地塞米松/促肾上腺皮质激素释放激素试验——它比地塞米松抑制试验更好吗？
The dex/CRH test--is it better than the DST?
作者信息
Watson Stuart, Gallagher Peter, Smith Margaret S, Ferrier I Nicol, Young Allan H
机构信息
School of Neurology, Neurobiology and Psychiatry, The Stanley Research Centre, University of Newcastle upon Tyne, Leazes Wing (Psychiatry), Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
出版信息
Psychoneuroendocrinology. 2006 Aug;31(7):889-94. doi: 10.1016/j.psyneuen.2006.03.001. Epub 2006 May 15.
The dexamethasone suppression test (DST), frequently abnormal in mood disorder patients, is considered to measure glucocorticoid receptor-mediated negative feedback. We examined the hypothesis that the, apparently more sensitive, dexamethasone/corticotrophin-releasing-hormone (dex/CRH) test unveils subtle hypothalamic-pituitary-adrenal axis disturbance not detected by the DST in 82 patients with mood disorders and 28 controls. There was a close correlation between the cortisol responses on the two tests (r(s)=0.73, p<0.0005). However, ROC analysis revealed that the dex/CRH test had better diagnostic performance than the DST (p=0.031). The sensitivity of delta cortisol (from the dex/CRH) was 61.9% and the specificity 71.4%. The sensitivity of 1500 h cortisol (the DST) was 66.6% and the specificity was 47.6%. This suggests that the two tests measure common pathology but that the dex/CRH test has better diagnostic utility.
地塞米松抑制试验（DST）在情绪障碍患者中常常异常，该试验被认为是用于检测糖皮质激素受体介导的负反馈。我们检验了以下假设：在82例情绪障碍患者和28名对照中，明显更敏感的地塞米松/促肾上腺皮质激素释放激素（dex/CRH）试验能够揭示DST未检测到的下丘脑-垂体-肾上腺轴的细微紊乱。两种试验的皮质醇反应之间存在密切相关性（r(s)=0.73，p<0.0005）。然而，ROC分析显示dex/CRH试验比DST具有更好的诊断性能（p=0.031）。（dex/CRH试验中）皮质醇变化量（delta cortisol）的敏感性为61.9%，特异性为71.4%。（DST试验中）1500 h皮质醇的敏感性为66.6%，特异性为47.6%。这表明两种试验检测的是共同的病理情况，但dex/CRH试验具有更好的诊断效用。
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