血液透析患者的情绪困扰与健康相关生活质量：COOP-WONCA图表的临床价值

Emotional distress and health-related quality of life in patients on hemodialysis: the clinical value of COOP-WONCA charts.

作者信息

Arenas María Dolores, Alvarez-Ude Fernando, Reig-Ferrer Abilio, Zito Juan Pablo, Gil María Teresa, Carretón María Antonia, Albiach Begoña, Moledous Analía

机构信息

Perpetuo Socorro Hospital, Alicante - Spain.

出版信息

J Nephrol. 2007 May-Jun;20(3):304-10.

PMID:17557263

Abstract

BACKGROUND

A significant percentage of patients on hemodialysis (HD) present with affective disorders such as anxiety and/or depression. The purpose of this study was to explore adaptive mixed affective disorders of patients on HD and to analyze the clinical value of a brief health-related quality-of-life (HRQoL) instrument, the COOP-WONCA charts, in our population of HD patient.

METHODS

Seventy-five patients (mean age 49.2 years; range 20.1-64.9), who had been on HD for a mean 110 months (range 6.1-364.5 months) were studied. The Beck Depression Inventory (BDI), Hamilton Scale of Depression (HDRS) and Hamilton Scale of Anxiety (HARS) were used. To evaluate patient HRQoL, we used the validated Spanish version of the COOP-WONCA charts.

RESULTS

Of the 75 patients studied, 44.0% (BDI) and 53.4% (HDRS) had some depressive symptoms which were moderate-severe in 14.7% (BDI) and in 22.7% (HDRS). Anxiety symptoms were observed in 46.6% of the patients (13.3% were of moderate-severe degree). There was a high level of association between both depression scales (BDI and HDRS) (r=0.70; p<0.001), as well as between both scales and the HARS (HDRS, r=0.82; p<0.001; BDI, r=0.53; p<0.001). The most affected dimensions of the COOP-WONCA charts were "Physical fitness" and "Overall health," whereas the least affected were "Social activities" and "Daily activities." The global score of the COOP-WONCA charts was associated with the presence of depressive (BDI, r=0.64, and HDRS, r=0.75; p<0.001) and anxiety symptoms (HARS, r=0.52; p<0.001). A score of >or= 3 corresponding to the dimension "Feelings" on the COOP-WONCA charts allowed the detection of 81.8% of the patients with clinically significant depressive symptoms (BDI >18), with a sensitivity of 96.8% and a specificity of 75% for this cutoff point.

CONCLUSIONS

A high percentage of patients on HD present with mixed emotional disorders (anxiety and/or depression); a good correlation is observed between HRQoL and the levels of anxiety and depression in these patients; and measuring HRQoL with the COOP-WONCA charts may help diagnose such problems.

摘要

背景

相当一部分接受血液透析（HD）的患者存在焦虑和/或抑郁等情感障碍。本研究的目的是探讨HD患者的适应性混合情感障碍，并分析一种简短的健康相关生活质量（HRQoL）工具——COOP-WONCA图表在我们HD患者群体中的临床价值。

方法

研究了75例患者（平均年龄49.2岁；范围20.1 - 64.9岁），他们接受HD的平均时间为110个月（范围6.1 - 364.5个月）。使用了贝克抑郁量表（BDI）、汉密尔顿抑郁量表（HDRS）和汉密尔顿焦虑量表（HARS）。为评估患者的HRQoL，我们使用了经验证的西班牙语版COOP-WONCA图表。

结果

在研究的75例患者中，44.0%（BDI）和53.4%（HDRS）有一些抑郁症状，其中14.7%（BDI）和22.7%（HDRS）为中重度。46.6%的患者有焦虑症状（13.3%为中重度）。两个抑郁量表（BDI和HDRS）之间存在高度相关性（r = 0.70；p < 0.001），两个量表与HARS之间也存在高度相关性（HDRS, r = 0.82；p < 0.001；BDI, r = 0.53；p < 0.001）。COOP-WONCA图表中受影响最大的维度是“身体健康”和“总体健康”，而受影响最小的是 “社交活动” 和 “日常活动”。COOP-WONCA图表的总体得分与抑郁（BDI, r = 0.64，HDRS, r = 0.75；p < 0.001）和焦虑症状（HARS, r = 0.52；p < 0.001）的存在相关。COOP-WONCA图表中“情感”维度得分≥3分可检测出81.8%有临床显著抑郁症状（BDI>18）的患者，该临界值的敏感性为96.8%，特异性为75%。