유지 혈액투석치료를 받는 만성신부전에 수반된 우울증에서 항우울제 치료에 따른 우울증상 및 영양지표의 변화 = Changes of Depressive Symptoms and Nutritional Indices after Antidepressant Treatment in the Patients with Chronic Hemodialysis and Depression유지 혈액투석치료를 받는 만성신부전에 수반된 우울증에서 항우울제 치료에 따른 우울증상 및 영양지표의 변화

국문 초록 (Abstract)

목적: 유지 혈액투석치료를 받고 있는 만성신부전 환자에서 수반되는 우울증과 우울증상의 특성 및 정도를 조사하고, 항우울제 치료 전후의 우울증상 및 영양지표의 변화를 측정하여, 우울증과 우울증상의 치료가 유지 혈액투석치료를 받고 있는 만성신부전 환자에게 미치는 임상적 영향을 살펴보고자 하였다. 방법: 고신대학교 복음병원 인공신장실에서 6개월 이상 동안 유지 혈액투석치료를 받고 있는 만성신부전 환자 64명을 대상으로 우울증 및 우울정도와 영양상태 지표들을 조사하였다. 주요우울증의 진단은 반구조화된 면담을 통하여 DSM-IV TR 기준을 사용하였다. 우울증상의 정도는 17문항의 Hamilton Rating Scale for Depression (HRSD)을 사용하여 측정하였다. Subjective global assessment (SGA), body mass index (BMI), triceps skin fold thickness (TSF), mid-arm muscle circimference (MAMC)와 handgrip strength를 측정하였으며 KT/V, normalized protein catabolic rate (nPCR), 혈청 알부민 농도 등과 같은 영양지표도 측정하였다. 우울증이 있는 경우 8주간의 항우울제 약물치료를 시행하였고, 치료 이후 우울증상과 영양상태의 항목들을 재평가하였다. 결과: 만성신부전으로 유지 혈액투석치료를 받고 있는 환자들 중 우울증으로 진단된 환자는 19명으로 42.2% (주요 우울장애 11명 24.4%, 기분부전장애 8명 17.8%)였다. 우울증이 있는 경우 우울한 기분, 죄책감, 자살사고, 수면장애, 일과 활동의 저하, 정신운동의 지연, 정신적 불안 및 신체 불안, 전반적인 신체증상 및 건강염려 등이 유의하게 높았다. 항우울제 약물치료 후 우울한 기분과 정신적 불안, 죄책감, 자살사고, 일과 활동, 수면장애 및 전반적인 신체증상 등이 유의하게 호전되었다. 치료 후 TSF (p<0.05), handgrip strength (p<0.01)와 hematocrit (p<0.05)이 개선되었다. 결론: 유지 혈액투석 중인 만성신부전 환자에서 우울증이 수반될 경우 우울증상에 대한 항우울제 치료는 수면과 신체증상 등을 포함하여 우울증상을 호전시킬 뿐만 아니라 삶의 질을 향상시킬 것으로 기대되므로 적극적인 항우울제 치료가 필요하다고 하겠다.

다국어 초록 (Multilingual Abstract)

Purpose: Depression is common in patients with chronic renal failure on maintenance hemodialysis, though success rate of treatment is low. This study aimed to investigate the features and severity of the depressive symptoms and nutritional indices, and significant changes after antidepressant treatment. Methods: The authors assessed 45 patients. Diagnosis of depression was made using DSM-IV-TR and the depressive symptoms were evaluated using Hamilton Rating Scale for Depression via semistructured interview. Subjective global assessment, anthropometric measurements and nutritional indices such as Kt/V, nPCR were examined. Depressive patients were treated for 8 weeks with SSRI (citalopram), and all the variables were examined again after the treatment. Results: 19 (42.2%) patients were diagnosed as depression. Nutritional status was not different between patients with depression and those without depression. Compared to non-depressed patients, depressed patients showed significantly higher depressed mood, guilty feeling, suicide idea, psychic and somatic anxiety, lower work and activities, psychomotor retardation, sleep disturbances, general somatic symptoms and hypochondriasis. After antidepressant treatment, depressed mood, guilty feeling, suicide idea, psychic anxiety, initial insomnia, middle insomnia, early awakening, work and activities and general somatic symptoms were improved significantly. TSF (p<0.05), handgrip strength (p<0.01) and hematocrit (p<0.05) were significantly increased. Conclusion: Antidepressant treatment is helpful not only for the improvement of depressive symptoms such as sleep and somatic symptoms but for the improvement of quality of life. Proper treatment should be more actively attempted for the hemodialytic patients with depression.

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