Chilcot Joseph, Friedli Karin, Guirguis Ayman, Wellsted David, Farrington Ken, Davenport Andrew
Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Department of Psychology, Centre for Lifespan and Chronic Illness Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
Hemodial Int. 2017 Oct;21(4):542-548. doi: 10.1111/hdi.12500. Epub 2016 Sep 27.
Patients with advanced chronic kidney disease (CKD) on haemodialysis (HD) may have increased C reactive protein (CRP) values and depressive symptoms. There is debate about the strength and nature of previously reported associations. We investigated these issues in a cohort of patients on HD.
We screened for depressive symptoms using two valadiated depression screening tools: the Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire (PHQ-9). Demographic and clinical correlates of depression symptoms were eveluated in adjusted linear and logistic regression models, which included extra renal comorbidity and high CRP (>5 mg/L).
Three hundred and ninety-six HD patients were studied; 63.1% male, mean age 63.1 ± 16.4 years, median CRP 6 (5-15) mg/L. Depression scores were similar in those with normal and high CRP (BDI-II (9(5-17) vs. 11(6-20)) or PHQ (4(2-9) vs. 6(2-10)). In adjusted multivariable regression BDI-II scores were associated with previous history of depression (β 10.8, P < 0.001), serum albumin (β 0.41, P < 0.001), anuria (β 2.4, P < 0.037), diabetes (β 2.7, P = 0.033), and age (β -0.10, P = 0.009). High CRP was not independently associated with BDI-II (β 2.20, P = 0.057), though was with PHQ-9 (β 1.20, P = 0.046). In logistic regression those with high CRP were 1.9 times more likely to score ≥16 on BDI-II screening (P = 0.016), but did not relate significantly to a PHQ-score ≥10.
A relationship was observed between CRP and depression symptoms, though the effect was small, of unlikely clinical significance, and inconsistent between depression measures. Previous reports of this association may reflect overlap between symptoms of depression and advanced CKD.
接受血液透析（HD）的晚期慢性肾脏病（CKD）患者的C反应蛋白（CRP）值和抑郁症状可能会增加。关于先前报道的关联的强度和性质存在争议。我们在一组接受HD治疗的患者中研究了这些问题。
我们使用两种经过验证的抑郁筛查工具对抑郁症状进行筛查：贝克抑郁量表第二版（BDI-II）和患者健康问卷（PHQ-9）。在调整后的线性和逻辑回归模型中评估抑郁症状的人口统计学和临床相关性，这些模型包括肾外合并症和高CRP（>5mg/L）。
对396例HD患者进行了研究；男性占63.1%，平均年龄63.1±16.4岁，CRP中位数为6（5-15）mg/L。CRP正常和高的患者的抑郁评分相似（BDI-II：（9（5-17）对11（6-20））或PHQ：（4（2-9）对6（2-10））。在调整后的多变量回归中，BDI-II评分与既往抑郁史（β10.8，P<0.001）、血清白蛋白（β0.41，P<0.001）、无尿（β2.4，P<0.037）、糖尿病（β2.7，P=0.033）和年龄（β-0.10，P=0.009）相关。高CRP与BDI-II无独立相关性（β2.20，P=0.057），但与PHQ-9相关（β1.20，P=0.046）。在逻辑回归中，CRP高的患者在BDI-II筛查中得分≥16的可能性高1.9倍（P=0.016），但与PHQ评分≥10无显著相关性。
观察到CRP与抑郁症状之间存在关联，尽管这种影响很小，不太可能具有临床意义，且抑郁测量之间不一致。先前关于这种关联的报道可能反映了抑郁症状与晚期CKD症状之间的重叠。
