时间平均的焦虑积分独立预测腹膜透析相关性腹膜炎的风险  

Time-averaged anxiety scores independently predict the risk for peritoneal dialysis-associated peritonitis

作　　者：陈勇军[1,2,3] 王欢[1,2] 许莹[1,2] 许戎[1,2] 董捷[1,2] 

机构地区：[1]北京大学第一医院肾内科 [2]北京大学肾脏疾病研究所 卫生部肾脏疾病重点实验室 教育部肾脏疾病重点实验室,北京100034 [3]广州解放军四二一医院心理科,广州510318

出　　处：《中国血液净化》2012年第6期311-314,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨透析开始时,以及长期随访中的焦虑抑郁状态是否预测腹膜透析相关性腹膜炎的发生,以及其预测性是否受腹膜透析患者临床特征和合并症的影响。方法本研究共纳入2002年2月至2007年2月新增腹膜透析患者240名,随访观察2011年6月,将第一次腹膜炎发生作为终点事件,死亡、转血液透析和移植记为删失。收集患者透析开始时的人口学资料,生化参数和残余肾功能作为基线值。分别于透析开始,透析后1,2,3年采用Hamilton焦虑抑郁量表评估出基线和时间平均的焦虑抑郁积分。结果患者年龄(59.2±14.2)岁,40%为男性。随访时间(51±25)月,随访结束时110名(45.8%)患者死亡。从透析开始到首次腹膜炎的随访时间是31(18～61)月。COX回归分析提示,时间平均的焦虑积分,经多变量校正(经年龄,性别,体质量指数,糖尿病,教育程度,经济收入水平,血红蛋白,血白蛋白,肾小球滤过率和合并症指数),仍为腹膜炎的独立预测因子[HR=1.057(1.022～1.094)](P=0.001)。而基线时的焦虑抑郁积分均不能预测腹膜炎。结论时间平均的焦虑积分是腹膜透析相关性腹膜炎的独立预测因素.应在长期随访中密切关注腹膜透析患者的焦虑状态,预防腹膜炎的发生。Objectives To explore the impact of depression and anxiety at baseline and during follow-up period on the risk of peritonitis in patients on peritoneal dialysis(PD),and if this impact is confounded by clinical characteristics and co-morbidities.Methods This study included 240 incident patients who started PD between July 2002 and February 2007.All patients were followed up until June 2011.The first episode of peritonitis was viewed as outcome event.Death,transfer to hemodialysis and renal transplantation of the patients were censored.Demographics,biochemical data and residual renal function were collected at the baseline.The Hamilton depression and anxiety scales were repeatedly measured at baseline and after PD for one,two,and three years,to represent baseline and time-averaged depression and anxiety levels.Results In the 240 incident PD patients,the mean age was 59.2±14.2 years,and 40% patients were males.They were followed up for 51±25 months.Sixty-four patients(26.7%) died during the follow-up period of 34.7 months,and 110 of 240(45.8%) patients died at the end of study.The median interval from the initiation of PD to the first episode of peritonitis was 31(18～61) months.Multivariate COX regression analysis indicated that time-averaged anxiety scores were the independent predictors of peritonitis even after adjustment by age,gender,body mass index,education and income levels,hemoglobin,serum albumin,residual renal function,and Charlson index(HR=1.057,with the range of 1.022～1.094,P=0.001).However,neither anxiety nor depression scores at baseline could predict peritonitis risk.Conclusions Time-averaged anxiety scores independently predict the risk for peritonitis.Therefore,we should pay more attention to the anxiety status during the long-term follow-up in patients on PD.

关 键 词：腹膜透析 焦虑 抑郁 腹膜炎 

分 类 号：R395[哲学宗教—心理学]