维持性血液透析患者抑郁状态的相关因素分析

目的调查抑郁状态在维持性血液透析（maintenancehemodialysis，MHD）患者中的发生情况，探讨与抑郁相关的生理及社会因素，为进一步的心理干预做好前期工作。方法采用横断面调查，应用Zung抑郁自评量表对太仓市第一人民医院血液净化中心的102例MHD患者进行评估，根据患者是否合并抑郁状态分为非抑郁组（36例）和抑郁组（66例）。收集MHD患者的个人背景资料、临床资料、实验室数据以及问卷调查结果（以社会支持评定量表评分评估患者的社会支持程度，以营养不良-炎症评分评估患者的营养水平，以Charlson评分评估患者的合并症严重程度），采用SPSS13．0软件进行统计分析，探讨与抑郁状态相关的因素。结果102例MHD患者中，合并抑郁症的患者66例，发生率为64．7％，仅6例（占9％）的抑郁症患者曾主动寻求过医疗帮助。非抑郁组与抑郁组比较，年龄、营养不良一炎症评分、Charlson指数、C反应蛋白水平偏低（P〈0．05），而血白蛋白、社会支持评定量表评分、收入情况、有配偶的比例较高（P〈0．05）。进一步行多重线性回归分析发现，年龄、收入情况、Charlson指数、C反应蛋白均可独立的在不同程度上影响Zung抑郁自评量表评分，收入情况为影响Zung抑郁自评量表评分的最主要因素。结论MHD患者的抑郁症发病率较高，主动求医率低，年龄、收入水平、合并症的严重程度、C反应蛋白均为影响MHD患者抑郁程度的独立危险因素，而收入情况可能对抑郁程度的影响最大。

Related factors of depression in maintenance hemodialysis patients

Objective To investigate the incidence of depression in maintenance hemodialysis （MHD） patients, discuss the physiological and social related factors of depression, and implement the previous work for further psychological intervention. Methods One hundred and two patients treated with MHD were recruited from the Dialysis Center of Taicang First People＇s Hospital to participate in a cross-sectional study. Depression manifestations were assessed by Zung self-rating depression scale （SDS）. Patients were divided into non-depression group and depression group according to the SDS score. Their demographic characteristics, clinical information, laboratory parameters and results of questionnaire surveys were collected. Nutrition status was measured by the MIS, social support by SSRS,and complications were estimated by Charlson index. Data were analyzed using the Statistical Package of SPSS 13.0, then the related factors of depression were analyzed. Results In our blood puri- fication center, the overall incidence of depression was 64. 7%, and only 9% of the patients with de- pression had actively seeked medical help. In non-depression group, age was younger, and MIS score, Charlson index and CRP were lower in non-depression group （P〈0. 05）, while Alb, SSRS score, in- come, and the proportion of spouses were higher （P〈0. 05） than in depression group. Multiple linear regression analysis showed that age,Charlson index, income, and CRP could independently affect SDS scores to varying degrees. Income was the main factor influencing SDS score. Conclusions Depression symptoms were frequently seen in MHD patients, but only few patients actively seeked medical help. Age,complicatlons,income and CRP were independent risk factors of depressive status of the MHD patients. Income may be the most important factors related to depressive status.