伴焦虑痛苦特征抑郁症患者人格、气质特征与下丘脑-垂体-肾上腺素轴的关系  

The relationship between personality,temperament characteristics and hypothalamic-pituitary-adrenergic axis in depressed patients with anxiety distress

作　　者：许月 杨建中[1] 徐莉[1] 卫芋君 周芳[1] 张艳[1] 元静[1] XU Yue;YANG Jian-zhong;XU Li;WEI Yu-jun;ZHOU Fang;ZHANG Yan;YUAN Jing(The Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)

机构地区：[1]昆明医科大学第二附属医院,650101

出　　处：《临床精神医学杂志》2023年第6期452-456,共5页Journal of Clinical Psychiatry

摘　　要：目的:探讨伴有焦虑痛苦特征抑郁症患者人格、气质特征与下丘脑-垂体-肾上腺素轴活动水平的关联性,为临床识别及诊疗提供参考依据。方法:纳入2017年1月至2021年5月昆明医科大学第二附属医院精神科就诊的727例首发未治疗抑郁症患者。根据汉密尔顿抑郁量表-24项(HAMD-24)将被试者分为伴焦虑特征组和不伴焦虑特征组。采用HAMD-24、艾森克人格问卷(EPQ)、气质问卷对被试者进行评估,检测血清促肾上腺皮质激素(ACTH)及血浆皮质醇(Cor)水平并进行分析。结果:(1)伴焦虑特征组年龄显著高于不伴焦虑特征组(P<0.001);伴焦虑特征组HAMD-24总分、焦虑/躯体化、阻滞、绝望感因子分及抑郁相关因子分总和显著高于不伴焦虑特征组(P均<0.05)。(2)伴焦虑特征组具有更高的EPQ神经质得分(P<0.01)。(3)伴焦虑特征组皮质醇分泌异常增多发生率高于不伴焦虑特征组(P<0.05)。(4)Logistic回归发现HAMD-24总分、EPQ神经质分是伴焦虑痛苦特征抑郁症的高危因素。结论:伴焦虑痛苦特征抑郁症患者病情更严重且具有更高的神经质倾向,皮质醇分泌异常增多发生率较高;抑郁严重程度、高神经质倾向可能是抑郁症患者出现焦虑特征的危险因素。Objective:To explore the correlation between personality and temperament traits and the activity level of the hypothalamic-pituitary-adrenergic axis in patients with depression accompanied with anxiety distress traits,and to provide a reference basis for clinical identification and diagnosis.Method:727 patients with first untreated depression who attended the psychiatric department of the Second Affiliated Hospital of Kunming Medical University from January 2017 to May 2021 were included.Subjects were divided into the group with anxiety traits and the group without anxiety traits according to the Hamilton depression scale-24(HAMD-24).HAMD-24,Eysenck personality questionnaire(EPQ)and temperament questionnaire were used to assess the subjects,and serum adrenocorticotropic hormone(ACTH)and plasma cortisol(Cor)levels were measured and analyzed.Results:①The age of the group with anxiety traits was significantly higher than that of the group without anxiety traits(P<0.001);the sum of HAMD-24 total score,anxiety/somatization,blocking,despair factor scores,and depression-related factor scores of the group with anxiety traits was significantly higher than that of the group without anxiety traits(all P<0.05).②The group with anxiety features had higher EPQ neuroticism scores(P<0.01).③The incidence of abnormally increased cortisol secretion was higher in the group with anxiety traits than in the group without anxiety traits(P<0.05).④Logistic regression analysis revealed that HAMD-24 total score and EPQ neuroticism were the high-risk factors for depression with anxiety-distressing features.Conclusion:Depressed patients with anxious distress are more severe and have a higher neuroticism tendency and higher incidence of abnormally increased cortisol levels;depression severity and high neuroticism tendency may be risk factors for the development of anxiety distress in depressed patients.

关 键 词：抑郁障碍 抑郁伴焦虑痛苦特征 人格 气质 下丘脑-垂体-肾上腺素轴 

分 类 号：R749.4[医药卫生—神经病学与精神病学]