2型糖尿病患者伴发焦虑抑郁现状及其影响因素分析

李梦凡; 厉雪艳; 梁冰

doi:10.16766/j.cnki.issn.1674-4152.002004

2型糖尿病患者伴发焦虑抑郁现状及其影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002004

1.
蚌埠医学院第一附属医院全科医学科, 安徽蚌埠 233004
2.
安徽医科大学附属巢湖医院神经内科, 安徽巢湖 238001

基金项目:

安徽高校自然科学研究项目 KJ2019A0270

详细信息

通讯作者:
梁冰，E-mail：407281726@qq.com

中图分类号: R587.1 R749.72
计量
- 文章访问数: 958
- HTML全文浏览量: 315
- PDF下载量: 19
- 被引次数: 0
出版历程
- 收稿日期: 2020-09-28
- 网络出版日期: 2022-02-16

Anxiety and depression in patients with type 2 diabetes mellitus and their influencing factors

1.
Department of General Practice, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的使用医院焦虑抑郁量表(HADS)对2型糖尿病(T2DM)患者进行问卷调查，评估T2DM患者伴发焦虑抑郁状态的患病率，分析2型糖尿病患者焦虑抑郁的影响因素。方法对2019年11月—2020年1月蚌埠市社区医院及蚌埠医学院第一附属医院内分泌科住院的287例T2DM患者进行医学病历资料回顾和结构化问卷调查，收集患者社会人口学和健康数据。采用HADS量表评估患者焦虑抑郁状态，共有效完成HADS量表201例，其中焦虑抑郁组93例，非焦虑抑郁组108例，分析焦虑抑郁发生的影响因素[如性别、年龄、病程、受教育程度、婚姻、糖化血红蛋白(HbA1c)、并发症等]。结果 201例T2DM患者中，焦虑抑郁发生率为46.3%，病程、HbA1c、并发症和合并症的个数与焦虑抑郁的发生相关(均P < 0.05)。多元logistic回归分析结果提示，病程、HbA1c和糖尿病肾病等是焦虑抑郁发生的危险因素。结论 2型糖尿病患者焦虑抑郁状态发生率高，心理状态较差，受病程、糖尿病并发症个数、合并症个数及HbA1c等相关因素的影响。
- 2型糖尿病 /
- 焦虑 /
- 抑郁 /
- 影响因素 /
- 糖化血红蛋白
Abstract: Objective The Hospital Anxiety and Depression Scale (HADS) was used to investigate the prevalence of anxiety and depression in patients with type 2 diabetes mellitus (T2DM), and the factors affecting anxiety and depression in T2DM were analysed. Methods A total of 287 patients with T2DM who were admitted at Bengbu Community Hospital and the Department of Endocrinology of the First Affiliated Hospital of Bengbu Medical College from November 2019 to January 2020 were selected. Their medical records were reviewed, and the patients were surveyed using a structured questionnaire to collect sociodemographic and health data. The HADS was used to evaluate the anxiety and depression status of the patients. A total of 201 patients, including 93 in the anxiety and depression group and 108 in the non-anxiety and depression group. The influencing factors of the occurrence of anxiety and depression, such as gender, age, course of disease, education, marriage, glycosylated hemoglobin (HbA1c) and complications were analysed. Results Amongst 201 patients with T2DM, the incidence rate of anxiety and depression was 46.3%. Age, course of disease, HbA1c, number of complications and complications were significantly correlated with the incidence of anxiety and depression (all P < 0.05). In multiple logistic regression analysis, the course of disease, HbA1c, diabetic nephropathy and other factors were the risk factors associated with the occurrence of anxiety and depression. Conclusion Patients with T2DM have a high incidence of anxiety and depression and a poor psychological state, which is affected by age, course of disease, number of diabetic complications, HbA1c and other related factors.
- Type 2 diabetes mellitus /
- Anxiety /
- Depression /
- Influencing factor /
- Glycosylated haemoglobin

HTML全文

表 1 2组2型糖尿病患者一般资料比较

组别	例数	性别(男/女, 例)	年龄(x±s, 岁)	病程(x±s, 年)	受教育年限(x±s, 年)	已婚/未婚(例)	吸烟/不吸烟(例)	糖化血红蛋白(x±s, %)
焦虑抑郁组	93	46/47	58.96±12.75	12.37±8.77	9.28±4.39	90/3	14/79	9.08±2.17
非焦虑抑郁组	108	64/44	57.57±15.75	6.74±7.02	10.12±4.72	107/0	19/88	8.70±2.09
统计量		1.936^a	0.677^b	5.107^b	-1.133^b	1.683^a	0.235^a	2.461^b
P值		0.164	0.499	< 0.001	0.258	0.195	0.628	0.015

组别	例数	胆固醇(x±s, mmol/L)	甘油三酯(x±s, mmol/L)	高密度脂蛋白(x±s, mmol/L)	低密度脂蛋白(x±s, mmol/L)	并发症个数(x±s, 个)	合并症个数(x±s, 个)	并发症和合并症总数(x±s, 个)
焦虑抑郁组	93	4.37±1.39	2.09±1.82	1.00±0.24	2.58±0.99	2.32±1.28	3.43±2.10	5.72±2.24
非焦虑抑郁组	108	4.19±1.34	1.53±1.02	1.03±0.33	2.50±0.83	0.90±0.88	2.18±1.62	3.09±2.02
统计量		1.433^b	2.851^b	0.008^b	1.093^b	9.066^b	4.693^b	8.736^b
P值		0.154	0.005	0.994	0.276	< 0.001	< 0.001	< 0.001
注：^a为χ²值，^b为t值。非焦虑抑郁组中婚姻状况和是否吸烟均有1例数据缺失。

下载: 导出CSV

表 2 2组2型糖尿病患者合并症及并发症比较[例(%)]

组别	例数	周围神经病变	动脉硬化	视网膜病变	糖尿病肾病	糖尿病足	外周血管病变	酮症酸中毒	高血压	冠心病	脂肪肝
焦虑抑郁组	93	58(62.4)	51(54.8)	50(53.8)	36(38.7)	8(8.6)	7(7.5)	6(6.5)	61(65.6)	20(21.5)	22(23.7)
非焦虑抑郁组	108	32(29.6)	33(30.6)	15(13.9)	9(8.3)	4(3.7)	3(2.8)	3(2.8)	38(35.2)	17(15.7)	15(13.9)
χ²值		21.656	12.113	36.311	26.536	2.136	2.384	0.835	18.484	1.106	3.174
P值		< 0.001	0.001	< 0.001	< 0.001	0.144	0.123	0.361	< 0.001	0.293	0.075

组别	例数	脑梗死	高脂血症	椎间盘突出	骨质疏松	甲状腺功能减低	前列腺增大	胆囊息肉	贫血	乙肝	肺结节
焦虑抑郁组	93	20(21.5)	9(9.7)	7(7.5)	5(5.4)	7(7.5)	3(3.2)	5(5.4)	4(4.3)	5(5.4)	4(4.3)
非焦虑抑郁组	108	16(14.8)	8(7.4)	5(4.6)	6(5.6)	5(4.6)	7(6.5)	4(3.7)	5(4.6)	3(2.8)	4(3.7)
χ²值		1.521	0.333	0.747	0.003	0.747	0.538	0.053	0.001	0.334	0.001
P值		0.217	0.564	0.387	0.956	0.387	0.463	0.818	0.999	0.563	0.999

下载: 导出CSV

表 3 焦虑抑郁及影响因素赋值情况

项目	赋值方法
焦虑抑郁	是=1，否=0
并发症(周围神经病变、动脉硬化、视网膜病变、糖尿病肾病、糖尿病足、外周血管病变、酮症酸中毒)	有=1，无=0
合并症(高血压、冠心病、脂肪肝、脑梗、高脂血症、椎间盘突出、骨质疏松、甲状腺功能减低等)	有=1，无=0
注：连续变量均以实际值赋值。

下载: 导出CSV

表 4 2型糖尿病伴发焦虑抑郁影响因素的logistic回归分析

项目	B	SE	Wald χ²	P值	OR值	95% CI
病程	0.079	0.025	10.015	0.002	1.082	1.030~1.136
糖化血红蛋白	0.315	0.096	10.793	0.001	1.371	1.136~1.654
甘油三酯	0.455	0.174	6.886	0.009	1.577	1.122~2.216
视网膜病变	1.823	0.399	20.906	< 0.001	6.193	2.834~13.533
动脉硬化	0.657	0.369	3.178	0.075	1.929	0.937~3.975
周围神经病变	0.585	0.362	2.608	0.106	1.795	0.883~3.649
糖尿病肾病	1.000	0.466	4.601	0.032	2.719	1.090~6.784
高血压	1.080	0.360	8.994	0.003	2.945	1.454~5.964
并发症与合并症总数	0.637	0.111	32.683	< 0.001	1.891	1.520~2.353

下载: 导出CSV

参考文献(16)

[1]	PETERSMANN A, MVLLER-WIELAND D, MVLLER U A, et al. Definition, classification and diagnosis of diabetes mellitus[J]. Exp Clin Endocrinol Diabetes, 2019, 127(S1): S1-S7.
[2]	WANG L, GAO P, ZHANG M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J]. JAMA, 2017, 317(24): 2515-2523. doi: 10.1001/jama.2017.7596
[3]	ZHENG Y, LEY S H, HU F B. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications[J]. Nat Rev Endocrinol, 2018, 14(2): 88-98. doi: 10.1038/nrendo.2017.151
[4]	SNOEK F J, BREMMER M A, HERMANNS N. Constructs of depression and distress in diabetes: Time for an appraisal[J]. Lancet Diabetes Endocrinol, 2015, 3(6): 450-460. doi: 10.1016/S2213-8587(15)00135-7
[5]	HACKETT R A, STEPTOE A. Type 2 diabetes mellitus and psychological stress-a modifiable risk factor[J]. Nat Rev Endocrinol, 2017, 13(9): 547-560. doi: 10.1038/nrendo.2017.64
[6]	ALBEKAIRY A, ABURUZ S, ALSABANI B, et al. Exploring factors associated with depression and anxiety among hospitalized patients with type 2 diabetes mellitus[J]. Med Princ Pract, 2017, 26(6): 547-553. doi: 10.1159/000484929
[7]	COLLINS M M, CORCORAN P, PERRY I J. Anxiety and depression symptoms in patients with diabetes[J]. Diabet Med, 2009, 26(2): 153-161. doi: 10.1111/j.1464-5491.2008.02648.x
[8]	刘新宁, 侯连龙, 何善娴, 等. 北京社区2型糖尿病患者抑郁焦虑的相关因素分析[J]. 中国医药, 2018, 13(6): 875-878. doi: 10.3760/j.issn.1673-4777.2018.06.019
[9]	李田园, 潘琦, 张梅, 等. 应用医院用焦虑抑郁量表探讨住院2型糖尿病患者焦虑抑郁的发生风险[J]. 中国糖尿病杂志, 2019, 27(9): 671-676. doi: 10.3969/j.issn.1006-6187.2019.09.007
[10]	ZIGMOND A S, SNAITH R P. The hospital anxiety and depression scale[J]. Acta Psychiatr Scand, 1983, 67(6): 361-370. doi: 10.1111/j.1600-0447.1983.tb09716.x
[11]	汪凯, 朱春燕, 陈海波. 综合医院焦虑、抑郁与躯体化症状诊断治疗的专家共识[J]. 中华神经科杂志, 2016, 49(12): 908-917. doi: 10.3760/cma.j.issn.1006-7876.2016.12.002
[12]	BAJAJ S, AGARWAL S K, VARMA A, et al. Association of depression and its relation with complications in newly diagnosed type 2 diabetes[J]. Indian J Endocrinol Metab, 2012, 16(5): 759-763. doi: 10.4103/2230-8210.100670
[13]	GOK METIN Z, ARSLAN I E. Diabetic peripheral neuropathic pain from the perspective of turkish patients: A qualitative study[J]. J Transcult Nurs, 2018, 29(6): 514-522. doi: 10.1177/1043659617753044
[14]	ZHENG Y H, REN C Y, SHEN Y, et al. A cross-sectional study on the correlation between inflammatory cytokines, negative emotions, and onset of peripheral neuropathy in type 2 diabetes[J]. Neuropsychiatr Dis Treat, 2020, 16: 2881-2890. doi: 10.2147/NDT.S278439
[15]	MA Y, LI X, ZHAO D D, et al. Association between cognitive vulnerability to depression - dysfunctional attitudes and glycaemic control among in-patients with type 2 diabetes in a hospital in Beijing: A multivariate regression analysis[J]. Psychol Health Med, 2018, 23(2): 189-197. doi: 10.1080/13548506.2017.1339894
[16]	唐兢, 杨祺, 李潇, 等. 社区老年2型糖尿病患者心理健康指导效果研究[J]. 中华全科医学, 2019, 17(3): 433-435, 507. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201903027.htm