维持性血液透析患者抑郁状态与死亡率的相关性：一项基于观察性研究的系统评价与Meta分析-现代医学

维持性血液透析患者抑郁状态与死亡率的相关性：一项基于观察性研究的系统评价与Meta分析

单位：东南大学附属中大医院血液净化中心, 江苏南京 210009

分类号：R473.5

出版年·卷·期（页码）：2026·54·第一期（114-124）

摘要：

目的：旨在系统地回顾和分析维持性血液透析(MHD)患者抑郁状态与死亡率之间的关系。方法：检索Embase、Pubmed、Web of Science、CNKI、VIP、CBM数据库自建库至2025年5月中 MHD患者抑郁状态与死亡率的相关文献，进行筛选及质量评价后合并分析。结果：共纳入14篇文献，均为观察性队列研究。14篇文献中随访时间最短为1年，最长为7年；样本量最少为40例患者，最多为45 076例患者。Meta分析的结果提示，抑郁状态能够引起MHD患者全因死亡率的升高[未调整风险比(HR)=1.14, 95%CI:1.07~1.21, Z=4.061, P<0.001；调整HR=1.21, 95% CI:1.12~1.31, Z=4.456, P<0.001]，但对MHD患者心血管死亡率无显著影响(HR=1.13, 95%CI:0.90~1.43, Z=1.061，P=0.289)。本研究纳入文献之间存在显著的异质性与发表偏倚。结论：抑郁状态能够显著引起MHD患者全因死亡率的升高，应尽早对MHD患者进行抑郁状态的筛查，提前进行干预。

Objective: This study aims to systematically review and analyze the relationship between depression status and the risk of death in maintenance hemodialysis(MHD)patients. Methods: Literature on the association between depressive status and mortality in MHD patients was systematically retrieved from Embase, PubMed, Web of Science, CNKI, VIP and CBM databases from their inception to May 2025. After literature screening and quality assessment, a pooled analysis was performed. Results: A total of 14 observational cohort studies were included. The follow-up duration ranged from 1 year(shortest) to 7 years(longest), with sample sizes varying from 40 to 45 076 patients. Meta-analysis results indicated that depressive status were associated with an increased risk of all-cause mortality in MHD patients [unadjusted hazard ratio(HR)=1.14, 95%CI 1.07-1.21, Z=4.061, P<0.001; adjusted HR=1.21, 95%CI 1.12-1.31, Z=4.456, P<0.001]. However, no significant effect on cardiovascular mortality was observed(HR=1.13, 95%CI 0.90-1.43, Z=1.061, P=0.289). Significant heterogeneity and publication bias were detected among the included studies. Conclusion: Depressive status can significantly increase the all-cause mortality rate of MHD patients. Screening for depressive status in MHD patients should be conducted as early as possible, and intervention should be carried out in advance.

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