Department of Medicine and Biostatistics and Epidemiology, Jesse Brown VA Medical Center and University of Illinois Medical Center, 5000 S. 5th Avenue, Hines, IL 60141, USA.
Kidney Int. 2011 Sep;80(6):670-8. doi: 10.1038/ki.2011.153. Epub 2011 Jun 1.
This study was designed to examine the impact of elevated depressive affect on health outcomes among participants with hypertensive chronic kidney disease in the African-American Study of Kidney Disease and Hypertension (AASK) Cohort Study. Elevated depressive affect was defined by Beck Depression Inventory II (BDI-II) thresholds of 11 or more, above 14, and by 5-Unit increments in the score. Cox regression analyses were used to relate cardiovascular death/hospitalization, doubling of serum creatinine/end-stage renal disease, overall hospitalization, and all-cause death to depressive affect evaluated at baseline, the most recent annual visit (time-varying), or average from baseline to the most recent visit (cumulative). Among 628 participants at baseline, 42% had BDI-II scores of 11 or more and 26% had a score above 14. During a 5-year follow-up, the cumulative incidence of cardiovascular death/hospitalization was significantly greater for participants with baseline BDI-II scores of 11 or more compared with those with scores <11. The baseline, time-varying, and cumulative elevated depressive affect were each associated with a significant higher risk of cardiovascular death/hospitalization, especially with a time-varying BDI-II score over 14 (adjusted HR 1.63) but not with the other outcomes. Thus, elevated depressive affect is associated with unfavorable cardiovascular outcomes in African Americans with hypertensive chronic kidney disease.
本研究旨在探讨高血压性慢性肾脏病患者中，抑郁情绪升高对健康结局的影响。抑郁情绪升高的定义为贝克抑郁量表 II （BDI-II）评分≥11，≥14，或评分增加 5 个单位。采用 Cox 回归分析，将心血管死亡/住院、血清肌酐倍增/终末期肾病、总住院率和全因死亡率与基线、最近一次年度访视时（时变）或从基线到最近一次访视的平均值（累积）时的抑郁情绪相关联。在基线时的 628 名参与者中，42%的 BDI-II 评分≥11，26%的评分>14。在 5 年的随访期间，基线 BDI-II 评分≥11 的参与者的心血管死亡/住院累积发生率明显高于评分<11 的参与者。基线、时变和累积的抑郁情绪升高均与心血管死亡/住院的风险显著增加相关，尤其是时变的 BDI-II 评分>14（调整后的 HR 1.63），但与其他结局无关。因此，在高血压性慢性肾脏病的非裔美国人中，升高的抑郁情绪与不良的心血管结局相关。
