先进急诊医学

慢性肾脏病患者的抑郁症研究概述

周 毅

右江民族医学院研究生学院

王 洁

右江民族医学院附属医院

黄 美英

右江民族医学院附属医院

蒙 华美

右江民族医学院研究生学院

DOI: https://doi.org/10.59429/xjjz.v6i4.8648

Keywords: 慢性肾脏病；抑郁症；发病机制；干预措施

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Abstract

慢性肾脏病（CKD）合并抑郁症（MDD）具有高发病率及不良结局特点。研究发现，CKD 患者的脑结构 异常和慢性炎症是抑郁症的关键因素，信号分子和神经营养因子的变化也显著影响抑郁发生。运动等非药物干预可 通过其抗炎作用改善患者症状，而药物对 CKD 患者的抑郁症状疗效有待商榷。通过分析慢性肾脏病患者抑郁症发病 机制及干预措施，为制定安全有效处方及综合治疗策略提供新视角。

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References

[1] NG203. Chronic kidney disease in adults: assessment andmanagement Clinical guideline NG203[Z].2021.

[2] Collaboration G B D C K D. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2020,395(10225):709-33.

[3] Giannakopoulou O, Lin K, Meng X, et al. The Genetic Architecture of Depression in Individuals of East Asian Ancestry: A Genome-Wide Association Study[J]. JAMA Psychiatry,2021, 78(11):1258-69.

[4] Palmer S, Vecchio M, Craig J C, et al. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies[J]. Kidney Int,2013,84(1):179-91.

[5] Moodalbail D G, Reiser K A, Detre J A, et al. Systematic review of structural and functional neuroimaging findings in children and adults with CKD[J]. Clin J Am Soc Nephrol,2013,8(8):1429-48.

[6] Brouns R, De Deyn P P. Neurological complications in renal failure: a review[J]. Clin Neurol Neurosurg,2004,107(1):1-16.

[7] Sexton C E, Mackay C E, Ebmeier K P. A systematic review and meta-analysis of magnetic resonance imaging studies in late-life depression[J]. Am J Geriatr Psychiatry,2013,21(2):184-95.

[8] Meurs M, Roest A M, Groenewold N A, et al. Gray matter volume and white matter lesions in chronic kidney disease: exploring the association with depressive symptoms[J]. Gen Hosp Psychiatry, 2016(40):18-24.

[9] Aron A R, Robbins T W, Poldrack R A. Inhibition and the right inferior frontal cortex[J]. Trends Cogn Sci,2004,8(4):170-7.

[10] Song J, Ma W, Gu X, et al. Metabolomic signatures and microbial community profiling of depressive rat model induced by adrenocorticotrophic hormone[J]. J Transl Med,2019,17(1):224.

[11] Turkmen K, Guney I, Yerlikaya F H, et al. The Relationship Between Neutrophil-to-Lymphocyte Ratio and Inflammation in End-Stage Renal Disease Patients[J]. Renal Failure,2011, 34(2):155-9.

[12] Zhang Z-H, Li M-H, Liu D, et al. Rhubarb Protect Against Tubulointerstitial Fibrosis by Inhibiting TGF-β/Smad Pathway and Improving Abnormal Metabolome in Chronic Kidney Disease[J]. Frontiers in Pharmacology,2018:9.

[13] Zhou X, Liu L, Lan X, et al. Polyunsaturated fatty acids metabolism, purine metabolism and inosine as potential independent diagnostic biomarkers for major depressive disorder in children and adolescents[J]. Molecular Psychiatry,2018,24(10):1478-88.

[14] Coppen A, Shaw D M, Malleson A, et al. Tryptamine Metabolism in Depression[J]. British Journal of Psychiatry,2018,111(479):993-8.

[15] Chen H, Miao H, Feng Y L, et al. Metabolomics in dyslipidemia[J]. Adv Clin Chem,2014(66):101-19.

[16] Guix F X, Uribesalgo I, Coma M, et al. The physiology and pathophysiology of nitric oxide in the brain[J]. Prog Neurobiol, 2005,76(2):126-52.

[17] Selley M L. Increased (E)-4-hydroxy-2-nonenal and asymmetric dimethylarginine concentrations and decreased nitric oxide concentrations in the plasma of patients with major depression[J]. J

[18] Zoccali C. Traditional and emerging cardiovascular and renal risk factors: an epidemiologic perspective[J]. Kidney Int,2006,70(1):26-33.

[19] Duman R S. Pathophysiology of depression: the concept of synaptic plasticity[J]. Eur Psychiatry,2002,17 Suppl(3):306-10.

[20] Yang H, Qi L, Pei D. Effect of psychosocial interventions for depression in adults with chronic kidney disease: a systematic review and meta-analysis[J]. BMC Nephrol,2024,25(1):17.

[21] Rodrigue J R, Mandelbrot D A, Pavlakis M. A psychological intervention to improve quality of life and reduce psychologicaldistress in adults awaiting kidney transplantation[J]. Nephrol Dial

Transplant,2011,26(2):709-15.

[22] Lee M C, Wu S V, Hsieh N C, et al. Self-Management Programs on eGFR, Depression, and Quality of Life among Patients with Chronic Kidney Disease: A Meta-Analysis[J]. Asian Nurs Res (Korean Soc Nurs Sci),2016,10(4):255-62.

[23] Glowacki K A-N K, Burrows M. Erratum regarding previously published articles in volume 16, 17, 18 and 19[J]. Mental Health and Physical Activity,2021(20).

[24] Gleeson M, Bishop N C, Stensel D J, et al. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention

and treatment of disease[J]. Nature Reviews Immunology, 2011,11(9):607-15

[25] Viana J L, Kosmadakis G C, Watson E L, et al. Evidence for Anti-Inflammatory Effects of Exercise in CKD[J]. Journal of the American Society of Nephrology,2014,25(9):2121-30.

[26] van Oosten M J M, Koning D, Logtenberg S J J, et al. Chronic prescription of antidepressant medication in patients with chronic kidney disease with and without kidney replacement therapy compared with matched controls in the Dutch general population[J]. Clin Kidney J,2022,15(4):778-85.

[27] Pearce C J, Hall N, Hudson J L, et al. Approaches to the identification and management of depression in people living with chronic kidney disease: A scoping review of 860 papers[J]. J Ren Care,2024,50(1):4-14.

[28] Chen J W, Xie S Q. Agomelatine versus paroxetine in treating depressive and anxiety symptoms in patients with chronic kidney disease[J]. Neuropsychiatr Dis Treat,2018(14):547-52.

[29] Xia M, Ai N, Pang J. Preliminary Exploration of Clinical Efficacy and Pharmacological Mechanism of Modified Danggui-Shaoyao San in the Treatment of Depression in Patients with Chronic Kidney Disease[J]. Drug Des Devel Ther,2022(16):3975-89.