中老年人群抑郁症状与肾脏高滤过的相关性

doi:10.12122/j.issn.1673-4254.2026.10.02

摘要/Abstract

摘要：

目的探讨中老年人群抑郁症状及抑郁发作与肾脏高滤过（RHF）的相关性。方法本横断面研究纳入了REACTION研究兰州地区9469例中老年受试者。排除肾脏高滤过（eGFR）<60 mL·min^-1·1.73 m^-2、尿白蛋白/肌酐比值≥30 mg/g、恶性肿瘤及抑郁问卷资料不全或服用抗抑郁药物者后，采用患者健康问卷-9（PHQ-9）评估抑郁症状，并按PHQ-9<5、5≤PHQ-9<10 及 PHQ-9≥10分组；同时评估抑郁发作状态。以校正年龄、性别、身高、体质量、高血压和糖尿病后的对数eGFR回归残差第95百分位以上定义RHF。采用多因素logistic回归分析抑郁状态与RHF的相关性，并采用限制性三次样条分析PHQ-9总分与RHF风险的剂量-反应关系。进一步采用随机森林、SHAP和Boruta方法进行探索性分析。结果限制性三次样条分析显示，PHQ-9总分与RHF风险之间存在显著非线性关联，整体关联及非线性成分均有统计学意义。多因素调整混杂因素后，与PHQ-9 0~4分组相比，PHQ-9 5~9分组RHF风险无显著升高，而PHQ-9≥10分组RHF风险显著增加（OR=1.854，95% CI：1.074~3.201，P=0.027）。按PHQ-9<10分和≥10分二分类后，PHQ-9≥10分者RHF风险仍显著升高（OR=1.864，95% CI：1.080~3.210，P=0.025）。与无抑郁发作者相比，轻度抑郁发作与RHF无显著相关，而重度抑郁发作与RHF风险升高独立相关（OR=1.547，95% CI：1.082~2.212，P=0.017）。探索性机器学习分析显示，抑郁发作和临床相关抑郁症状均为RHF风险识别的稳定特征，但其贡献弱于年龄、空腹血糖和收缩压等传统因素。结论中老年人群中抑郁症状与RHF风险存在非线性关联，且风险升高主要出现在PHQ-9达到临床意义阈值后。重度抑郁发作亦与RHF风险升高相关，其时序关系及潜在机制仍需前瞻性研究进一步验证。

关键词: 抑郁症状, 抑郁发作, 肾脏高滤过, 中老年人, 患者健康问卷-9

Abstract:

Objective To investigate the associations of depressive symptoms and depressive episodes with renal hyperfiltration (RHF) in middle-aged and older adults. Methods This cross-sectional study was conducted among 9469 middle-aged and older participants from Lanzhou site of the REACTION study. After excluding individuals with estimated glomerular filtration rate (eGFR) <60 mL·min^-1·1.73 m^-2, urine albumin-to-creatinine ratio ≥30 mg/g, malignant tumors, incomplete depression questionnaire data, or antidepressant use, the participants were assessed for depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) and categorized in <5, 5-9, and ≥10 groups. Depressive episode status was also evaluated. RHF was defined as residuals above the 95th percentile from a regression model of log-transformed eGFR adjusted for age, sex, height, weight, hypertension, and diabetes. The associations of depressive status with RHF and the dose-response relationship between PHQ-9 total score and RHF risk were assessed using multivariable logistic regression and restricted cubic spline analysis, respectively. Random forest, SHAP, and Boruta were used for exploratory analyses. Results Restricted cubic spline analysis showed a significant nonlinear association between PHQ-9 total score and RHF risk. After multivariable adjustment, a significantly increased RHF risk was found in the PHQ-9 ≥10 group (OR=1.854, 95% CI: 1.074-3.201; P=0.027) but not in the PHQ-9 5-9 and PHQ-9 0-4 groups. When PHQ-9 was dichotomized as <10 and ≥10, a PHQ-9 score ≥10 was associated with a higher risk of RHF (OR=1.864, 95% CI: 1.080-3.210; P=0.025). Mild depressive episodes were not associated with RHF, whereas major depressive episodes were independently associated with increased RHF risks (OR=1.547, 95% CI: 1.082-2.212; P=0.017). Exploratory machine learning analyses showed that depressive episodes and clinically relevant depressive symptoms were stable features for RHF risk identification but with weaker contributions than age, fasting blood glucose, and systolic blood pressure. Conclusion In middle-aged and older adults, depressive symptoms are nonlinearly associated with RHF risks, which increased significantly when PHQ-9 score reached a clinically meaningful threshold. Major depressive episodes are also associated with increased RHF risks, and their temporal relationship and underlying mechanisms require further investigation in prospective studies.

Key words: depressive symptoms, depressive episode, renal hyperfiltration, middle-aged and older adults, Patient Health Questionnaire-9

杨孟迪, 尹鸿涛, 李红利, 李琼, 季晓, 甄东户. 中老年人群抑郁症状与肾脏高滤过的相关性[J]. 南方医科大学学报, 2026, 46(10): 2296-2308.

Mengdi YANG, Hongtao YIN, Hongli LI, Qiong LI, Xiao JI, Donghu ZHEN. Association between depressive symptoms and renal hyperfiltration in middle-aged and older adults[J]. Journal of Southern Medical University, 2026, 46(10): 2296-2308.

图/表 8

参考文献 49

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Characteristics	Depressive Symptoms				Depressive Episode
Characteristics	PHQ<5	5≤PHQ<10	PHQ≥10	P	No	Mild	Severe	P
Case (n)	8075 (85.3)	1160 (12.3)	234 (2.5)		8196 (86.6)	681 (7.2)	592 (6.3)
Age (year)	57.34±8.41	56.97±8.37	56.21±8.42	0.054	57.40±8.39	56.24±8.28^a	56.64±8.64^a	<0.001
Gender				<0.001				<0.001
Men	2462 (30.5)	231 (19.9)^a	45 (19.2)^a		2469 (30.1)	152 (22.3)^a	117 (19.8)^a
Women	5613 (69.5)	929 (80.1)^a	189 (80.8)^a		5757 (69.9)	529 (77.7)^a	475 (80.2)^a
Height	162.17±7.61	160.83±7.33^a	160.88±7.42^a	<0.001	162.11±7.60	161.47±7.55^a	160.65±7.36^a	<0.001
Weight	63.91±10.49	61.70±9.70^a	61.26±10.28^a	<0.001	63.86±10.49	62.49±9.67^a	61.20±9.93^ab	<0.001
BMI	24.26±3.32	23.82±3.19^a	23.61±3.20^a	<0.001	24.25±3.33	23.94±3.10^a	23.66±3.14^a	<0.001
No single*	7094 (87.9)	972 (83.8)^a	180 (76.9)^ab	<0.001	7200 (87.8)	569 (83.6)^a	477 (80.6)^a	<0.001
High school level	4486 (55.6)	613 (52.8)	132 (56.4)	0.208	4541 (55.4)	367 (53.9)	323 (54.6)	0.704
Sleep quality				0.048				0.588
Good	6396 (79.2)	955 (82.3)^a	186 (79.5)		6510 (79.4)	550 (80.8)	477 (80.6)
Poor	1679 (20.8)	205 (17.7)^a	48 (20.5)		1686 (20.6)	131 (19.2)	115 (19.4)
SBP	128.60±19.17	125.94±18.73^a	124.04±17.01^a		128.44±19.14	127.37±19.07	125.23±18.15^ab	<0.001
DBP	76.65±10.64	75.27±10.38^a	74.04±10.28^a	<0.001	76.53±10.62	76.36±10.63	74.89±10.48^ab	0.001
FPG	5.60 (5.10, 6.26)	5.50 (5.03, 6.14)^a	5.46 (5.08, 6.20)	0.013	5.60 (5.10, 6.27)	5.50 (5.03, 6.20)	5.48 (5.01, 6.02)^a	0.001
2hPG	7.52 (6.10, 9.81)	7.35 (5.99, 9.50)	7.40 (6.04, 10.00)	0.158	7.52 (6.10, 9.80)	7.34 (5.90, 9.72)	7.39 (5.95, 9.40)	0.047
HDL	1.22±0.30	1.25±0.31^a	1.24±0.31	0.005	1.22±0.30	1.23±0.30	1.23±0.32	0.712
Low HDL	2298 (24.3)	290 (25.0)^a	52 (22.2)	0.007	2295 (28.0)	190 (27.9)	155 (26.2)	0.635
LDL	2.55±0.77	2.60±0.76^a	2.52±0.79	0.116	2.56±0.77	2.48±0.76^a	2.55±0.77	0.033
High LDL	216 (2.7)	31 (2.7)	5 (2.1)	0.880	222 (2.7)	17 (2.5)	13 (2.2)	0.727
TC	4.53±1.03	4.62±1.05^a	4.52±1.11	0.036	4.55±1.03	4.45±1.03^a	4.56±1.08	0.059
High TC	418 (5.2)	60 (5.2)	16 (6.8)	0.529	436 (5.3)	28 (4.1)	30 (5.1)	0.39
TG	1.49 (1.07, 2.11)	1.46 (1.06, 2.06)	1.45 (1.00, 2.17)	0.523	1.49 (1.07, 2.11)	1.44 (1.04, 2.05)	1.47 (1.03, 2.07)	0.145
High TG	1697 (21.0)	224 (19.3)	56 (23.9)	0.208	1727 (21.1)	130 (19.1)	120 (20.3)	0.441
SCr	0.76±0.14	0.74±0.13^a	0.73±0.12^a	<0.001	0.76±0.13	0.74±0.14^a	0.74±0.13^a	<0.001
eGFR	92.47±12.30	92.63±12.34	94.02±13.05	0.161	92.40±12.27	93.42±12.48^a	93.36±12.88	0.028
UACR	2.15 (1.38, 3.33)	2.24 (1.37, 3.40)	2.16 (1.29, 3.25)	0.547	2.16 (1.38, 3.33)	2.21 (1.37, 3.30)	2.12 (1.33, 3.35)	0.770
Smoking				0.001				0.079
Now not	6760 (83.7)	1024 (88.3)^a	202 (86.3)		6882 (84.0)	588 (86.3)	516 (87.2)
Occasionally	232 (2.9)	19 (1.6)^a	6 (2.6)		233 (2.8)	11 (1.6)	13 (2.2)
Often	1083 (13.4)	117 (10.1)^a	26 (11.1)		1081 (13.2)	82 (12.0)	63 (10.6)
Drinking				0.052				0.240
Now not	5846 (72.4)	864 (74.5)	172 (73.5)		5968 (72.8)	487 (71.5)	427 (72.1)
Occasionally	1791 (22.2)	255 (22.0)	46 (19.7)		1787 (21.8)	163 (23.9)	142 (24.0)
Often	438 (5.4)	41 (3.5)	16 (6.8)		441 (5.4)	31 (4.6)	23 (3.9)
Regular exercise	1778 (22.0)	240 (20.7)	53 (22.6)	0.567	1818 (22.2)	139 (20.4)	114 (19.3)	0.159
DM	1929 (23.9)	270 (23.3)	62 (26.5)	0.573	1977 (24.1)	153 (22.5)	131 (22.1)	0.366
HT	2956 (36.9)	387 (33.4)	63 (26.9)^a	0.001	2983 (36.4)	242 (35.5)	181 (30.6)^a	0.017
CCVD	349 (4.3)	75 (6.5)^a	12 (5.1)	0.005	368 (4.5)	34 (5.0)	34 (5.7)	0.329
RHF	403 (5.0)	53 (4.6)	17 (7.3)	0.225	403 (4.9)	29 (4.3)	41 (6.9)	0.063

Characteristics	Depressive Symptoms				Depressive Episode
Characteristics	PHQ<5	5≤PHQ<10	PHQ≥10	P	No	Mild	Severe	P
Case (n)	8075 (85.3)	1160 (12.3)	234 (2.5)		8196 (86.6)	681 (7.2)	592 (6.3)
Age (year)	57.34±8.41	56.97±8.37	56.21±8.42	0.054	57.40±8.39	56.24±8.28^a	56.64±8.64^a	<0.001
Gender				<0.001				<0.001
Men	2462 (30.5)	231 (19.9)^a	45 (19.2)^a		2469 (30.1)	152 (22.3)^a	117 (19.8)^a
Women	5613 (69.5)	929 (80.1)^a	189 (80.8)^a		5757 (69.9)	529 (77.7)^a	475 (80.2)^a
Height	162.17±7.61	160.83±7.33^a	160.88±7.42^a	<0.001	162.11±7.60	161.47±7.55^a	160.65±7.36^a	<0.001
Weight	63.91±10.49	61.70±9.70^a	61.26±10.28^a	<0.001	63.86±10.49	62.49±9.67^a	61.20±9.93^ab	<0.001
BMI	24.26±3.32	23.82±3.19^a	23.61±3.20^a	<0.001	24.25±3.33	23.94±3.10^a	23.66±3.14^a	<0.001
No single*	7094 (87.9)	972 (83.8)^a	180 (76.9)^ab	<0.001	7200 (87.8)	569 (83.6)^a	477 (80.6)^a	<0.001
High school level	4486 (55.6)	613 (52.8)	132 (56.4)	0.208	4541 (55.4)	367 (53.9)	323 (54.6)	0.704
Sleep quality				0.048				0.588
Good	6396 (79.2)	955 (82.3)^a	186 (79.5)		6510 (79.4)	550 (80.8)	477 (80.6)
Poor	1679 (20.8)	205 (17.7)^a	48 (20.5)		1686 (20.6)	131 (19.2)	115 (19.4)
SBP	128.60±19.17	125.94±18.73^a	124.04±17.01^a		128.44±19.14	127.37±19.07	125.23±18.15^ab	<0.001
DBP	76.65±10.64	75.27±10.38^a	74.04±10.28^a	<0.001	76.53±10.62	76.36±10.63	74.89±10.48^ab	0.001
FPG	5.60 (5.10, 6.26)	5.50 (5.03, 6.14)^a	5.46 (5.08, 6.20)	0.013	5.60 (5.10, 6.27)	5.50 (5.03, 6.20)	5.48 (5.01, 6.02)^a	0.001
2hPG	7.52 (6.10, 9.81)	7.35 (5.99, 9.50)	7.40 (6.04, 10.00)	0.158	7.52 (6.10, 9.80)	7.34 (5.90, 9.72)	7.39 (5.95, 9.40)	0.047
HDL	1.22±0.30	1.25±0.31^a	1.24±0.31	0.005	1.22±0.30	1.23±0.30	1.23±0.32	0.712
Low HDL	2298 (24.3)	290 (25.0)^a	52 (22.2)	0.007	2295 (28.0)	190 (27.9)	155 (26.2)	0.635
LDL	2.55±0.77	2.60±0.76^a	2.52±0.79	0.116	2.56±0.77	2.48±0.76^a	2.55±0.77	0.033
High LDL	216 (2.7)	31 (2.7)	5 (2.1)	0.880	222 (2.7)	17 (2.5)	13 (2.2)	0.727
TC	4.53±1.03	4.62±1.05^a	4.52±1.11	0.036	4.55±1.03	4.45±1.03^a	4.56±1.08	0.059
High TC	418 (5.2)	60 (5.2)	16 (6.8)	0.529	436 (5.3)	28 (4.1)	30 (5.1)	0.39
TG	1.49 (1.07, 2.11)	1.46 (1.06, 2.06)	1.45 (1.00, 2.17)	0.523	1.49 (1.07, 2.11)	1.44 (1.04, 2.05)	1.47 (1.03, 2.07)	0.145
High TG	1697 (21.0)	224 (19.3)	56 (23.9)	0.208	1727 (21.1)	130 (19.1)	120 (20.3)	0.441
SCr	0.76±0.14	0.74±0.13^a	0.73±0.12^a	<0.001	0.76±0.13	0.74±0.14^a	0.74±0.13^a	<0.001
eGFR	92.47±12.30	92.63±12.34	94.02±13.05	0.161	92.40±12.27	93.42±12.48^a	93.36±12.88	0.028
UACR	2.15 (1.38, 3.33)	2.24 (1.37, 3.40)	2.16 (1.29, 3.25)	0.547	2.16 (1.38, 3.33)	2.21 (1.37, 3.30)	2.12 (1.33, 3.35)	0.770
Smoking				0.001				0.079
Now not	6760 (83.7)	1024 (88.3)^a	202 (86.3)		6882 (84.0)	588 (86.3)	516 (87.2)
Occasionally	232 (2.9)	19 (1.6)^a	6 (2.6)		233 (2.8)	11 (1.6)	13 (2.2)
Often	1083 (13.4)	117 (10.1)^a	26 (11.1)		1081 (13.2)	82 (12.0)	63 (10.6)
Drinking				0.052				0.240
Now not	5846 (72.4)	864 (74.5)	172 (73.5)		5968 (72.8)	487 (71.5)	427 (72.1)
Occasionally	1791 (22.2)	255 (22.0)	46 (19.7)		1787 (21.8)	163 (23.9)	142 (24.0)
Often	438 (5.4)	41 (3.5)	16 (6.8)		441 (5.4)	31 (4.6)	23 (3.9)
Regular exercise	1778 (22.0)	240 (20.7)	53 (22.6)	0.567	1818 (22.2)	139 (20.4)	114 (19.3)	0.159
DM	1929 (23.9)	270 (23.3)	62 (26.5)	0.573	1977 (24.1)	153 (22.5)	131 (22.1)	0.366
HT	2956 (36.9)	387 (33.4)	63 (26.9)^a	0.001	2983 (36.4)	242 (35.5)	181 (30.6)^a	0.017
CCVD	349 (4.3)	75 (6.5)^a	12 (5.1)	0.005	368 (4.5)	34 (5.0)	34 (5.7)	0.329
RHF	403 (5.0)	53 (4.6)	17 (7.3)	0.225	403 (4.9)	29 (4.3)	41 (6.9)	0.063

Characteristics	Non-RHF	RHF	P
Case [n (%)]	8996 (95)	473 (5.0)
Age (year)	57.19±8.44	58.74±7.61	<0.001
Gender			0.101
Men	2617 (29.1)	121 (25.6)
Women	6379 (70.9)	352 (74.4)
Height	161.95±7.59	162.30±7.58	0.335
Weight	63.47±10.39	65.55±10.90	<0.001
BMI	24.15±3.28	24.86±3.65	<0.001
Sleep quality			0.040
Good	7143 (79.4)	394 (83.3)
Poor	1853 (20.6)	79 (16.7)
No single*	7840 (87.1)	406 (85.8)	0.406
High school level	4986 (55.4)	245 (51.8)	0.122
HDL	1.25±0.29	0.84±0.25	<0.001
Low HDL	2262 (25.1)	378 (79.9)	<0.001
LDL	2.60±0.75	1.74±0.62	<0.001
High LDL	251 (2.8)	1 (0.2)	0.001
TC	4.62±0.99	3.11±0.90	<0.001
High TC	493 (5.5)	1 (0.2)	<0.001
TG	1.52 (1.09, 2.14)	0.99 (0.70, 1.40)	<0.001
High TG	1954 (21.7)	23 (4.9)	<0.001
SBP	127.86±18.99	133.89±20.12	<0.001
DBP	76.41±10.61	76.54±10.78	0.790
FPG	5.56 (5.06, 6.20)	5.87 (5.46, 6.58)	<0.001
2hPG	7.50 (6.09, 9.72)	7.50 (6.12, 10.42)	0.283
SCr	0.77±0.12	0.51±0.08	<0.001
eGFR	91.65±11.82	109.35±9.29	<0.001
UACR	2.14 (1.37, 3.33)	2.42 (1.53, 3.64)	<0.001
Smoking			0.303
Now not	7581 (84.3)	405 (85.6)
Occasionally	241 (2.7)	16 (3.4)
Often	1174 (13.1)	52 (11.0)
Drinking			0.015
Now not	6511 (72.4)	371 (78.4)
Occasionally	2011 (22.4)	81 (17.1)
Often	474 (5.3)	21 (4.4)
Regular exercise	1990 (22.1)	81 (17.1)	0.010
Depressive Symptoms			0.225
PHQ<5	7672 (85.3)	403 (85.2)
5≤PHQ<10	1107 (12.3)	53 (11.2)
PHQ≥10	217 (2.4)	17 (3.6)
Depressive Episode			0.063
No	7793 (86.6)	403 (85.2)
Mild	652 (7.2)	29 (6.1)
Severe	551 (6.1)	41 (8.7)
DM	2123 (23.6)	138 (29.2)	0.006
HT	3190 (35.5)	216 (45.7)	<0.001
CCVD	401 (4.5)	35 (7.4)	0.003

Characteristics	Non-RHF	RHF	P
Case [n (%)]	8996 (95)	473 (5.0)
Age (year)	57.19±8.44	58.74±7.61	<0.001
Gender			0.101
Men	2617 (29.1)	121 (25.6)
Women	6379 (70.9)	352 (74.4)
Height	161.95±7.59	162.30±7.58	0.335
Weight	63.47±10.39	65.55±10.90	<0.001
BMI	24.15±3.28	24.86±3.65	<0.001
Sleep quality			0.040
Good	7143 (79.4)	394 (83.3)
Poor	1853 (20.6)	79 (16.7)
No single*	7840 (87.1)	406 (85.8)	0.406
High school level	4986 (55.4)	245 (51.8)	0.122
HDL	1.25±0.29	0.84±0.25	<0.001
Low HDL	2262 (25.1)	378 (79.9)	<0.001
LDL	2.60±0.75	1.74±0.62	<0.001
High LDL	251 (2.8)	1 (0.2)	0.001
TC	4.62±0.99	3.11±0.90	<0.001
High TC	493 (5.5)	1 (0.2)	<0.001
TG	1.52 (1.09, 2.14)	0.99 (0.70, 1.40)	<0.001
High TG	1954 (21.7)	23 (4.9)	<0.001
SBP	127.86±18.99	133.89±20.12	<0.001
DBP	76.41±10.61	76.54±10.78	0.790
FPG	5.56 (5.06, 6.20)	5.87 (5.46, 6.58)	<0.001
2hPG	7.50 (6.09, 9.72)	7.50 (6.12, 10.42)	0.283
SCr	0.77±0.12	0.51±0.08	<0.001
eGFR	91.65±11.82	109.35±9.29	<0.001
UACR	2.14 (1.37, 3.33)	2.42 (1.53, 3.64)	<0.001
Smoking			0.303
Now not	7581 (84.3)	405 (85.6)
Occasionally	241 (2.7)	16 (3.4)
Often	1174 (13.1)	52 (11.0)
Drinking			0.015
Now not	6511 (72.4)	371 (78.4)
Occasionally	2011 (22.4)	81 (17.1)
Often	474 (5.3)	21 (4.4)
Regular exercise	1990 (22.1)	81 (17.1)	0.010
Depressive Symptoms			0.225
PHQ<5	7672 (85.3)	403 (85.2)
5≤PHQ<10	1107 (12.3)	53 (11.2)
PHQ≥10	217 (2.4)	17 (3.6)
Depressive Episode			0.063
No	7793 (86.6)	403 (85.2)
Mild	652 (7.2)	29 (6.1)
Severe	551 (6.1)	41 (8.7)
DM	2123 (23.6)	138 (29.2)	0.006
HT	3190 (35.5)	216 (45.7)	<0.001
CCVD	401 (4.5)	35 (7.4)	0.003

Variable	Model1		Model2		Model3		Model4
Variable	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI) P
Depressive symptoms
PHQ<5	Ref.		Ref.		Ref.		Ref.
5≤PHQ<10	0.911 (0.680, 1.222)	0.535	0.918 (0.684, 1.233)	0.571	0.912 (0.679, 1.226)	0.543	0.969 (0.711, 1.320)	0.841
PHQ≥10	1.491 (0.901, 2.468)	0.120	1.548 (0.933, 2.567)	0.091	1.556 (0.935, 2.587)	0.089	1.854 (1.074, 3.201)	0.027
Depressive episode
No	Ref.		Ref.		Ref.		Ref.
Mild	0.860 (0.585, 1.264)	0.443	0.882 (0.599, 1.298)	0.523	0.875 (0.594, 1.298)	0.500	0.869 (0.576, 1.311)	0.503
Severe	1.439 (1.032, 2.007)	0.032	1.480 (1.059, 2.068)	0.022	1.481 (1.059, 2.073)	0.022	1.547 (1.082, 2.212)	0.017
Sensitivity analysis
PHQ-9<10	Ref.		Ref.		Ref.		Ref.
PHQ-9≥10	1.508 (0.912, 2.493)	0.109	1.565 (0.945, 2.592)	0.082	1.575 (0.948, 2.615)	0.079	1.864 (1.080, 3.210)	0.025