儿童期虐待对成年抑郁症患者HPA轴功能的影响

Effects of childhood abuse on HPA function in adult depression patients

目的探讨儿童期受虐对成年抑郁症患者HPA轴功能的影响。方法选取抑郁症患者98例,使用儿童虐待问卷(CTQ)、汉密尔顿抑郁量表(HAMD)评定儿童期受虐状况、抑郁严重程度,根据CTQ评分将受试者分为受虐组(31例)和无受虐组(67例),并设置健康对照组30例。入院当天各组行地塞米松抑制试验(DST),抗抑郁治疗4周后,再次按以上步骤进行DST,测量各组血浆皮质醇浓度,并计算各组试验的脱抑制率。结果治疗前三组DST前后皮质醇水平的差异有统计学意义(P<0.01),受虐组和无受虐组DST前后皮质醇水平均高于对照组(P<0.05)。三组DST的托抑制率比较差异有统计学意义(P<0.05),受虐组和无受虐组DST的脱抑制率均高于对照组(P<0.05)。两组治疗后HAMD总分低于治疗前(P<0.05)。治疗后无受虐组HAMD总分低于受虐组(P<0.05)。抗抑郁治疗4周后,三组DST前后皮质醇水平的差异有统计学意义(P<0.01)。受虐组和无受虐组DST前后皮质醇水平均高于对照组(P<0.05);且受虐组DST前后皮质醇水平高于无受虐组(P<0.05)。受虐组和无受虐组DST的脱抑制率均高于对照组(P<0.05);且受虐组的脱抑制率高于无受虐组(P<0.05)。结论抑郁症患者HPA轴功能存在明显异常,有儿童期虐待史的抑郁症患者对抗抑郁治疗的阻抗作用与HPA轴功能的亢进有密切关系。儿童期受虐导致HPA轴功能亢进可能是成年后罹患抑郁症的可能机制。

Objective To explore the effects of childhood abuse on HPA function in adult depression patients. Methods A total of 98 depression patients were selected and assessed with Hamilton Depression Scale(HAMD) and Childhood Trauma Questionnaire(CTQ), divided into abused group(31 cases) and non-abused group(67 cases) according to their CTQ scores. While the control group was fitted(30 cases). The dexamethasone suppression tests(DST) were conducted before and after four-week anti-depression treatment, and cortisol levels in different groups were detected. Also the disinhibition rates were counted. Results Before anti-depression treatment, the cortisol levels and disinhibition rates in the first DST in abused group and non-abused group were significantly higher than those in control group(P<0.05). After anti-depression treatments, the total scores of HAMD in abused group and non-abused group decreased significantly compared with those before treatment(P<0.05), and the score in non-abused group was lower than that in abused group(P<0.05). The cortisol levels and disinhibition rates in the DST in abused group and non-abused group were higher than those in control group(P<0.05). The cortisol level and disinhibition rate in abused group were higher than those in non-abused group(P<0.05). Conclusion HPA dysfunction and resistance to treatment in depression patients are related to childhood abuse. Childhood abuse which leads to HPA hyperfunction may be a risk factor for adult depression development.