脑卒中后抑郁的下丘脑-垂体-肾上腺轴功能变化的研究

目的　探讨脑卒中后抑郁的下丘脑 垂体 肾上腺轴 (HPA轴 )功能的变化。方法　选择 70例急性脑卒中患者 ,经流调中心用抑郁量表 (CES D)筛选 ,按精神障碍诊断统计手册第四版 (DSM Ⅳ )标准确定脑卒中后抑郁诊断 ,采用汉密尔顿抑郁量表 (HAMD)评定病情程度 ,分为卒中后抑郁组、卒中后无抑郁组并设正常对照组 ,于脑卒中后两周测定血浆基础皮质醇含量 ,进行地塞米松抑制试验 (DST)。结果　脑卒中后抑郁患者血浆皮质醇含量增加 ,地塞米松抑制试验阳性率显著高于卒中后无抑郁组及正常对照组 ,而且神经功能缺损程度也明显比卒中后无抑郁组严重。结论　脑卒中后抑郁存在HPA轴功能异常。DST可以反映脑卒中患者HPA轴的异常及神经功能缺损程度 ,尤其对于脑卒中后抑郁的早期诊断具有重要价值。

Hypothalamus-pituitary-adrenal axis in post-stroke depression: a study of its function

Objective To explore the dysfunction of hypothalamus pituitary adrenal (HPA) axis in post stroke depression(PSD).Methods The subjects studied were divided into three groups,i.e.,PSD,non PSD and healthy elderly control groups.Seventy cases of acute stroke patients were assessed with Center for Epidemiological Survey Depression Scale (CES D) for screening and a clinical diagnosis of depression was made with American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM Ⅳ).The patients with PSD were assessed with 17 item Hamilton Depression Rating Scales (HAMD) and identified as mild,moderate or severe depression.The plasma cortisol basic levels and the dexamethasone suppression test (DST) were carried out after two weeks.Results The plasma cortisol levels were significantly higher in PSD group and the frequency of positive DST in PSD group was higher than in non PSD and healthy elderly control groups.Conclusions These results suggested that the dysfunction of HPA axis might exist in patients with PSD but DST could reveal this dysfunction and the deficiency degree of their nerve functions,which may be important for early diagnosis of PSD.