Belayev Linda Y, Mor Maria K, Sevick Mary Ann, Shields Anne Marie, Rollman Bruce L, Palevsky Paul M, Arnold Robert M, Fine Michael J, Weisbord Steven D
Division of Renal-Electrolyte, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA.
Hemodial Int. 2015 Apr;19(2):216-24. doi: 10.1111/hdi.12247. Epub 2014 Nov 18.
Depressive symptoms and pain are common in patients on chronic hemodialysis (HD), yet their associations with quality of life (QOL) are not fully understood. We sought to characterize the longitudinal associations of these symptoms with QOL. As part of a trial comparing two symptom management strategies in patients receiving chronic HD, we assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and pain using the Short Form McGill Pain Questionnaire (SF-MPQ) monthly over 24 months. We assessed health-related QOL (HR-QOL) quarterly using the Short Form 12 (SF-12) and global QOL (G-QOL) using a single-item survey. We used random effects linear regression to analyze the independent associations of depressive symptoms and pain, scaled based on 5-point increments in symptom scores, with HR-QOL and G-QOL. Overall, 286 patients completed 1417 PHQ-9 and SF-MPQ symptom assessments, 1361 SF-12 assessments, and 1416 G-QOL assessments. Depressive symptoms were independently and inversely associated with SF-12 physical HR-QOL scores (β = -1.09; 95% confidence interval [CI]: -1.69, -0.50, P < 0.001); SF-12 mental HR-QOL scores (β = -4.52; 95% CI: -5.15, -3.89, P < 0.001); and G-QOL scores (β = -0.64; 95%CI: -0.79, -0.49, P < 0.001). Pain was independently and inversely associated with SF-12 physical HR-QOL scores (β = -0.99; 95% CI: -1.30, -0.68, P < 0.001) and G-QOL scores (β = -0.12; 95%CI: -0.20, -0.05, P = 0.002); but not with SF-12 mental HR-QOL scores (β = -0.16; 95%CI: -0.050, 0.17, P = 0.34). In patients receiving chronic HD, depressive symptoms and to a lesser extent pain, are independently associated with reduced HR-QOL and G-QOL. Interventions to alleviate these symptoms could potentially improve patients' HR-QOL and G-QOL.
抑郁症状和疼痛在慢性血液透析（HD）患者中很常见，然而它们与生活质量（QOL）之间的关联尚未完全明确。我们试图描述这些症状与生活质量的纵向关联。作为一项比较慢性HD患者两种症状管理策略的试验的一部分，我们在24个月内每月使用患者健康问卷-9（PHQ-9）评估抑郁症状，使用简短麦吉尔疼痛问卷（SF-MPQ）评估疼痛。我们每季度使用简短健康调查12项量表（SF-12）评估健康相关生活质量（HR-QOL），并通过单项调查评估总体生活质量（G-QOL）。我们使用随机效应线性回归分析抑郁症状和疼痛（根据症状评分以5分增量进行缩放）与HR-QOL和G-QOL之间的独立关联。总体而言，286名患者完成了1417次PHQ-9和SF-MPQ症状评估、1361次SF-12评估以及1416次G-QOL评估。抑郁症状与SF-12身体HR-QOL评分呈独立负相关（β=-1.09；95%置信区间[CI]：-1.69，-0.50，P<0.001）；与SF-12心理HR-QOL评分呈独立负相关（β=-4.52；95%CI：-5.15，-3.89，P<0.001）；与G-QOL评分呈独立负相关（β=-0.64；95%CI：-0.79，-0.49，P<0.001）。疼痛与SF-12身体HR-QOL评分呈独立负相关（β=-0.99；95%CI：-1.30，-0.68，P<0.001）以及与G-QOL评分呈独立负相关（β=-0.12；95%CI：-0.20，-0.05，P=0.002）；但与SF-12心理HR-QOL评分无关（β=-0.16；95%CI：-0.050，0.17，P=0.34）。在接受慢性HD的患者中，抑郁症状以及程度较轻的疼痛与HR-QOL和G-QOL降低独立相关。缓解这些症状的干预措施可能会改善患者的HR-QOL和G-QOL。
