上海精神医学
上海精神醫學
상해정신의학
SHANGHAI ARCHIVES OF PSYCHIATRY
2013年
1期
32-39
,共8页
李宏伟*%高镇松%吴强%黄佩珊%林春湖%陈耿谊
李宏偉*%高鎮鬆%吳彊%黃珮珊%林春湖%陳耿誼
리굉위*%고진송%오강%황패산%림춘호%진경의
背景目前对抑郁障碍患者自杀行为的神经-内分泌研究仍较少,且结果多不一致.目的探讨国内抑郁障碍患者下丘脑-垂体-肾上腺(hypothalamus-pituitary-adrenal, HPA)轴释放功能与自杀行为的关系.方法比较14例2个月内有过自杀行为的抑郁障碍患者(抑郁研究组)和15例不伴自杀行为的抑郁障碍患者(抑郁对照组)的HPA轴功能.以地塞米松抑制试验(dexamethasone suppression test, DST)、一天中血浆皮质醇浓度的昼夜变化(在帕罗西汀治疗前及治疗6周后评估)以及治疗前和治疗后的24小时尿17-羟皮质醇和24小时尿游离皮质酮,评估HPA轴释放功能.同时以汉密顿抑郁量表(Hamilton Depression Rating Scale, HAMD)评定抑郁严重程度.另外测定15名无抑郁障碍的健康体检者的白天皮质醇浓度.结果抑郁研究组与抑郁对照组之间24h尿皮质醇浓度的差异无统计学意义,尿皮质醇浓度差异也无统计学意义.治疗前两组血浆皮质醇的午夜分泌低谷均不明显,而治疗后的分泌低谷变得明显.抑郁研究组DST阳性率显著高于对照组(57%对20%,χ2=4.24,p=0.039).无论治疗前后,抑郁研究组患者血浆皮质醇水平与HAMD量表总分及绝望感和自杀观念的因子分呈显著正相关,但是抑郁对照组中这些相关系数无统计学意义.抑郁研究组早晨8点的血浆皮质醇浓度在治疗前后均显著高于健康对照组,而抑郁对照组的这一浓度并不比健康对照组高.结论本研究结果与先前关于抑郁症与HPA轴功能关系的研究结果大致相同.尽管如此,有自杀行为与无自杀行为的抑郁症患者之间还是存在某些差异.这些差异提示可能存在特定的自杀相关的HPA轴功能紊乱.有必要在大样本研究中进一步验证这些差异,以期能够在只报告有过自杀观念的人群中鉴别出实际有过自杀行为的个体.
揹景目前對抑鬱障礙患者自殺行為的神經-內分泌研究仍較少,且結果多不一緻.目的探討國內抑鬱障礙患者下丘腦-垂體-腎上腺(hypothalamus-pituitary-adrenal, HPA)軸釋放功能與自殺行為的關繫.方法比較14例2箇月內有過自殺行為的抑鬱障礙患者(抑鬱研究組)和15例不伴自殺行為的抑鬱障礙患者(抑鬱對照組)的HPA軸功能.以地塞米鬆抑製試驗(dexamethasone suppression test, DST)、一天中血漿皮質醇濃度的晝夜變化(在帕囉西汀治療前及治療6週後評估)以及治療前和治療後的24小時尿17-羥皮質醇和24小時尿遊離皮質酮,評估HPA軸釋放功能.同時以漢密頓抑鬱量錶(Hamilton Depression Rating Scale, HAMD)評定抑鬱嚴重程度.另外測定15名無抑鬱障礙的健康體檢者的白天皮質醇濃度.結果抑鬱研究組與抑鬱對照組之間24h尿皮質醇濃度的差異無統計學意義,尿皮質醇濃度差異也無統計學意義.治療前兩組血漿皮質醇的午夜分泌低穀均不明顯,而治療後的分泌低穀變得明顯.抑鬱研究組DST暘性率顯著高于對照組(57%對20%,χ2=4.24,p=0.039).無論治療前後,抑鬱研究組患者血漿皮質醇水平與HAMD量錶總分及絕望感和自殺觀唸的因子分呈顯著正相關,但是抑鬱對照組中這些相關繫數無統計學意義.抑鬱研究組早晨8點的血漿皮質醇濃度在治療前後均顯著高于健康對照組,而抑鬱對照組的這一濃度併不比健康對照組高.結論本研究結果與先前關于抑鬱癥與HPA軸功能關繫的研究結果大緻相同.儘管如此,有自殺行為與無自殺行為的抑鬱癥患者之間還是存在某些差異.這些差異提示可能存在特定的自殺相關的HPA軸功能紊亂.有必要在大樣本研究中進一步驗證這些差異,以期能夠在隻報告有過自殺觀唸的人群中鑒彆齣實際有過自殺行為的箇體.
배경목전대억욱장애환자자살행위적신경-내분비연구잉교소,차결과다불일치.목적탐토국내억욱장애환자하구뇌-수체-신상선(hypothalamus-pituitary-adrenal, HPA)축석방공능여자살행위적관계.방법비교14례2개월내유과자살행위적억욱장애환자(억욱연구조)화15례불반자살행위적억욱장애환자(억욱대조조)적HPA축공능.이지새미송억제시험(dexamethasone suppression test, DST)、일천중혈장피질순농도적주야변화(재파라서정치료전급치료6주후평고)이급치료전화치료후적24소시뇨17-간피질순화24소시뇨유리피질동,평고HPA축석방공능.동시이한밀돈억욱량표(Hamilton Depression Rating Scale, HAMD)평정억욱엄중정도.령외측정15명무억욱장애적건강체검자적백천피질순농도.결과억욱연구조여억욱대조조지간24h뇨피질순농도적차이무통계학의의,뇨피질순농도차이야무통계학의의.치료전량조혈장피질순적오야분비저곡균불명현,이치료후적분비저곡변득명현.억욱연구조DST양성솔현저고우대조조(57%대20%,χ2=4.24,p=0.039).무론치료전후,억욱연구조환자혈장피질순수평여HAMD량표총분급절망감화자살관념적인자분정현저정상관,단시억욱대조조중저사상관계수무통계학의의.억욱연구조조신8점적혈장피질순농도재치료전후균현저고우건강대조조,이억욱대조조적저일농도병불비건강대조조고.결론본연구결과여선전관우억욱증여HPA축공능관계적연구결과대치상동.진관여차,유자살행위여무자살행위적억욱증환자지간환시존재모사차이.저사차이제시가능존재특정적자살상관적HPA축공능문란.유필요재대양본연구중진일보험증저사차이,이기능구재지보고유과자살관념적인군중감별출실제유과자살행위적개체.
Background:There have been few neuroendocrinology studies of suicidal behaviors among patients with depression and the results of these studies have been inconsistent. Aim:To explore the association between the function of the hypothalamus-pituitary-adrenal (HPA) axis and suicidal behaviors in Chinese patients with depression. Methods:Several measures of HPA functioning in 14 depressed patients who had had suicidal behaviors in the two prior months (‘depressed cases’) were compared to those of 15 depressed inpatients who did not have prior suicidal behaviors (‘depressed controls’):a dexamethasone suppression test (DST), the diurnal changes in serum cortisol levels during a single day before and after 6 weeks of treatment with paroxetine;and 24 h urinary 17-OH cortisol and free corticosterone before and after treatment. The Hamilton Depression Scale (HAMD) was used to measure the severity of depression. Daytime cortisol levels were also assessed in 15 non-depressed controls selected from individuals who had a routine health exam. Results:There were no statistically significant differences in the 24 h urinary measures of cortisol and corticosterone between depressed cases and depressed controls. In both groups the normal midnight drop in serum cortisol was non-significant prior to treatment but after treatment it became more pronounced. The DST was positive in more of the depressed cases than depressed controls (57%v. 20%,χ2=4.24, p=0.039). The correlation of cortisol serum levels with the HAMD total score and the item scores for hopelessness and suicidal ideation were statistically significant in the depressed case group both before and after treatment, but in the depressed control group these correlation coefficients did not reach statistical significance. The 08.00 h serum cortisol level in depressed cases was significantly greater than the level in non-depressed controls both before and after treatment, but the level in depressed controls was not significantly greater than that in non-depressed controls. Conclusion:These findings are broadly consistent with those of prior studies about the relationship of depression and the functioning of the HPA axis. There were, however, some differences between depressed patients that did and did not report prior suicidal behavior which may indicate suicide-specific characteristics of HPA axis dysfunction. These differences merit further assessment in larger studies that distinguish patients who have made suicide attempts from those who only report prior suicidal ideation.
