单相抑郁与双相障碍住院患者地塞米松抑制试验的对照研究

目的 通过地塞米松抑制试验(DST)了解单相抑郁和双相障碍患者在不同情绪状态下的下丘脑-垂体-肾上腺轴功能改变情况. 方法对38例单相抑郁住院患者和63例双相障碍住院患者(双相障碍Ⅰ型19例,双相障碍Ⅱ型44例;双相障碍抑郁发作者33例,双相障碍躁狂发作者18例,双相障碍混合发作者12例)进行DST,其中17例单相抑郁、35例双相障碍患者在治疗4周后再次行DST,比较各组DST脱抑制率差异.结果 治疗前,单相抑郁的DST脱抑制率(36.8%)与双相障碍(14.3%)、双相障碍Ⅰ型(10.5%)、双相障碍Ⅱ型(15.9%)以及双相障碍抑郁发作(15.2%)之间比较差异有统计学意义(P<0.05);双相障碍Ⅰ型(10.5%)与双相障碍Ⅱ型(15.9%)之间,双相障碍抑郁发作(15.2%)、双相障碍混合发作(16.7%)和双相障碍躁狂发作(11.1%)两两比较差异均无统计学意义(P>0.05).治疗后,DST脱抑制率在上述各组间差异无统计学意义(P>0.05).治疗后单相抑郁的DST脱抑制率随着病情改善而降低,但较治疗前差异无统计学意义(P>0.05),双相障碍的DST脱抑制率在治疗前后比较差异无统计学意义(P>0.05).结论在疾病期,单相抑郁的DST脱抑制率高于双相障碍;双相障碍的DST脱抑制率与临床分型、发作类型、病情无关.

Dexamethasone suppression test in inpatients with unipular depression or bipolar disorder:a comparison study

ObJective To study the hypothalamic-pituitary-adrenal (HPA) axis function with dexamethasone suppression test (DST) in inpatients with unipolar depression or bipolar disorder at different mood states. Methods DST was performed in 38 inpatients with unipolar depression and 63 with bipolar disorder (19 with type Ⅰ, 44 with type Ⅱ], 33 with depressive episode, 18 with manic episode and 12 with combined episodes]). After 4 weeks' treatment, DST was performed again on 17 patients with unipolar depression and 35 with bipolar disorder to compare the negative suppression ratio. Results Before treatment, the negative suppression rate of DST was significantly different between unipolar depression (36.8%) and bipolar disorder (14.3%), type Ⅰ bipolar disorder (10.5%), type Ⅱ bipolar disorder (15.9%) or bipolar disorder with current depressive episode (15.2%) (P<0.05). However, no statistic differences were showed among type Ⅰ bipolar disorder and type Ⅱ bipolar disorder, depressive episode of bipolar disorder (15.2%), manic episode of bipolar disorder (16.7%) or combined episodes of bipolar disorder (11.1%) (P>0.05). After treatment, the same comparison was performed, but negative suppression rate of DST was not significantly different among all the groups (P>0.05). With the clinical improvement, negative suppression rate of DST decreased in patients with unipolar disorder;while no significant differences were found between pre-treatment and post-treatment in patients with both unipolar and bipolar disorders (P>0.05). Conclusion At the status of illness, the negative suppression rate of DST in the unipolar depression, being independent from the clinical subtypes, types of episode and severity of the illness in bipolar disorder, is much higher than that in the bipolar disorder.