抑郁障碍患者丘脑-垂体-肾上腺轴释放功能与病情关系的研究  

A Correlated Study on Release Fuction of Hypothalamus-pituitary-adrenal(HPA) Axis and the Ill-conditions in Patients with Depression Disorder

作　　者：李宏伟[1] 高镇松[1] 吴强[1] 黄佩珊[1] 林春湖[1] 陈耿谊[1] 

机构地区：[1]广东省汕头市第四人民医院,广东汕头515021

出　　处：《黑龙江医学》2011年第11期808-810,855,共4页Heilongjiang Medical Journal

基　　金：广东省医学科研基金项目(A2009648)

摘　　要：目的探讨抑郁障碍患者下丘脑-垂体-肾上腺(HPA)轴释放功能与病情的关系。方法对50例抑郁障碍患者以电化学发光法测定血浆皮质醇和昼夜分泌节律,同步测定24 h尿17-羟皮质醇、24 h尿游离皮质酮、地塞米松抑制试验(DST),评估其下丘脑-垂体-肾上腺(HPA)轴的释放功能,同时以汉密顿抑郁量表(HAMD-17)、临床疗效总评量表(CGI-SI)评定病情。经常规抗抑郁治疗6周后重复测试1次,分析抑郁障碍患者HPA轴释放功能的变化与病情的相关性,并与30例健康者对照。结果研究组在入组时(发病期),病情较严重,HAMD总分和CGI-SI分都较高,此期24 h尿游离皮质酮和血浆皮质醇均显著升高(P<0.05),呈HPA过度分泌现象,且其昼夜分泌节律呈钝化现象,午夜0AM分泌低谷现象消失(P<0.01);治疗6周末(好转后),昼夜分泌节律逐渐恢复,DST阳性率达42%;发病期血浆皮质醇水平的变化值与HAMD-17总分的下降、CGI-SI的变化值呈显著正相关(r=0.376,P<0.05;r=0.447,P<0.01)。结论 HPA轴功能过度活动与抑郁障碍的病情严重度相关,血浆皮质醇水平升高可做为抑郁障碍患者病情复燃或复发的指标。Objective To explore the correlation between the release function of hypothalamus-pituitary-adrenal（HPA） axis and the ill-conditions in patients with depression disorder.Methods Using electrochemistry luminescence,totally 50 cases with depression disorder were tested plasma cortisol and morning-night secretion rhythm,and,24 h urine 17-OH cortisol and 24 h urine free corticosterone,dexamethasone suppression test（DST）,so as to evaluate the release function of hypothalamus-pituitary-adrenal（HPA） axis.At the same time,all the patients were assessed with hamilton depression scale（HAMD） and clinical global impression（CGI-SI） to measure ill-conditions.After 6 weeks′ routine anti-depression drug treatment tested the above items once more.The correlations between the release function of hypothalamus-pituitary-adrenal（HPA） axis and the ill-conditions were analyzed and compared with the healthy control（n=30）.Results In the study,patients during onset before treatment showed sever ill-condition and higher total scores of HAMD and CGI-SI.The levels of plasma cortisol and 24 h urine free corticosterone increased（P0.05）,the HPA axis showed over-secretion but the morning-night secretion rhythm was deactivation without mid-night valley（P0.01）.After 6 weeks′ treatment,with the ill-conditions improving,the morning-night secretion rhythm recovered and the DST positive rate was 42%.The changes of plasma cortisol level showed significantly positive correlated with the changes of total scores of HAMD and CGI-SI（r=0.376,P0.05;r=0.447,P0.01）.Conclusion There were close correlation between the over-release function of hypothalamus-pituitary-adrenal（HPA） axis and the ill-conditions in patients with depression disorder.The higher level of plasma cortisol could be regarded as re-onset or re-light of depression disorder.

关 键 词：抑郁障碍 下丘脑-垂体-肾上腺轴 皮质醇 神经内分泌 

分 类 号：R74[医药卫生—神经病学与精神病学]