精神分裂症下丘脑-垂体-肾上腺轴功能研究

A study of hypothalamus pituitary adrenal axis function in schizophrenia

目的:了解精神分裂症患者治疗前后下丘脑-垂体-肾上腺(HPA)轴促肾上腺皮质激素释放激素(CRH)、促肾上腺皮质激素(ACTH)和皮质醇(CORT)的分泌水平和节律变化。方法:在治疗前、治疗2周、4周、8周用放射免疫测定法检测30例精神分裂症患者全天3次(8:00,16:00,24:00)HPA轴激素的水平,并采用阳性与阴性症状量表(PANSS)评定精神症状。比较治疗前后患者HPA激素水平和分泌节律,以及全天3次CORT总量与PANSS分的关系。10名正常对照组HPA水平采用同样方法检测。结果:患者治疗前HPA轴激素水平均明显高于同时点对照组(P均<0.01);治疗8周,HPA轴激素水平有明显降低,但仍高于对照组(P<0.05)。治疗前,患者激素分泌节律紊乱;治疗8周后节律正常。全天3次CORT总量与PANSS总分、阳性症状分、一般精神病理分呈显著正相关(r=0.351、r=0.425、r=0.406,P<0.05),与阴性症状分无显著相关(r=0.297,P>0.05)。结论:精神分裂症患者存在HPA轴激素分泌和节律的异常,精神症状越严重,全天皮质醇总量越高。

Objective ： To understand the changes of the secretion level and rhythm of hypothalamus pituitary adrenal （HPA） axis hormones including corticotropin releasing （CRH）, adrenocorticotropic hormone （ACTH） and cortisol（CORT） before and after treatment in patients with schizophrenia. Method： 30 patients with schizophrenia were observed before and after 2,4 and 8 week treatment, the levels of HPA hormones were measured with radioimmunoassay three times a day（ at 8：00,16：00,24：00 ） and the symptoms were investigated with the positive and negative syndrome scale （PANSS）. We compared the level and rhythm of HPA hormones before and after medicine treatment and the relationship between the whole day （three times） CORT concentration and PANSS scores. The levels of HPA of 10 normal controls were examined by the same way. Results： Before treatment,the levels of patients HPA hormones were all significantly higher than normal controls at the same time of the day （P 〈0.01 ） ;after 8 week medicine treatment, HPA hormone levels decreased significantly, but still higher than normal controls （ P 〈 0.05 ）. Before treatment, the rhythm of HPA was disturbance ; After 8 week treatment,it was normal. The whole day （ three times ） CORT concentration was significantly related to the total PANSS scores , positive symptom scores , general psychopathology symptom scores （ r = 0. 3 5 1 , r= 0. 425 ,r = 0. 406, P 〈 0.05 ） , while not significantlyrelatedtothe negative symptom scores （ r = 0. 297, P 〉 0.05 ）. Conclusion：Patients with schizophrenia have abnormal secretion and rhythm in HPA, more seriously syndrome had higher CORT concentration the whole day.