抑郁症共病糖尿病患者的皮质醇水平与帕罗西汀治疗的疗效

Higher level of serum cortisol associated with less responses of 8 week paroxetine treatment in patients with depression comorbid type 2 diabetes

目的:探讨抑郁症共病2型糖尿病的患者中皮质醇水平的相关因素,了解皮质醇水平与帕罗西汀抗抑郁疗效的关系。方法:选取符合中国精神障碍分类与诊断标准第3版(CCMD-3)中抑郁发作的诊断标准,并合并2型糖尿病的患者200例。根据血清皮质醇的浓度,分为皮质醇升高组(n=100)和皮质醇正常组(n=100),用汉密顿抑郁量表(HAMD)测查抑郁严重程度,用自编问卷调查人口学资料、生活习惯及病程等信息,计算体质量指数,测查糖化血红蛋白水平。对两组患者使用抗抑郁药物帕罗西汀治疗8周,使用HAMD减分率评估疗效。结果:Logistic回归分析显示,抑郁症共病2型糖尿病的患者皮质醇升高的危险因素包括糖化血红蛋白≥6.5%(6.5%～8.0%,OR=2.72;≥8.0%,OR=5.69),HAM D评分≥20分(OR=3.31)、体质量指数≥25(OR=3.56)、年龄35～50岁(OR=2.37);保护因素包括每周运动时间≥4 h(OR=0.28)、抑郁病程>12个月(OR=0.10)。帕罗西汀治疗8周后,皮质醇升高组患者的HAMD减分率低于皮质醇正常组[(0.66±0.11)vs.(0.86±0.05),P<0.01],HAMD减分率与糖化血红蛋白水平(β=-0.26,P<0.05)和皮质醇水平呈负相关(β=-0.17,P<0.05)。结论:本研究提示导致抑郁症共病2型糖尿病患者皮质醇升高的危险因素可能为糖化血红蛋白高、体质量指数高、抑郁症状重、年龄35～50岁;保护因素可能为运动多、抑郁症病程长。皮质醇和糖化血红蛋白水平较高的患者帕罗西汀疗效可能较差。

Objective： To study the related factors of cortisol increasing and effect of paroxetine treatment in patients with diabetes. Methods： Totally 200 patients with comorbid depression and type 2 diabetes were includ： ed. The depression diagnosis was made according to the Chinese Classification and Diagnostic Criteria of Mental Disorders, Third Edition （CCMD-3）. The patients were divided into high cortisol group and normal cortisol group according to the serum concentration of cortisol. They were assessed with the Hamilton Depression Scale （HAMD） for severity of depression symptom and assessed with a self-made questionnaire for demographic data, living habits, and course of disease. Their body mass indices were calculated and the levels of glycosylated hemoglobin were measured. The two groups both received 8-week treatment of paroxetine, and the treatment effect was evaluated with the HAMD score-reducing rate. Results： Logistic regression analysis showed that higher level of glycosylated he- moglobin （HbAlc/〉 6. 5%, OR = 2. 72; HbAlc i〉 8.0%, OR = 5.69）, HAMD score of ~ 20 （ OR = 3.31 ）, body mass index of 〉125 （ OR = 3.56）, and age of 35 - 50 （ OR = 2. 37） were risk factors of higher cortisol level. The ex- ercise time of≥4 h per week （OR =0. 28） and depression course of〉 12 months （OR =0. 10） were protective factors. After 8-week treatment with paroxetine, the HAMD score-reducing rates were higher in high cortisol group than in normal cortisol group [（0.66±0. 11） vs. （0. 86 ±0. 05）, P 〈0. 01]. The HAMD score-reducing rates were negatively correlated with the levels of glycosylated hemoglobin （β = -0. 26, P 〈 0. 05） and cortisol （β = -0. 17, P 〈 0.05）. Conclusion： It suggests that higher level of glycosylated hemoglobin, more severe symptom of depression, higher body mass index, age of 35 - 50 years may be the risk factors of increasing cortisol; longer exercise time and longer course of depression may be the protective factors. The patients with higher levels of cortisol and glycosylated hemoglobin may have poorer response to paroxetine treatment.