血液透析老年患者中疼痛-抑郁共病与日常生活能力的相关性研究^*

Impact of comorbidity of pain and depression on activities of daily living in elderly patients on hemodialysis

摘要

目的 探究维持性血液透析老年患者疼痛-抑郁共病的现况, 分析与日常生活能力 (ADL) 的相关性。方法 选取 2023 年 4 月—10 月北京友谊医院进行维持性血液透析治疗的老年患者作为研究对象。 评估患者疼痛程度、 抑郁情绪及 ADL。 采用多因素 logistic 回归模型探究疼痛-抑郁共病与维持性血液透析老年患者 ADL 的相关性及 ADL 下降的影响因素。结果 共纳入 208 例患者, 45 例 (21.6%) 具有疼痛-抑郁共病, 42 例 (20.2%) 合并 ADL 下降。 与无疼痛抑郁组相比较, 疼痛-抑郁共病组患者合并 ADL 下降的更多 (P<0.05)。 多因素 logistic 回归分析显示, 疼痛-抑郁共病、 年龄、 握力及透析前血肌酐是维持性血液透析老年患者 ADL 下降的独立影响因素 (P<0.05)。结论 维持性血液透析老年患者中疼痛-抑郁共病的患病率较高, 疼痛-抑郁共病、 年龄、 握力及透析前血肌酐是维持性血液透析老年患者 ADL 下降的独立影响因素。

Abstract

Objective To investigate the status of pain-depression comorbidity in elderly maintenance hemodialysis patients and analyze its correlation with activities of daily living (ADL). Methods Elderly patients who underwent maintenance hemodialysis in Beijing Friendship Hospital from April to October 2023 were selected as the study subjects. Patients were assessed for pain, depression, and ADL. Multivariate logistic regression model was used to investigate the correlation between pain-depression comorbidity and ADL and the influencing factors of ADL decline in elderly maintenance hemodialysis patients. Results A total of 208 patients were included, 45 (21.6%) had pain-depression comorbidity and 42 (20.2%) had decreased ADL. Patients in the pain-depression comorbidity group had more decreased ADL compared with the pain-free depression group (P<0.05). Multivariate logistic regression analysis showed that pain-depression comorbidity, age, grip strength and predialysis serum creatinine were independent factors for ADL decline in elderly maintenance hemodialysis patients (P<0.05). Conclusion The prevalence of pain-depression comorbidity was higher in elderly maintenance hemodialysis patients, and pain-depression comorbidity, age, grip strength, and predialysis serum creatinine were independent factors for ADL decline in elderly maintenance hemodialysis patients.

关键词

慢性疼痛 / 抑郁 / 日常生活活动能力 / 血液透析

Key words

Chronic pain / Depression / Activities of daily living / Hemodialysis

参考文献

[1] Zhang L, Zhao M H, Zuo L, et al. China Kidney Disease Network (CK—NET) 2016 annual data report[J]. Kidney Int Suppl (2011), 2020, 10(2): e97-e185.

[2] 张沫, 蒋仁莲, 邵高海, 等 . 我国近十年维持性血液透析患者抑郁患病率的 Meta 分析[J]. 东南大学学报(医学版), 2024, 43(3): 355-363.

[3] Zhang M, Jiang R L, Shao G H, et al. The prevalence of depression among Chinese maintenance hemodialysis patients in the past ten years: a meta—analysis[J]. J Southeast Univ(Med Sci Edit), 2024, 43(3): 355-363.

[4] Lambourg E, Colvin L, Guthrie G, et al. The prevalence of pain among patients with chronic kidney disease using systematic review and meta—analysis[J]. Kidney Int, 2021, 100(3): 636-649.

[5] Samoudi A F, Marzouq M K, Samara A M, et al. The impact of pain on the quality of life of patients with end—stage renal disease undergoing hemodialysis: a multicenter cross—sectional study from Palestine[J]. Health Qual Life Outcomes, 2021, 19(1): 39.

[6] Zhou L, Wang W, Ma X . The bidirectional association between the disability in activities of daily living and depression: a longitudinal study in Chinese middle—aged and older adults[J]. BMC Public Health, 2024, 24(1): 1884.

[7] Liu P, Chen H, Tong B, et al. Association between multisite musculoskeletal pain and disability trajectories among community—dwelling older adults[J]. Aging Clin Exp Res, 2024, 36(1): 115.

[8] 金漂飘, 张雨晗, 于恩彦 . 慢性疼痛和抑郁障碍共病机制的研究进展[J]. 浙江临床医学, 2023, 25(4): 622-624.

[9] Jin P P, Zhang Y H, Yu E Y. Research Progress on Comorbidity Mechanisms of Chronic Pain and Depressive Disorders[J]. Zhejiang Clin Med J, 2023, 25(4): 622-624.

[10] Mossey J M, Gallagher R M . The longitudinal occurrence and impact of comorbid chronic pain and chronic depression over two years in continuing care retirement community residents[J]. Pain Med, 2004, 5(4): 335-348.

[11] Murata S, Ono R, Omata J, et al. Coexistence of chronic musculoskeletal pain and depressive symptoms and their combined and individual effects on onset of disability in older adults: a cohort study[J]. J Am Med Dir Assoc, 2019, 20(10): 1263-1267.e3.

[12] Charlson M E, Pompei P, Ales K L, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation[J]. J Chronic Dis, 1987, 40(5): 373-383.

[13] Sheikh J I, Yesavage J A . Geriatric Depression Scale (GDS) recent evidence and development of a shorter version[J]. Clin Gerontol, 1986, 5: 165-172.

[14] Farrar J T, Young J P, Jr LaMoreaux L, et al. Clinical importance of changes in chronic pain intensity measured on an 11—point numerical pain rating scale[J]. Pain, 2001, 94(2): 149-158.

[15] Mahoney F I, Barthel D W . Functional evaluation: the Barthel index[J]. Md State Med J, 1965, 14: 61-65.

[16] Zhao S S, Holmes M V, Alam U . Disentangling the relationship between depression and chronic widespread pain: A Mendelian randomisation study[J]. Semin Arthritis Rheum, 2023, 60: 152188.

[17] Werneck A O, Stubbs B . Bidirectional relationship between chronic pain and depressive symptoms in middle—aged and older adults[J]. Gen Hosp Psychiatry, 2024, 89: 49-54.

[18] Chen L, Ashton—James C E, Shi B, et al. Variability in the prevalence of depression among adults with chronic pain: UK Biobank analysis through clinical prediction models[J]. BMC Med, 2024, 22(1): 167.

[19] Ai Z, Tang C, Peng P, et al. Prevalence and influencing factors of chronic pain in middle—aged and older adults in China: results of a nationally representative survey[J]. Front Public Health, 2023, 11: 1110216.

[20] 杨柳, 何雯雯, 郝旭磊, 等 . 老年血液透析患者日常生活活动能力的影响因素调查分析[J]. 中日友好医院学报, 2024, 38(1): 25-30.

[21] Yang L, He W W, Hao X L, et al. Investigation of self—care ability and frailty of daily living activities in elderly hemodialysis patients and risk factor assessment[J]. J Chin—Jpn Friendship Hosp, 2024, 38(1): 25-30.

[22] 应金萍, 蔡根莲, 潘梦燕, 等 . 维持性血液透析患者衰弱表型对日常生活活动能力的影响[J]. 中华肾脏病杂志, 2021, 37(8): 639-646.

[23] Ying J P, Cai G L, Pan M Y, et al. Effect of frailty phenotype on activities of daily living in maintenance hemodialysis patients[J]. Chin J Nephrol, 2021, 37(8): 639-646.

[24] Cheng D, Zhang Q, Wang Z, et al. Association between sarcopenia and its components and dependency in activities of daily living in patients on hemodialysis[J]. J Ren Nutr, 2021, 31(4): 397-402.

[25] Sy J, McCulloch C E, Johansen K L . Depressive symptoms, frailty, and mortality among dialysis patients[J]. Hemodial Int, 2019, 23(2): 239-246.

[26] Kurita N, Wakita T, Fujimoto S, et al. Hopelessness and depression predict sarcopenia in advanced CKD and dialysis: a multicenter cohort study[J]. J Nutr Health Aging, 2021, 25(5): 593-599.

[27] 张颖, 刘雪琴, 刘晓辉, 等 . 维持性血液透析患者疲乏发生率及影响因素的系统评价[J]. 中华护理教育, 2023, 20(11): 1391-1397.

[28] Zhang Y, Liu X Q, Liu X H, et al. Systematic review of fatigue prevalence and its influencing factors in patients with maintenance hemodialysis[J]. Chin J Nurs Educ, 2023, 20(11): 1391-1397.

[29] 郁赛赛, 张佳美 . 血液透析患者的疲劳现状及其影响因素分析[J]. 当代护士, 2023, 30(10): 36-42.

[30] Yu S S, Zhang J M. Fatigue Status and analysis of influencing factors in hemodialysis patients[J]. Contemp Nurse, 2023, 30(10): 36-42.

[31] Shu X, Lin T, Wang H, et al. Diagnosis, prevalence, and mortality of sarcopenia in dialysis patients: a systematic review and meta—analysis[J]. J Cachexia Sarcopenia Muscle, 2022, 13(1): 145-158.

[32] Sá Martins V, Adragão T, Aguiar L, et al. Prognostic value of the malnutrition—inflammation score in hospitalization and mortality on long—term hemodialysis[J]. J Ren Nutr, 2022, 32(5): 569-577.

[33] 蔡蒙, 吴敏婕, 吴申慧, 等 . 老年综合评估对老年衰弱患者结局影响的系统评价[J]. 护理与康复, 2024, 23(6): 30-35, 42.

[34] Cai M, Wu M J, Wu S H, et al. Impact of comprehensive geriatric assessment on outcomes in frail elderly patients: a systematic review[J]. J Nurs Rehabil, 2024, 23(6): 30-35, 42.

基金资助

^*首都卫生发展科研专项(2022-2-2028)