透析患者における虚血性心疾患とメンタルヘルス Ischemic heart disease may be associated with poor mental health in hemodialysis patients

【目的】透析患者を対象として，虚血性心疾患（IHD）の存在が患者のメンタルヘルスに及ぼす影響について検討した．【対象・方法】昭和大学病院の関連施設で治療中の維持透析患者50名を対象とした．メンタルヘルスの指標はSF-36v2.0の下位尺度8項目の中からMental health（MH）scoreにて，うつ症状はCenter for Epidemiologic Studies-Depression（CES-D）Scaleにて検討した．これらの検査と同時期の週初め透析前に患者背景の調査，各種血液検査を施行した．【結果】IHD群はnon-IHD群と比較して，高い糖尿病罹患率，高感度CRP値を認めた．さらに，IHD群はnon-IHD群と比較し，MH scoreの有意な低下を認めた．またIHD群は，統計学的有意差はないもののnon-IHD群と比較し高いCES-D scoreを認めた．ステップワイズ重回帰分析を行った結果，IHDの存在がMH scoreに対する有意な説明変数となった（p＜0.05，標準化回帰係数＝−0.308）．【結論】以上の結果から，IHDの存在は透析患者のメンタルヘルスにも影響を及ぼす可能性が示唆された．

[Objective] To examine the influence of ischemic heart disease (IHD) against poor mental health (MH) in dialysis patients. [Methods] Subjects consisted of 50 patients with end-stage renal failure who underwent regular hemodialysis in a hospital affiliated with Showa University Hospital. MH was estmated by the MH score on SF-36v2.0. Moreover, depressive symptoms were assessed by the Center for Epidemiologic Studies-Depression (CES-D) Scale. All subjects underwent SF-36v2.0, CES-D Scale, clinical and laboratory tests, and were divided into two groups (IHD group or non-IHD group). [Results] Morbidity due to diabetes mellitus and serum levels of high sensitive C-reactive protein were significantly higher, and MH scores were significantly lower in patients in the IHD group. Stepwise regression analysis demonstrated that the history of IHD had a significant impact on MH score in hemodialysis patients. [Conclusion] These findings suggest that IHD may be involved in poor MH among hemodialysis patients.