Dialysis Service, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy.
J Nephrol. 2012 Sep-Oct;25(5):689-98. doi: 10.5301/jn.5000042.
Little is known about the course of the symptoms of depression/anxiety and the factors predictive of such courses in hemodialysis (HD) patients. This study aimed at evaluating the possible changes of Beck Depression Inventory (BDI) and Hamilton Anxiety Rating Scale (HARS) over time, and factors associated with such changes in HD patients.
We screened 110 patients for study participation. Of these, 30 were excluded because of dialytic vintage <6 months, alcohol/substance abuse, inability to answer to the questionnaires, diagnosis of psychotic or neurological disorders or recent stressful life events. Eighty patients were included in the study and BDI, HARS, Charlson Comorbidity Index, SF-36 Vitality Subscale, Mini-Mental State Examination (MMSE), routine laboratory parameters, C-reactive protein (CRP) and interleukin-6 were measured at baseline. The 18-month course of BDI and HARS was measured in patients with baseline BDI ≤14.
At baseline, 42 patients had BDI >14 and 38 patients ≤14. In patients with BDI ≤14, the BDI decreased/remained stable in 19 and increased in 19. Patients with increased BDI had lower baseline MMSE (22.6 ± 2.6 vs. 25.9 ± 2.7, p=0.004) and higher baseline serum CRP (6.07 ± 4.2 vs. 1.64 ± 1.59, p=0.003). At multivariate analysis the relationship between BDI changes and MMSE and serum CRP was statistically significant. In 25 patients, the HARS decreased/remained stable, while in 13 it increased. Characteristics of the 2 groups of patients did not differ significantly.
In a meaningful proportion of HD patients, symptoms of depression worsen over time, and CRP and MMSE are independent predictors of such change.
对于血液透析（HD）患者中抑郁/焦虑症状的病程以及对这些病程有预测作用的因素知之甚少。本研究旨在评估贝克抑郁量表（BDI）和汉密尔顿焦虑量表（HARS）随时间可能发生的变化，以及与 HD 患者这些变化相关的因素。
我们筛选了 110 名患者参与研究。其中，30 名因透析龄<6 个月、酒精/物质滥用、无法回答问卷、诊断为精神或神经障碍或近期发生应激性生活事件而被排除。80 名患者被纳入研究，在基线时测量了 BDI、HARS、Charlson 合并症指数、SF-36 活力子量表、简易精神状态检查（MMSE）、常规实验室参数、C 反应蛋白（CRP）和白细胞介素-6。在基线时 BDI≤14 的患者中测量了 18 个月的 BDI 和 HARS 病程。
基线时，42 名患者的 BDI>14，38 名患者的 BDI≤14。在 BDI≤14 的患者中，19 名患者的 BDI 降低/保持稳定，19 名患者的 BDI 增加。BDI 增加的患者基线 MMSE 评分较低（22.6±2.6 比 25.9±2.7，p=0.004），血清 CRP 水平较高（6.07±4.2 比 1.64±1.59，p=0.003）。多变量分析显示，BDI 变化与 MMSE 和血清 CRP 之间的关系具有统计学意义。在 25 名患者中，HARS 降低/保持稳定，而在 13 名患者中则增加。两组患者的特征无显著差异。
在相当一部分 HD 患者中，抑郁症状随时间恶化，CRP 和 MMSE 是这种变化的独立预测因素。
