抑郁症未用药患者唾液皮质醇觉醒反应与自杀意念的关系

Associations between cortisol awakening response and suicide idea in drug-naive patients with major depressive disorder

目的:探讨抑郁症未用药患者的自杀意念与唾液皮质醇觉醒反应(CAR)的关系。方法:对30例未服药的抑郁症患者(抑郁症组)及30名健康志愿者(健康对照组)进行自杀意念自评量表(SIOSS)评估及早晨觉醒后0、30、45及60 min时的唾液皮质醇水平检测;分析影响SIOSS评分的相关因素。结果:抑郁症组SIOSS总分及各因子评分(P均<0.01)、觉醒后0、30、45 min时唾液皮质醇浓度及CAR曲线下面积(AUCg)显著高于健康对照组(t=2.892,t=3.209,t=2.350,t=3.418;P<0.05或P<0.01);以年龄、性别、体质量指数、睡眠时间以及觉醒时间作为协变量分析发现,其对皮质醇浓度既无主效应也无交互作用。结论:抑郁症患者存在较强的自杀意念及CAR水平显著升高;CAR可能是预测抑郁症患者自杀意念强度的生物学指标。

Objective： To investigate the suicide idea and cortisol awakening response （CAR） in patients with major depressive disorder （MDD） and to explore the relationship between those two aspects. Method： A total of 30 treatment free patients with MDD meeting DSM-IV diagnostic criteria were recruited, thirty age-and gender-matched healthy controls were involved in this study as well. All the subjects were evaluated with the self-rating idea of suicide scale （SIOSS） and were arranged to collect salivary eortisol samples at four time point throughout the morning： immediately upon awakening, 30,45, and 60 rain following awakening to assess the CAR. Salivary eortisol concentration was analyzed using a commercial available enzyme immunoassay. Results：As compared with healthy controls, MDD patients showed an increased SIOSS score, elevated cortisol levels at 0,30,45 min following awakening, and a greater CAR area under the curve relative to ground （t = 2. 892,t = 3. 209, t = 2. 350, t = 3. 418 ; P 〈 0.05 or P 〈 0. 01 ）. Scores of the Hamilton depression scale （HAMD）, cortiso] levels at 0,30,45 min following awakening, and the CAR AUC gwere associated with scores of SIOSS. Conclusion：MDD patients have increased suicide idea and enhanced CAR, the CAR level could be a biomarker to predict suicide idea in MDD patients.