单相与双相抑郁障碍患者血浆皮质醇水平对比研究

A comparative study of plasma cortisol levels between unipolar and bipolar depression patients

目的 探讨单相与双相抑郁障碍患者血浆皮质醇水平与抑郁严重程度的关系.方法 将30例单相抑郁障碍患者设为单相组,30例双相抑郁障碍患者设为双相组;于入组第1 d及常规治疗6周末清晨8∶00采集血液标本,采用电化学发光法测定血浆皮质醇浓度,同时采用汉密顿抑郁量表、临床疗效总评量表病情严重程度分量表评定患者抑郁严重程度.抽取同期30名健康体检者设为对照组,于体检时采用上述方法检测血浆皮质醇浓度.对治疗前后两组患者汉密顿抑郁量表、临床疗效总评量表病情严重程度分量表评分及3组被试的血浆皮质醇水平进行统计分析,并对两组患者临床疗效总评量表病情严重程度分量表、汉密顿抑郁量表评分变化与血浆皮质醇水平变化进行相关分析.结果 治疗6周末,单相组及双相组血浆皮质醇水平、汉密顿抑郁量表及临床疗效总评量表病情严重程度分量表评分均较治疗前显著降低（P＜0.05）;同期两组间比较,差异均无显著性（P＞0.05）.治疗前,单相组及双相组患者血浆皮质醇水平均显著高于对照组（P＜0.05）,治疗6周末与对照组比较差异均无显著性（P＞0.05）.相关分析结果显示,治疗前后两组患者血浆皮质醇水平与汉密顿抑郁量表总分、绝望感因子分及临床疗效总评量表病情严重程度分量表分值呈显著正相关（R=0.3709-0.4971,P＜0.05或0.01）,治疗前两组患者血浆皮质醇水平与HAMD焦虑/躯体化因子分呈显著正相关性（P＜0.05）.结论 单相与双相抑郁障碍患者的血浆皮质醇水平均较高,与抑郁严重程度呈正相关.

Objective To explore the relationship between plasma cortisol levels and depression severity of unipolar and bipolar depression patients. Methods Thirty unipolar depression patients were assigned to unipolar group and 30 bipolar ones to bipolar group; fasting blood samples were collected at 8 a.m. of the 1st day of study and of the end of the 6th week, plasma cortisol levels were detected using electrochemiluminescence method, depression severity was assessed with the Hamilton Depression Scale （HAMD） and Clinical Global Impression （CGI-SI）. Thirty healthy examinees were assigned to control group selected in the corresponding period, plasma cortisol levels were detected using aboveentioned method during health examination. Pre- and post-treatment HAMD and CGI-SI score of patients＇ groups and plasma cortisol levels of 3 groups were added up and analyzed, and correlation analyses carried out on the changes of CGI-SI and HAMD scores and of plasma cortisol levels. Results At the end of the 6th week, plasma cortisol levels, HAMD and CGI-SI score lowered more significantly compared with pretreatment in both unipolar and bipolar group （P〈0.05） ; contemporary group comparisons showed no significant differences （P〈0.05）. Plasma cortisol levels of both unipolar and bipolar group were significantly higher than those of control group before treatment （P〈0.05） and had no significant differences at the end of the 6th week （P〉0.05）. Correlation analysis showed that plasma cortisol levels of both unipolar and bipolar group were significant- ly positively related to the total and feeling of despair score of the HAMD and CGI-SI score before and after treatment （R=-0. 3709-0. 4971, P〈0.05 or 0.01） and to anxiety/somatization score before treatment （P〈0.05）. Conclusion Plasma cortisol levels of both unipolar and bipolar depression patients are higher, which is positively related to depression severity.