基于尿素动力学模型评估维持性血液透析患者透析充分性与患者焦虑和抑郁之间的关联性分析  

Analysis of the association between dialysis adequacy and anxiety and depression in maintenance hemodialysis patients based on urea dynamics model

作　　者：杨晓翠 杜俊林 尹青 余翼 周军 YANG Xiaocui;DU Junlin;YIN Qing(Dujiangyan People's Hospital,Dujiangyan 611830,China)

机构地区：[1]都江堰市人民医院,都江堰611830

出　　处：《国际精神病学杂志》2024年第1期215-218,229,共5页Journal Of International Psychiatry

基　　金：四川省医学会科研课题(编号:2017SHD015)。

摘　　要：目的探讨基于尿素动力学模型(ureakineticmodel,UKM)评估维持性血液透析(Maintenance hemodialysis,MHD)患者透析充分性与患者焦虑和抑郁之间的关联性分析。方法回顾性分析2021年6月~2022年6月收治的64例MHD患者的临床资料,通过临床资料将患者分为透析充分组(44例)、透析不充分组(20例),比较两组UKM参数[时间平均尿素浓度(Time-average Concentration of urea,TACurea)、整体尿素清除率(urea clearance index,KT/V)、蛋白质分解代谢率(Protein catabolism rate,PCR)];采用ROC曲线得出UKM参数界值,比较不同UKM参数水平患者焦虑自评量表评分(SAS)、抑郁自评量表评分(SDS)水平,采用Spearman相关分析UKM参数与SAS、SDS评分相关性。结果透析充分组TACurea、PCR值均明显高于透析不充分组(t=20.406、5.390,P<0.05);两组KT/V值比较无差异(P>0.05)。通过ROC曲线分析可知,TACurea界值为16.23 mmol/L、PCR界值为0.61 g/kg^(-1)·d^(-1)。TACurea≥16.23 mmol/L组患者SAS、SDS评分均明显低于TACurea<16.23 mmol/L组患者(t=3.222、5.209,P<0.05);PCR≥0.61 g/kg^(-1)·d^(-1)组患者SAS、SDS评分均明显低于PCR<0.61 g/kg^(-1)·d^(-1)组患者(t=5.043、3.443,P<0.05)。Spearman相关分析显示,TACurea、PCR与SAS、SDS评分均呈显著负相关(r=-0.367、-0.563,-0.560、-0.410,P<0.01)。结论基于UKM模型可准确评估MHD患者透析充分性,且其透析充分性与患者焦虑和抑郁之间存在明显关联,患者透析越充分焦虑抑郁水平越低。Objective Exploring the correlation analysis between dialysis adequacy and anxiety and depres-sion in maintenance hemodialysis(MHD)patients based on the urea kinetic model(UKM).Method A retrospec-tive analysis was conducted on the clinical data of64 MHD patients admitted from June 2021 to June 2022.Based on the clinical data,the patients were divided into dialysis charging group(44 cases)and dialysis non charging group(20 cases),Compare two sets of UKM parameters[Time average concentration of urea(TACruea),urea clearance index(KT/V),and protein catabolism rate(PCR)].The ROC curve was used to obtain the boundary values of UKM param-eters,and the levels of anxiety self rating scale(SAS)and depression self rating scale(SDS)were compared among pa-tients with different levels of UKM parameters.Spearman correlation analysis was used to analyze the correlation between UKM parameters and SAS and SDS scores.Result The TACruea and PCR values in the dialysis sufficient group were significantly higher than those in the dialysis non sufficient group(t=20.406,5.390,P<0.05).There was no differ-ence in KT/V values between the two groups(P>0.05).Through ROC curve analysis,it can be seen that the TACurea cutoff value is 16.23 mmol/L,and the PCR cutoff value is 0.61 g/kg^(-1)·d^(-1).The SAS and SDS scores of patients with TA-Cruea≥16.23 mmol/L were significantly lower than those of patients with TACruea<16.23 mmol/L(t=3.222,5.209,P<0.05).The SAS and SDS scores of patients in the PCR≥0.61 g/kg^(-1)·d^(-1) group were significantly lower than those in the PCR<0.61 g/kg^(-1)·d^(-1) group(t=5.043,3.443,P<0.05).Spearman correlation analysis showed a significant nega-tive correlation between TACurea,PCR,SAS,and SDS scores(r=-0.367,-0.563,-0.560,-0.410,P<0.01).Conclusion Based on the UKM model,the dialysis adequacy of MHD patients can be accurately evaluated,and there is a significant correlation between dialysis adequacy and patient anxiety and depression.The more thorough dialy-sis,the lower the level of anxiety and depression in

关 键 词：尿素动力学模型 维持性血液透析 透析充分性 焦虑 抑郁 

分 类 号：R749.92[医药卫生—神经病学与精神病学]