维持性血液透析患者衰弱与焦虑、抑郁的相关性

doi:10.3969/j.issn.1006-5725.2024.18.018

Abstract

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。

Key words: maintenance hemodialysis, frailty, anxiety, depression, correlation study

CLC Number:

R459.5

Hongmei LIU,Huahong ZHOU,Xiangjiu CHEN,Guobao HONG,Xiongbin WU,Yanjuan LIANG,Chunting LI,Meidi ZHENG,Yueqin LAI,Fanna. LIU. Association of frailty with anxiety and depression in patients on maintenance hemodialysis[J]. The Journal of Practical Medicine, 2024, 40(18): 2612-2617.

Figures/Tables 2

Tab.1

Comparison of general data and clinical data between frailty group and non-frailty group"

项目	非衰弱组（n = 72）	衰弱组（n = 29 ）	t/χ²值	P值
性别（男/女）/例	42/30	14/15	0.847	0.358
年龄（x ± s）/岁	54.63 ± 13.17	63.79 ± 13.72	3.125	0.002
透析龄［M（P₂₅，P₇₅）］/年	3.00（1.00，5.00）	2.00（2.00，5.00）	-0.856	0.392
身高（x ± s）/cm	161.99 ± 7.96	159.69 ± 9.85	1.225	0.223
干体质量（x ± s）/kg	61.44 ± 10.11	57.56 ± 11.97	1.654	0.101
体质量指数（x ± s）/（kg/m²）	23.32 ± 3.27	22.42 ± 3.40	1.237	0.219
握力值（x ± s）/kg	23.68 ± 7.47	18.81 ± 7.63	2.946	0.004
跌倒史（有/无）/例	24/48	11/18	0.193	0.660
运动（有/无）/例	32/40	3/26	10.615	0.001
高血压（是/否）/例	67/5	26/3	0.328	0.567
糖尿病（是/否）/例	21/51	12/17	1.402	0.236
脑卒中（是/否）/例	11/61	16/13	16.799	0.000
冠心病（是/否）/例	21/51	21/8	15.917	0.000
抑郁（是/否）/例	23/49	19/10	9.592	0.002
焦虑（是/否）/例	9/63	16/13	20.211	< 0.001
血红蛋白［M（P₂₅，P₇₅）］/（g/L）	111.15 ± 14.80	111.86 ± 17.37	0.207	0.836
血清铁［M（P₂₅，P₇₅）］/（μmol/L）	11.10（7.73，14.98）	12.00（9.50，16.10）	-1.013	0.311
铁蛋白［M（P₂₅，P₇₅）］/（μg/L）	105.50（56.15，163.50）	180.00（104.00，297.50）	-3.018	0.003
总铁结合力（x ± s）/（μmol/L）	46.65 ± 10.70	42.98 ± 9.48	1.609	0.111
转铁蛋白饱和度［M（P₂₅，P₇₅）］/%	24.89（17.87，36.19）	33.11（19.16，41.34）	-1.689	0.091
透析前BUN（x ± s）/（mmol/L）	24.13 ± 6.72	22.97 ± 5.23	0.833	0.407
透后BUN（x ± s）/（mmol/L）	8.29 ± 3.63	7.76 ± 3.54	0.669	0.505
尿素下降率（x ± s）	0.66 ± 0.09	0.67 ± 0.10	0.467	0.651
尿素清除指数（x ± s）	1.42 ± 0.37	1.49 ± 0.46	0.729	0.468
血钾（x ± s）/（mmol/L）	4.63 ± 0.68	4.96 ± 1.12	1.478	0.143
二氧化碳总量（x ± s）/（mmol/L）	19.96 ± 3.77	20.00 ± 4.74	0.041	0.968
血肌酐（x ± s）/（μmol/L）	1 077.39 ± 308.54	984.03 ± 318.29	1.345	0.183
尿酸（x ± s）/（μmoml/L）	401.74 ± 137.18	427.10 ± 125.56	0.894	0.373
血总钙（x ± s）/（mmol/L）	2.25 ± 0.24	2.25 ± 0.22	< 0.001	1.000
校正钙（x ± s）	2.31 ± 0.25	2.24 ± 0.50	0.717	0.475
血磷（x ± s）/（mmol/L）	1.80 ± 0.60	1.89 ± 0.67	0.629	0.531
钙磷乘积（x ± s）	51.33 ± 20.26	53.42 ± 23.31	0.422	0.674
iPTH［M（P₂₅，P₇₅）］/（pg/mL）	220.00（116.45， 469.70）	140.50（94.60， 230.60）	-2.004	0.045
白蛋白（x ± s）/（g/L）	37.04 ± 4.97	36.00 ± 4.06	1.090	0.278
前白蛋白（x ± s）/（mg/L）	393.56 ± 87.42	368.31 ± 67.51	1.558	0.122
CRP［M（P₂₅，P₇₅）］/（mg/L）	1.02（0.50，3.10）	4.50（0.60，12.96）	-2.532	0.011
血糖（x ± s）/（mmol/L）	8.69 ± 3.43	10.48 ± 5.06	1.748	0.084
糖化血红蛋白（x ± s）/%	6.34 ± 1.32	6.93 ± 1.59	1.767	0.080
低密度脂蛋白（x ± s）/（mmol/L）	2.22 ± 0.78	2.46 ± 0.65	1.583	0.117
胆固醇（x ± s）/（mmol/L）	4.03 ± 1.22	4.40 ± 0.95	1.628	0.107
甘油三酯［M（P₂₅，P₇₅）］/（mmol/L）	1.83（1.21，2.85）	1.84（1.21，2.29）	-0.612	0.541

Tab.1

Tab.2

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项目	B	SE	Wald	P值	OR	95%CI
年龄	0.032	0.4027	1.409	0.235	1.033	0.979 ~ 1.089
握力值	-0.809	0.051	3.017	0.082	0.915	0.827 ~ 1.012
运动	2.197	0.935	5.518	0.019	9.000	1.439 ~ 56.291
脑卒中	2.196	1.021	4.624	0.032	8.986	1.215 ~ 66.491
冠心病	0.560	0.764	0.537	0.464	1.750	0.392 ~ 7.821
PHQ-9评分	-2.701	1.197	5.094	0.024	0.067	0.006 ~ 0.701
GAD-7评分	2.317	0.824	7.906	0.005	10.141	2.017 ~ 50.979
铁蛋白	0.007	0.002	7.933	0.005	1.007	1.002 ~ 1.011
iPTH	0.000	0.001	0.210	0.646	1.000	0.999 ~ 1.002
CRP	0.034	0.026	1.660	0.198	1.035	0.982 ~ 1.090

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

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