【关键词】 糖尿病;抑郁症;危险因素 中图分类号:R587.1;R749.4+1 文献标识码:A DOI:10.3969/j.issn.1003-1383.2018.01.013 Analysis of prevalence and risk factors of diabetics combined with depression in Zhuang nationality OU Lina
【关键词】 糖尿病;抑郁症;危险因素
中图分类号:R587.1;R749.4+1 文献标识码:A DOI:10.3969/j.issn.1003-1383.2018.01.013
Analysis of prevalence and risk factors of diabetics combined with depression in Zhuang nationality
OU Lina,YANG Dawei
【Abstract】 Objective Cross-sectional survey was conducted to investigate the prevalence of diabetics combined with depression in Zhuang nationality,and to analyze its risk factors,so as to provide new perspectives and basis for the education of patients with diabetes mellitus.
Methods A total of 420 hospitalized patients were enrolled,which included 264 males and 156 females,aged(53.3±12.63) years,and the course of disease was(4.13±3.27) years.Hospital Anxiety and Depression Scale (HADS) was used to measure the depression score of the patients.The depression score was 0~7 in non depression group and 8~21 in depression group,and the prevalence of depression in diabetics patients was obtained.A comparative study was carried out on general situation like age,sex,body mass index,course of disease,smoking,diabetes education and treatment methods and educational background as well as related biochemical data like blood pressure,blood lipid,glycosylated hemoglobin,C reactive protein,urinary albumin/creatinine ratio(ACR) between the two groups.Meanwhile,Logistic regression analysis was used to find out the risk factors of depression.
Results 39.28% (165 cases) of patients had varying degrees of depressive symptoms,of which 108 cases were male,accounting for 65.45%,and 57 cases were female,accounting for 34.55%.Age,diastolic blood pressure,cystatin C,VLDL,TG,HbA1c,CRP and ACR in the depression group were higher than those of the non depression group,difference was statistically significant(P<0.01).Binary Logistic analysis showed that cystatin C (OR=2.03,95% CI 1.11~3.71),diastolic pressure(OR=1.05,95% CI 1.00~1.10),ACR (OR=1.03,95% CI 1.00 ~1.07) were risk factors for depression in diabetic patients.And there was no significant correlation between sex,body mass index,course of disease,smoking,diabetes education,etc.
Conclusion Diabetes patients with depression are prevalent in Guangxi Zhuang nationality,cystatin C,diastolic blood pressure and ACR are possible independent risk factors for the incidence of it.
【Key words】 diabetes;depression;risk factors
目前糖尿病已成為我国继心脑血管疾病、肿瘤之后的另一个重要的慢性疾病。2008年,中华医学会的一项流行病学调查让人感到触目惊心,我国某些地区20岁以上的人群中,糖尿病患病率已经达到9.7%,糖耐量异常率已经达到15.5%[1]。2型糖尿病作为目前我国最常见的慢性疾病之一,常给患者带来许多心理问题,其中以抑郁症最为常见[2]。广西地区壮族人群仍缺乏大标本的有关数据。本研究立足于此,针对广西壮族人群糖尿病患者进行抑郁症患病率及相关危险因素进行调查。
2.1 糖尿病患者抑郁症的患病率及两组患者临床资料对比
在收集的420例患者中,39.29%(165例)的糖尿病患者患有抑郁症,其中男性108例占65.45%,女性57例占34.55%。60.71%的(255例)糖尿病患者无抑郁症,其中男性157例占61.45%,女性98例占38.55%,两组性别构成差异无统计学意义。抑郁组的年龄、舒张压、胱抑素C、极低密度脂蛋白、甘油三酯、糖化血红蛋白、C反应蛋白及ACR高于非抑郁组,差异有统计学意义(P<0.01)。见表1。
2.2 二元Logistic回归分析
在二元Logistic回归分析中,以抑郁量表评分为因变量,对抑郁量表评分0~7分赋值为0,抑郁量表评分8~21分赋值为1;年龄0~40岁赋值为0,41~60岁赋值为1,60岁以上赋值为2;性别男赋值为1,女赋值为0;体重指数0~18赋值为0,18.1~24.0赋值为1,24.0以上赋值为2;病程0~5年赋值为0,5年以上赋值为1;不吸烟赋值为0,吸烟赋值为1;参加过糖尿病教育赋值为0,未参加过赋值为1;学历高中以下赋值为0,高中及以上赋值为1;血压、血脂、糖化血红蛋白、C反应蛋白、肾小球滤过率、ACR为实际值;以上指标为自变量。最终结果显示胱抑素C(OR=2.03,95% CI 1.11~3.71),舒张压(OR=1.05,95% CI 1.00~1.10),ACR(OR=1.03,95% CI 1.00~1.07)是糖尿病患者合并抑郁症的危险因素。见表2。
3 讨 论
近年来,因抑郁出现自杀、伤人的事件时有报道。抑郁为一种常见的心理问题,主要表现为情绪失落,对事物失去兴趣或愉快感,思维迟缓、注意力难以集中等。近年来大量的研究表明慢性疾病诸如冠心病[3]、高血压[4~6]等均会增加抑郁症的发病。本研究共收集420例住院及门诊患者,发现抑郁症的患病率高达39.28%,这与国内有关研究[2]显示的抑郁症的患病率相仿,表明广西壮族人群中糖尿病患者抑郁症发病率与其他民族人群无明显差异。但是目前极高的患病率及极低的诊断率说明在糖尿病患者中抑郁未得到足够的重视,由其带来的社会不良事件亦得不到足够有效的控制,值得我们广大医务工作者反思,应加强对糖尿病患者的心理干预,避免不良事件的发生。
本研究中显示,胱抑素C是糖尿病合并抑郁的独立危险因素。胱抑素C是一种广泛存在于人体组织的半胱氨酸蛋白酶抑制剂。它由于只经肾小球滤过而被清除,重吸收后亦不返回血液,因此其能有效反映人体肾小球滤过功能的变化,近年来较多的研究与糖尿病肾病的早期诊断相联系[7]。Marc M.Budge等[8]研究发现,在老年人群中,胱抑素C与认识能力密切相关,但具体如何影响老年人的认识能力仍不明确。Evgueni Minev等[9]发现在健康老年人群中,血中高胱抑素C与抑郁症的发病密切相关。另外Lovisa A Olsson[10]在一项研究中指出,肾功能是老年人幸福感的主观决定因素,胱抑素C与男性抑郁情绪有显著的相关性。本研究结果与上述研究结果基本相符,我们认为胱抑素C与抑郁的发病密切相关,是其发病的独立危险因素,但其机制仍有待进一步研究探讨。
在本研究中,舒张压同样是糖尿病合并抑郁的独立危险因素。目前有较多的研究指出高血压与抑郁的发病密切相关[6]。可能原因与焦虑抑郁等情绪障碍会引起自主神经系统功能和下丘脑-垂体-肾上腺素轴(HPA)功能调节紊乱[11],舒张压(容量性负荷)的升高,会引起皮质醇、醛固酮的分泌异常,从而负反馈引起HPA轴的异常,而HPA轴的异常又会引起血压的异常,两者呈现恶性循环。
尿白蛋白/肌酐比值作为近年来兴起的对糖尿病肾病诊断十分重要的诊断依据之一,未见有与抑郁症相关的报道。但从本研究得出的三个结果来看,无论是胱抑素C、尿蛋白还是舒张压,都与肾脏的功能密切相关,这与 Osson等人[10]的研究相符,但其内在机制仍待进一步研究。
本研究為以后进一步研究糖尿病与抑郁症之间的联系提供了基础资料及研究方向,为糖尿病患者宣教增加了新的内容,为临床医生更好地诊断糖尿病并抑郁提供了部分理论依据。
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