Abstract:

Objective To investigate the anxiety,depression and fatigue in patients after renal transplant in one month（T1）,six months（T2） and one year（T3）,and to explore their impact on health status. Methods A longitudinal study was conducted among 180 patients admitted to the department of organ transplantation of a tertiary hospital for renal transplantation from May 2016 to June 2018. The questionnaire included general information questionnaire,Patient Health Questionnaire-9（PHQ-9）,Generalized Anxiety Disorder-7（GAD-7）,the Multi-dimensional Fatigue Inventory（MFI） and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire（EORTC-QLQ-C30）. Results ①The incidence of anxiety at T1,T2,T3 was 28.9%,29.4%,33.9%,and depression was 39.4%,36.3%,37.8%,severe fatigue was 14.4%,11.3%,and 14.3%,respectively. ②There was no statistically significant change in anxiety and depression scores after kidney transplantation（P>0.05）,however,fatigue scores decreased over time（F=7.667,P<0.001）,and overall health status scores decreased significantly one year after kidney transplantation（F=3.746,P<0.028）. ③The results of the generalized estimation equation showed that depression negatively affected the overall postoperative health status（Wald χ ²=21.155,P<0.001）.④Sensitivity analysis showed that results of multiple imputation and deletion were consistent,and depression could still predict the overall health status（Wald χ ²=12.386,P<0.001）. Conclusion The incidence rates of anxiety,depression and severe fatigue were 33.9%,37.8%,and 14.3%,respectively one year after transplantation. The overall health status at T3 was lower than that at T1 and T2. Depression can negatively affect postoperative health status,which should be concerned by health care workers.

Key words: Kidney Transplantation, Anxiety, Depression, Fatigue, Health status, Longitudinal Studies

摘要：

目的 探讨肾移植患者术后1个月、6个月及1年的焦虑、抑郁、疲乏变化情况,及其对健康状况的影响。方法 采用纵向研究设计,于2016年5月—2018年6月以某三级甲等医院所有入住器官移植科进行肾移植手术的180例患者作为研究对象,进行问卷调查。问卷包括一般资料调查表、患者健康问卷、广泛性焦虑量表、多维疲乏量表与生命质量测定量表。结果 ①术后1个月、6个月及1年焦虑发生率分别为28.9%、29.4%、33.9%,抑郁发生率分别为39.4%、36.3%、37.8%,重度疲乏发生率为14.4%、11.3%、14.3%。②肾移植术后焦虑、抑郁得分变化无统计学意义（P>0.05）,疲乏得分随着时间不断下降（F=7.667,P<0.001）,术后1年总体健康状况得分也显著下降（F=3.746,P<0.028）。③广义估计方程结果显示,抑郁可负向影响术后总体健康状况（Wald χ ²=21.155,P<0.001）。④敏感性分析表明,插补与删失结果保持一致,抑郁仍可预测总体健康状况（Wald χ ²=12.386,P<0.001）。结论 焦虑、抑郁及重度疲乏在术后1年发生率分别为33.9%、37.8%、14.3%,术后1年总体健康状况相比术后1个月与术后6个月有所下降,焦虑、疲乏对术后整体健康状况的影响无统计学意义,而抑郁可负向影响患者术后健康状况,应引起医护人员的关注。

关键词: 肾移植, 焦虑, 抑郁, 疲乏, 健康状况, 纵向研究