质量的影响研究[J]. 川北医学院学报, 2023,38(2):265-268.
10 FLYTHE J E. Ascending to new heights in our understanding of the treatment of depression among individuals receiving hemodialysis[J]. Ann Intern Med, 2019, 170(6):414-415. doi:10.7326/M19-0526
11 JIANG J, YI HAN A Y, GOH J. Association of the FRAIL scale with rehabilitation outcomes in the community hospital setting[J]. Singapore Med J, 2022, 63(10):585-592. doi:10.11622/smedj.2021137
12 LEE C, ROUND J M, HANLON J G, et al. Generalized anxiety disorder 7-Item (GAD-7) scores in medically authorized cannabis patients-ontario and alberta, canada[J]. Can J Psychiat, 2022, 67(6):470-480. doi:10.1177/07067437211043393
13 NEGERI Z F, LEVIS B, SUN Y, et al. Accuracy of the patient health questionnaire-9 for screening to detect major depression: Updated systematic review and individual participant data meta-analysis[J]. BMJ, 2021,375:n2183. doi:10.1136/BMJ.N2183
14 ONELLI M, WIEBE N, GILL J S,et al. Frailty and clinical outcomes in patients treated with hemodialysis: A prospective cohort study[J]. Kidney Med, 2023,5(8):100684. doi:10.1016/j.xkme.2023.100684
15 李娜,白彝华,蒋红樱,等. 长期维持性透析患者的衰弱现况及其影响因素[J]. 实用医学杂志,2024,40(3):330-335.
16 CLEGG A, YOUNG J, ILIFFE S,et al. Frailty in elderly people [J].Lancet,2013,381(9868):752-762. doi:10.1016/s0140-6736(12)62167-9
17 BAO Y, DALRYMPLE L, CHERTOW G M,et al. Frailty,dialysis initia-tion, and mortality in end-stage renal disease[J]. Arch Intern Med,2012,172(14):1071-1077. doi:10.1001/archinternmed.2012.3020
18 陶建青,龚冀荣,陆锦滢,等. 我国综合医院患者抑郁焦虑障碍患病率的Meta分析[J]. 四川精神卫生,2018,31(1):73-78.
19 ARIAS-GUILLéN M, ROMANO B, YUGUERO-ORTIZ A,et al. Frailty in hemodialysis patients: Results of a screening program and multidisciplinary interventions[J]. Clin Kidney J,2023,16(11):2174-2184. doi:10.1093/ckj/sfad115
20 HIRISCAU E I, BODOLEA C. The role of depression and anxiety in frail patients with heart failure[J]. Diseases, 2019, 7(2):45. doi:10.3390/diseases7020045
21 陈娟,谢军,孙媛媛,等. 老年衰弱患者焦虑、抑郁、生活质量状况的分析[J]. 实用临床医药杂志,2019,23(4):73-77.
22 樊少仪,徐福平,裴中,等. 广州地区老年人睡眠障碍与衰弱的相关性[J]. 实用医学杂志,2020,36(14):1908-1912. doi:10.3969/j.issn.1006-5725.2020.14.010
23 JOSEPH J, VELLAISAMY M, SUBRAMANIAN T, et al. Frailty in patients with chronic kidney disease stage five[J]. Cureus, 2023,15(8):e43787.
24 KOJIMA S, USUI N, UEHATA A, et al. Relationships between frailty and exercise capacity in patients undergoing hemodialysis: A cross-sectional study[J]. Geriatr Gerontol Int,2023,23(11):795-802. doi:10.1111/ggi.14681
25 ANGULO J, ASSAR M EL, áLVAREZ-BUSTOS A,et al. Physical activity and exercise: Strategies to manage frailty[J]. Redox Biol, 2020, 35:101513. doi:10.1016/j.redox.2020.101513
26 DENT E, DALY R M, HOOGENDIJK E O, et al. Exercise to Prevent and Manage Frailty and Fragility Fractures[J]. Curr Osteoporos Rep, 2023, 21(2):205-215. doi:10.1007/s11914-023-00777-8
27 贾雪威,宋湘勤. 运动对抑郁症治疗的研究进展[J]. 心理月刊, 2022, 17(16): 234-237. doi:10.19738/j.cnki.psy.2022.16.078
28 ZHANG Y, JIANG X. The effects of physical activity and exercise therapy on frail elderly depression: A narrative review[J]. Medicine (Baltimore), 2023, 102(34):e34908. doi:10.1097/md.0000000000034908
29 庞媛月,曹童童,董雪. 老年脑卒中患者衰弱相关研究进展[J]. 老年医学研究, 2024,5(1):56-61.
30 任艳珠. 糖尿病肾病患者C反应蛋白、铁蛋白与营养状况的评估[D]. 太原:山西医科大学, 2019.
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