Dahl R E, Kaufman J, Ryan N D, Perel J, al-Shabbout M, Birmaher B, Nelson B, Puig-Antich J
Western Psychiatric Institute and Clinic, University of Pittsburgh, School of Medicine, Department of Psychiatry, PA 15213.
Biol Psychiatry. 1992 Jul 15;32(2):109-26. doi: 10.1016/0006-3223(92)90015-r.
Dexamethasone Suppression Test (DST) studies conducted in children and adolescents are reviewed, together with factors hypothesized to explain discrepancies in rates of DST nonsuppression across studies. These factors are then examined in a controlled study of 27 adolescents with major depressive disorder (MDD) and 34 normal controls (NC). Subjects were given 1 mg of dexamethasone at 11:00 PM, and the following day serum samples for cortisol were collected each hr from 8 AM to 11 PM through an indwelling catheter. There were no significant differences found between the MDD and NC subjects on any postdexamethasone cortisol measure. Further, cortisol suppressors and nonsuppressors were not distinguished by any of the hypothesized factors identified from the review, including inpatient status, presence of suicidality, endogenous features, psychotic symptoms, or prior history of MDD. Questions about the appropriateness of the 1 mg dose of dexamethasone (currently the standard dose used with adolescents) are raised, together with a discussion of the effects of stress on DST findings.
本文回顾了在儿童和青少年中进行的地塞米松抑制试验（DST）研究，以及假设用于解释各研究中DST未被抑制率差异的因素。然后，在一项针对27名患有重度抑郁症（MDD）的青少年和34名正常对照（NC）的对照研究中对这些因素进行了检验。受试者在晚上11点服用1毫克地塞米松，第二天通过留置导管从上午8点到晚上11点每小时采集一次血清皮质醇样本。在任何地塞米松后皮质醇测量指标上，MDD组和NC组受试者之间均未发现显著差异。此外，根据综述中确定的任何假设因素，包括住院状态、自杀倾向、内源性特征、精神病症状或MDD既往史，均无法区分皮质醇抑制者和非抑制者。文中提出了关于1毫克地塞米松剂量（目前青少年使用的标准剂量）是否合适的问题，并讨论了压力对DST结果的影响。
