徐道祥 史惠敏 林小东

[摘要] 目的 研究維持性血液透析患者精神心理状况及其与血清色氨酸水平的相关性。 方法 选取我院2015年3月～2016年12月122例进行维持性血液透析的患者及115例健康志愿者为研究对象，将122例进行维持性血液透析的患者纳入研究组，115例健康志愿者纳入对照组。检测两组焦虑和抑郁等心理状况及血清色氨酸水平。 结果 （1）研究组患者焦虑阳性发生率和抑郁阳性发生率均高于对照组（P<0.05）。（2）抑郁组患者IL-6、犬尿氨酸高于非抑郁组患者，抑郁组患者Trp、HGB低于非抑郁组患者（P<0.05）。（3）焦虑组患者Scr、BUN高于非焦虑组患者，焦虑组患者血钙、血磷低于非焦虑组患者（P<0.05）。（4）抑郁与IL-6、犬尿氨酸呈显著正相关性（r=0.351，P=0.021；r=0.256，P=0.002），焦虑与Scr、BUN呈显著正相关性（r=0.152，P=0.034；r=0.689，P=0.016）。结论 炎性因子诱导使维持性血液透析患者色氨酸代谢成犬尿氨酸，中枢内5-HT水平降低，促使患者出现抑郁和焦虑等负面心理情绪，且抑郁与IL-6、犬尿氨酸水平呈显著正相关性，焦虑与Scr、BUN水平呈显著正相关性。

[关键词] 维持性血液透析；心理状况；血清色氨酸水平；相关性

[中图分类号] R692.5；R749.4 [文献标识码] A [文章编号] 1673-9701（2018）02-0001-03

[Abstract] Objective To study and analyze the psychological and mental state of patients with maintenance hemodialysis and its correlation with serum tryptophan levels. Methods A total of 122 patients undergoing maintenance hemodialysis from March 2015 to December 2016 in our hospital and 115 healthy volunteers were selected as the study subjects. 122 patients with maintenance hemodialysis were included in the study group， and 115 healthy volunteers were included in the control group. The psychological status of anxiety and depression and serum tryptophan levels in two groups were detected. Results （1）The incidence of anxiety-positive and depression-positive in the study group was higher than that in the control group（P<0.05）. （2）The levels of IL-6 and kynurenine in the depression group were higher than those in the non-depression group， while Trp and HGB in the depression group were lower than those in non-depression group（P<0.05）. （3）The levels of Scr and BUN in the anxiety group were higher than those in non-anxiety group. The levels of serum calcium and phosphorus in the anxiety group were lower than those in the non-anxiety group（P<0.05）. （4）There was a significant positive correlation between depression and IL-6 and kynurenine（r=0.351， P=0.021； r=0.256， P=0.002）， and there was a significant positive correlation between anxiety and Scr and BUN（r=0.152， P=0.034； r=0.689， P=0.016）. Conclusion Inflammatory factors induce tryptophan metabolism into kynurenine in the patients undergoing maintenance hemodialysis. Central 5-HT level is decreased， inducing depression and anxiety and other negative emotions in patients. Depression and IL-6 and kynurenine levels are significantly positively correlated， and anxiety and SCr and BUN levels are significantly positively correlated.

[Key words] Maintenance hemodialysis； Mental status； Serum tryptophan level； Correlation

维持性血液透析是延长和挽救终末期肾病患者生命的方法之一[1]。终末期肾病患者肾脏的基本功能丧失，常常会出现明显萎缩和代谢产物潴留[2]。终末期肾病患者大部分为尿毒症患者，此类患者有着较高的死亡率，常采用肾脏替代疗法即维持性血液透析进行治疗[3]。维持性血液透析治疗常常会给患者带来巨大的痛苦，导致患者精神心理上出现焦虑、抑郁等负面情绪[4]。研究显示[5]，有20%～30%的维持性血液透析患者会出现抑郁、焦虑等负面心理状况。还有研究显示[6]，维持性血液透析患者的负面心理状况与体内血清色氨酸水平有关。本文旨在探讨维持性血液透析患者的精神心理状况及其与血清色氨酸水平的相关性，现报道如下。

1 资料与方法

1.1 一般资料

选取我院2015年3月～2016年12月收治的122例进行维持性血液透析的患者及115例健康志愿者为研究对象，将122例进行维持性血液透析的患者纳入研究组，115例健康志愿者纳入对照组。……