中老年期抑郁症治疗前后血清硫化脱氢表雄酮和皮质醇及其比率研究

The study on plasma cortisol and dehydroepiandrosterone sulfate(DHEAS) levels and the ratio of cortisol/DHEAS in middle-aged patients with depression before and after treatment with citalopram hydrobromide

目的探讨中老年抑郁症患者血清皮质醇、硫化脱氢表雄酮(dehydroepiandrosterone sulfate,DHEAS)及二者比率在治疗前后的变化。方法对40例中老年期首发抑郁症患者在治疗前及西酞普兰20mg/d治疗6周后进行血清皮质醇、DHEAS的浓度测定,并和40名正常对照进行比较。采用24项汉密尔顿抑郁量表(HAMD)评定患者症状。结果治疗前患者组血清皮质醇和皮质醇/DHEAS比率明显高于正常对照组(P<0.01),而DHEAS明显低于对照组(P<0.01),治疗6周后上述指标均明显改善(P<0.01和P<0.05),但均仍与对照组有差异(P<0.05)。治疗前,轻度抑郁组和重度抑郁组与对照组的血清皮质醇、DHEAS、皮质醇/DHEAS比率的差异均有统计学意义(P<0.05),重度组3个指标的异常均较轻度组更明显(P<0.05或P<0.01),治疗后两组差异无统计学意义(P>0.05)。治疗前,患者组的DHEAS含量、皮质醇/DHEAS比率均与HAMD分值有线性回归关系;而治疗前后皮质醇/DHEAS比率变化与HAMD减分率明显相关(r=0.42,P<0.01)。结论中老年期抑郁症患者血清皮质醇、DHEAS、皮质醇/DHEAS比率存在异常,均与抑郁程度相关,比率的变化与抑郁症状的改善有关。

Objective To analyze the changes of the eortisol,dehydroepiandrosterone sulfate （DHEAS） and the ratio of corfisol/DHEAS in middle-aged patients with depression before and after treatment. Methods Forty middle-age people with depression and 40 health middle-aged people were recruited in the study. Serum cortisol and DHEAS levels were measured before and six months after treatment with citalopram hydrobromide 20 mg/d using ELISA. Depression symp- toms were evaluated using Hamilton depression scale（HAMD）. Results Before treatment, serum cortisol levels, the ratio of cortisol/DHEAS were significantly higher and serum DHEAS levels were significantly lower in patient group than in con- trol group （P 〈0. O1 ）. Six weeks after treatment, serum cortisol levels, the ratio of cortisol/DHEAS and serum DHEAS levels were significantly improved in patient group although still abnormal. Before treatment, there was a significant differ- ence in serum cortisol, DHEAS levels and the ratio of cortisol/DHEAS among moderate patient group, severe patient group and control group（P 〈0. 05, P 〈0. 01）and the abnormality of these parameters were more obvious in severe group than in moderate group（P 〈0. 05, P 〈0. 01 ）. After treatment, there was no significant difference in these three parameters between moderate group and severe group. The serum DHEAS levels and the ratio of cortisol/DHEAS have a linear regression relation with the value of HAMD in patient group before treatment. The change of the ratio of cortisol/DHEAS before and after treat- ment is associated with the reduced value of HAMD （ r = 0. 42,P 〈 0. 01 ）. Conclusions Elderly patients with depression have abnormality in serum cortisol, DHEAS levels and the ratio of cortisol/DHEAS and the abnormality is associated with the de- gree of depression. The change of the rate of cortisol/DHEAS is associated with the improvements in depressive symptoms.