终末期肾病患者脑血管反应性与抑郁状态的关系  

Relationship Between Cerebrovascular Reactivity and Depression in Patients With End-Stage Renal Disease

作　　者：李姝莹 陈睿 唐玮婷 马晓杰 蔡华彬 游咏 LI Shuying;CHEN Rui;TANG Weiting;MA Xiaojie;CAI Huabin;YOU Yong(Department of Neurology,The Second Affiliated Hospital of Hainan Medical University,Haikou 570100,China;Health Care Center,Hainan General Hospital,Haikou 570311,China;Department of Rehabilitation Therapy,The Second Affiliated Hospital of Hainan Medical University,Haikou 570100,China;Department of Neurology,Maoming People’s Hospital,Maoming,Guangdong 525000,China)

机构地区：[1]海南医学院第二附属医院神经内科,海口570100 [2]海南省人民医院医疗保健中心,海口570311 [3]海南医学院第二附属医院康复治疗科,海口570100 [4]茂名市人民医院神经内科,广东茂名525000

出　　处：《中国医学科学院学报》2024年第3期348-353,共6页Acta Academiae Medicinae Sinicae

基　　金：海南省重点研发计划(ZDYF2020227);海南省自然科学基金青年项目(821QN409)。

摘　　要：目的探讨持续血液透析的终末期肾病(ESRD)患者脑血管反应性(CVR)与情绪障碍的关系。方法收集持续血液透析ERSD患者的临床资料,采用汉密尔顿焦虑量表(HAMA)和贝克抑郁问卷评估患者焦虑和抑郁状态,采用经颅多普勒超声监测屏气试验时脑血流动力学变化,并计算屏气指数。屏气指数≥0.69为CVR正常,屏气指数<0.69为CVR异常。采用二元Logistic回归分析影响ESRD患者抑郁状态的因素。结果CVR异常组总胆固醇(P=0.010)、低密度脂蛋白水平(P=0.006)和抑郁状态发生率(P=0.012)高于正常组。抑郁组较无抑郁组的病程更长(P=0.039)、体重指数更低(P=0.048)、HAMA评分更高(P=0.001)、焦虑状态发生率更高(P<0.001)、屏气指数更低(P=0.015)、CVR异常发生率更高(P=0.012)。二元Logistic回归分析显示焦虑(OR=22.915,95%CI=2.653~197.956,P=0.004)和CVR异常(OR=0.074,95%CI=0.008~0.730,P=0.026)是抑郁状态发生的危险因素。结论CVR异常可能是ESRD患者发生抑郁状态的危险因素。Objective To investigate the relationship between cerebrovascular reactivity(CVR)and emotional disorders in the patients undergoing continuous hemodialysis for end-stage renal disease(ESRD).Methods The clinical data of the ESRD patients undergoing continuous hemodialysis were collected.Anxiety and depression of the patients were assessed by the Hamilton anxiety scale(HAMA)and Beck depression inventory,respectively.The cerebral hemodynamic changes during the breath holding test were monitored by transcranial Doppler sonography,and the breath-holding index(BHI)was calculated.The BHI≥0.69 and BHI<0.69 indicate normal CVR and abnormal CVR,respectively.Binary Logistic regression was employed to analyze the factors affecting the depressive state of ESRD patients.Results The group with abnormal CVR exhibited higher total cholesterol level(P=0.010),low density lipoprotein level(P=0.006),and incidence of depression(P=0.012)than the group with normal CVR.Compared with the non-depression group,the depression group displayed prolonged disease course(P=0.039),reduced body mass index(P=0.048),elevated HAMA score(P=0.001),increased incidence of anxiety(P<0.001),decreased BHI(P=0.015),and increased incidence of abnormal CVR(P=0.012).Binary Logistic regression analysis indicated anxiety as a contributing factor(OR=22.915,95%CI=2.653-197.956,P=0.004)and abnormal CVR as a risk factor(OR=0.074,95%CI=0.008-0.730,P=0.026)for depression.Conclusion Impaired CVR could pose a risk for depression in the patients with ESRD.

关 键 词：终末期肾病 脑血管反应性 抑郁 焦虑 经颅多普勒超声 

分 类 号：R741[医药卫生—神经病学与精神病学]