青少年非自杀性自伤患者自杀未遂与HPT轴和HPA轴功能改变的研究  

Relationship of HPA axis and HPT axis impairment with suicide attempts in non-suicidal self-injury adolescents

作　　者：王丹[1,2] 王雪[1,2] 吴涵[1,2] 金文青[1,2] 王雯 任艳萍 Wang Dan;Wang Xue;Wu Han;Jin Wenqing;Wang Wen;Ren Yanping(Beijing Key Laboratory of Mental Disorders,National Clinical Research Center for Mental Disorders&National Center for Mental Disorders,Beijing Anding Hospital,Capital Medical University,Beijing 100088,China;Advanced Innovation Center for Human Brain Protection,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京安定医院,国家精神疾病医学中心,国家精神心理疾病临床医学研究中心,精神疾病诊断与治疗北京市重点实验室,北京100088 [2]人脑保护高精尖创新中心,首都医科大学,北京100069

出　　处：《首都医科大学学报》2024年第1期68-74,共7页Journal of Capital Medical University

基　　金：国家重点研发计划项目(2017YFC1311101)。

摘　　要：目的探讨伴非自杀性自伤(non-suicidal self-injury,NSSI)行为的青少年心境障碍患者发生自杀未遂(suicide attempt,SA)与下丘脑-垂体-甲状腺(hypothalamic-pituitary-thyroid,HPT)轴功能和下丘脑-垂体-肾上腺(hypothalamic-pituitary-adrenal,HPA)轴功能改变的相关性。方法选取2020年12月至2022年5月在首都医科大学附属北京安定医院住院的近1年有NSSI史的13~19岁青少年心境障碍患者进行横断面调查,根据近一年是否存在SA将患者分为非SA组和SA组。根据SA发生的时间段(1个月)将SA组患者分为近期SA和既往SA。收集患者临床特征、甲状腺功能[游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、总三碘甲状腺原氨酸(total triiodothyronine,TT3)、总甲状腺素(total thyroxine,TT4)、促甲状腺激素(thyroid stimulating hormone,TSH)]及促肾上腺皮质激素(adrenocorticotropin,ACTH)、皮质醇(cortisol,CORT)水平。采用多因素Logistic回归分析SA的影响因素。结果共入组79例伴NSSI青少年心境障碍患者,其中49例(62.03%)发生SA,其中29例(59.18%)患者为近1个月内发生SA。单因素分析显示,SA组和非SA组患者在首次发病年龄、性别、教育水平方面差异有统计学意义(P<0.05)。近期SA组患者和既往SA组患者在年龄、TSH、ACTH水平存在差异(P<0.05)。Logistic回归分析显示,女性(P=0.027,OR=2.941,95%CI:1.131~7.649)是患者发生SA的独立危险因素,ACTH水平降低(P=0.043,OR=1.019,95%CI:1.001~1.037)是近期发生SA的相关因素。结论女性伴NSSI青少年心境障碍患者易发生SA,ACTH水平低是近期发生SA的危险因素。Objective To explore the correlation between suicide attempt(SA)in adolescents with non-suicidal self-injury(NSSI)and the function change of the hypothalamic-pituitary-thyroid(HPT)axis and the hypothalamic-pituitary-adrenal(HPA)axis function change.Methods A cross-sectional survey was conducted among adolescents aged 13-19 years with a history of NSSI who were hospitalized in Beijing Anding Hospital,Capital Medical University from December 2020 to May 2022.The clinical features,thyroid function[free triiodothyronine(FT3),free thyroxine(FT4),total T3(TT3),total T4(TT4),thyroid stimulating hormone(TSH)],adrenocorticotropin(ACTH)and cortisol(CORT)levels were collected.The patients were divided into non-SA group and SA group according to the absence or presence of SA in the last one year.According to the time period of SA occurrence(1 month),patients in the SA group were divided into recent SA and past SA.The multivariate logistic regression model was used to analyze the influencing factors of SA behavior.Results A total of 79 adolescent patients of mood disorder with NSSI were enrolled.Among them,49(62.03%)patients had SA and 29(59.18%)patients had attempted suicide within the past month.The univariate analysis showed that there were statistical differences in age of disease onset,gender,and education level between the SA and non-SA groups(P<0.05).There were statistical differences in age,TSH,and ACTH level between the recent SA group and past SA group(P<0.05).The logistic regression analysis showed that female(P=0.027,OR=2.941,95%CI:1.131-7.649)was risk factor for SA behavior.Low ACTH level(P=0.043,OR=1.019,95%CI:1.001-1.037)was related factor for recent SA.Conclusion Female adolescents of mood disorders with NSSI were more likely to attempt suicidality and ACTH was related with recent SA.

关 键 词：青少年 非自杀性自伤 自杀未遂 下丘脑-垂体-甲状腺轴 下丘脑-垂体-肾上腺轴 

分 类 号：R749[医药卫生—神经病学与精神病学]