Montinaro V, Iaffaldano G P, Granata S, Porcelli P, Todarello O, Schena F P, Pertosa G
Azienda Ospedaliero-Universitaria Consorziale Policlinico, University of Bari, Italy.
Clin Nephrol. 2010 Jan;73(1):36-43. doi: 10.5414/cnp73036.
BACKGROUND: Mental disorders are frequent in hemodialysis (HD) patients. Depression and anxiety along with physical co-morbidity affect quality of life (QOL). Uremia is associated with inflammation and release of cytokines by lymphomonocytes. Inflammatory cytokines are relevant in depression. The aim of this study was to assess the psychological alterations and QOL in HD patients, and to correlate them with pattern of cytokine production. PATIENTS: 30 HD patients and 20 subjects with CKD Stage I-II K-DOQI. Psychometric tests were administered: 1) Hospital Anxiety and Depression Scale (HADS) composed of an anxiety subscale (HADS-A) and a depression subscale (HADS-D); 2) Kidney Disease Quality of Life (KDQOL) modified, including a cognitive function subscale (KDQOL-CF). Whole blood samples collected at beginning of HD session were diluted with RPMI/heparin and incubated for 24 h in presence of lipopolysaccharide (LPS). IL-1Gamma, IL-6, TNF-alpha and IL-10 were assayed on supernatants and results were normalized per number of lymphomonocytes (ng/106 cells). RESULTS: A depressive mood was more frequent in HD patients (50%) than controls (20%, p < 0.0001). No difference for anxiety (HD = 43%, controls = 45%) was observed. QOL score was significantly lower in HD than controls (p = 0.006) and correlated inversely with HADS total, HADS-A and HADS-D (p < 0.0001). Albumin, Kt/V and phosphate were comparable in patients with or without anxiety or depression. Cytokine production was significantly higher in HD patients than controls (IL-1beta p = 0.05; IL-6 p = 0.010; TNF-alpha p < 0.0001; IL-10, p = 0.0019). HD patients with the HADS-A positive for anxiety showed higher IL-6 production (p = 0.026), while IL-1beta levels were not associated with symptoms of depression. KDQOL-CF correlated inversely with levels of IL-6, TNF-alpha and IL-10. CONCLUSIONS: HD patients have symptoms of depression and anxiety that negatively affect QOL. These symptoms are independent of the efficiency of dialysis and nutritional status. On the contrary, IL-6 is linked to the presence of psychological discomfort in these patients.
背景：精神障碍在血液透析（HD）患者中很常见。抑郁和焦虑以及身体合并症会影响生活质量（QOL）。尿毒症与炎症以及淋巴细胞释放细胞因子有关。炎性细胞因子与抑郁症相关。本研究的目的是评估HD患者的心理改变和生活质量，并将它们与细胞因子产生模式相关联。 患者：30例HD患者和20例CKD I-II期K-DOQI受试者。进行了心理测试：1）医院焦虑抑郁量表（HADS），由焦虑分量表（HADS-A）和抑郁分量表（HADS-D）组成；2）改良的肾脏疾病生活质量量表（KDQOL），包括认知功能分量表（KDQOL-CF）。在HD治疗开始时采集的全血样本用RPMI/肝素稀释，并在脂多糖（LPS）存在的情况下孵育24小时。检测上清液中的IL-1γ、IL-6、TNF-α和IL-10，并将结果按淋巴细胞数量进行标准化（ng/106细胞）。 结果：HD患者中抑郁情绪（50%）比对照组（20%，p<0.0001）更常见。未观察到焦虑方面的差异（HD = 43%，对照组 = 45%）。HD患者的生活质量评分显著低于对照组（p = 0.006），且与HADS总分、HADS-A和HADS-D呈负相关（p<0.0001）。有或无焦虑或抑郁的患者在白蛋白、Kt/V和磷酸盐方面相当。HD患者的细胞因子产生显著高于对照组（IL-1β p = 0.05；IL-6 p = 0.010；TNF-α p<0.0001；IL-10，p = 0.0019）。HADS-A焦虑阳性的HD患者IL-6产生更高（p = 0.026），而IL-1β水平与抑郁症状无关。KDQOL-CF与IL-6、TNF-α和IL-10水平呈负相关。 结论：HD患者有抑郁和焦虑症状，对生活质量有负面影响。这些症状与透析效率和营养状况无关。相反，IL-6与这些患者心理不适的存在有关。
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