Department of Psychiatry, Leiden University Medical Center, Postbus 9600, 2300, RC, Leiden, Netherlands.
Departments of Internal Medicine and Nephrology, Jeroen Bosch Hospital, Den Bosch, Netherlands.
BMC Psychol. 2017 Jan 12;5(1):1. doi: 10.1186/s40359-016-0170-z.
The aim was to investigate whether mild kidney dysfunction and low-grade inflammation in post-myocardial infarction patients are independently associated with markers of mental well-being (i.e. depressive and apathy symptoms, and dispositional optimism).
In post-myocardial infarction patients, kidney function was assessed by estimated glomerular filtration rate (eGFR) calculated from the combined CKD-EPI formula based on serum levels of both creatinine and cystatine C. Systemic inflammation was assessed using high sensitivity C-reactive protein (hs-CRP) levels. The 15-item Geriatric Depression Scale (GDS-15), the 3-item apathy subscale and the 4-item optimism questionnaire (4Q) were used to measure mental well-being and were analyzed using linear multivariable regression analysis.
Of the 2355 patients, mean age was 72.3 (range 63-84) years and 80.1% were men. After multivariable adjustment, a poorer kidney function was associated with more depressive symptoms (β = -0.084, p < 0.001), more apathy symptoms (β = -0.101, p < 0.001), and less dispositional optimism (β = 0.072, p = 0.002). Moreover, higher levels of hs-CRP were associated with more depressive symptoms (β = 0.051, p = 0.013), more apathy symptoms (β = 0.083, p < 0.001) and less dispositional optimism (β = -0.047 p = 0.024). Apathy showed the strongest independent relation with both low eGFR and high hs-CRP.
In post-myocardial infarction patients, impaired kidney function and systemic inflammation showed a stronger association with apathy than with depressive symptoms and dispositional optimism.
本研究旨在探讨心肌梗死后患者轻度肾功能障碍和轻度炎症是否与心理健康相关标志物（即抑郁和淡漠症状及倾向性乐观）独立相关。
在心肌梗死后患者中，通过基于血清肌酐和胱抑素 C 的 CKD-EPI 公式计算肾小球滤过率估计值（eGFR）来评估肾功能。采用高敏 C 反应蛋白（hs-CRP）水平评估全身炎症。采用 15 项老年抑郁量表（GDS-15）、3 项淡漠量表和 4 项乐观问卷（4Q）来评估心理健康，并采用线性多变量回归分析进行分析。
在 2355 例患者中，平均年龄为 72.3（63-84）岁，80.1%为男性。经过多变量调整后，肾功能较差与更多的抑郁症状（β=-0.084，p<0.001）、更多的淡漠症状（β=-0.101，p<0.001）和更少的倾向性乐观（β=0.072，p=0.002）相关。此外，hs-CRP 水平升高与更多的抑郁症状（β=0.051，p=0.013）、更多的淡漠症状（β=0.083，p<0.001）和更少的倾向性乐观（β=-0.047，p=0.024）相关。淡漠与低 eGFR 和高 hs-CRP 均具有最强的独立相关性。
在心肌梗死后患者中，肾功能不全和全身炎症与淡漠的相关性强于与抑郁症状和倾向性乐观的相关性。
