【摘要】 目的:了解维持性血液透析(MHD)患者焦虑、抑郁障碍的患病率，探讨其对全因死亡率的影响。方法:本研究为前瞻性队列研究，以2021年7月—9月内蒙古自治区人民医院肾内科血液透析中心的MHD患者为研究对象，采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)进行焦虑、抑郁状态的初筛，再由精神科医生进行简明国际神经精神访谈(M.I.N.I.)诊断并分为焦虑障碍组、无焦虑障碍组和抑郁障碍组、无抑郁障碍组。随访至2022年12月31日，终点事件为全因死亡，Kaplan-Meier生存曲线比较组间累积生存率的差异，多因素COX回归分析MHD患者全因死亡的危险因素，评估焦虑、抑郁障碍与全因死亡的关系。结果:研究共纳入MHD患者219例，其中焦虑状态的患病率为25.6%,焦虑障碍患病率8.2%;抑郁状态的患病率为38.8%,抑郁障碍患病率25.6%。随访期内22例(10.0%)MHD患者死亡，焦虑障碍(HR=7.407,95%CI 2.794～19.640,P<0.001)、Hb<90 g/L(HR=3.555,95%CI 1.275～9.915,P=0.015)、频繁透析中低血压(HR=3.211,95%CI 1.162～8.877,P=0.025)是与全因死亡独立相关。结论:MHD患者有较高的焦虑、抑郁障碍患病率，其中焦虑障碍是MHD患者全因死亡的独立危险因素，需肾科医生引起高度关注。更多还原

【Abstract】 Objective:This study aimed to estimate the prevalence of anxiety disorder and depressive disorder among patients undergoing maintenance hemodialysis(MHD) patients and test association with all-cause mortality. Methods:MHD patients in the hemodialysis center of the Inner Mongolia People’s Hospital from July to September 2021 were selected as the study subjects. Symptoms of anxiety and depression were assessed using the Hamilton Anxiety Scale(HAMA) and Hamilton Depression Scale(HAMD), respectively. The participants were interviewed and diagnosed using the Mini-International Neuropsychiatric Interview(M.I.N.I.) by an experienced psychiatrist, and they were classified into anxiety disorder group, no anxiety disorder group, depressive disorder group, and no depressive disorder group. Follow-up until December 31, 2022, the endpoint event was all-cause mortality. Survival was analyzed using Kaplan-Meier plots. Multivariable Cox proportional hazard models were used to calculate HRs to determine the hazard of anxiety disorder and depressive disorder on all-cause mortality. Results:A total of 219 MHD patients were included in this study. The prevalence of anxiety symptoms among MHD patients was 25.6% while that of anxiety disorder was 8.2%. The prevalence of depressive symptoms among MHD patients was 38.8% while that of depressive disorder was 25.6%. During follow-up, 22 patients(10.0%) died. Anxiety disorder(HR=7.407, 95%CI 2.794～19.640, P<0.001), Hb<90 g/L(HR=3.555, 95%CI 1.275～9.915, P=0.015), frequent intradialytic hypotension(HR=3.211, 95%CI 1.162～8.877, P=0.025) remained independently associated with all-cause mortality. Conclusion:Patients undergoing MHD are subject to a high-than-usual prevalence of anxiety and depressive disorder, Anxiety disorder is an independent risk factor for all-cause mortality in MHD patients. Nephrologist should pay high attention to it.更多还原