Maes M, Vandewoude M, Schotte C, Maes L, Martin M, Blockx P
Dept. of Biological Psychiatry, University Hospital of Antwerp, Edegem, Belgium.
Psychiatry Res. 1990 Nov;34(2):107-26. doi: 10.1016/0165-1781(90)90013-u.
Baseline 8 a.m. adrenocorticotropic hormone (ACTH) and cortisol levels and the postdexamethasone ACTH/cortisol values at 8 a.m. and 4 p.m. were determined in 86 depressed females diagnosed using DSM-III criteria. Postdexamethasone ACTH and cortisol values were significantly correlated with their baseline levels. We have shown that regression analysis should be used to assess dexamethasone-induced changes as the residual ACTH and cortisol responses, with the relative effects of the baseline data on the hormone responses being partialed out. The residual ACTH and cortisol values were significantly increased in the most severely depressed females as compared to minor depressives. The residual ACTH responses were markedly correlated with the residual cortisol responses. Cortisol nonsuppression during a depressive episode appeared to be determined by an augmented ACTH escape from dexamethasone suppression. The residual ACTH and cortisol responses could prove to be the most sensitive reflection of the disorder in the negative feedback by dexamethasone on the pituitary. In clinical practice, the ratio ln (postdexamethasone ACTH): ln (basal ACTH) can be used, since this ratio is linearly correlated with the residual ACTH responses.
对86名根据《精神疾病诊断与统计手册》第三版（DSM-III）标准确诊的抑郁症女性患者，测定了其上午8点的基线促肾上腺皮质激素（ACTH）和皮质醇水平，以及上午8点和下午4点地塞米松给药后的ACTH/皮质醇值。地塞米松给药后的ACTH和皮质醇值与其基线水平显著相关。我们已经表明，应使用回归分析来评估地塞米松诱导的变化，即作为残余ACTH和皮质醇反应，同时排除基线数据对激素反应的相对影响。与轻度抑郁症患者相比，最严重抑郁症女性患者的残余ACTH和皮质醇值显著升高。残余ACTH反应与残余皮质醇反应显著相关。抑郁发作期间皮质醇不被抑制似乎是由ACTH从地塞米松抑制中逃逸增加所决定的。残余ACTH和皮质醇反应可能是地塞米松对垂体负反馈中该疾病最敏感的反映。在临床实践中，可以使用ln（地塞米松给药后ACTH）：ln（基础ACTH）的比值，因为该比值与残余ACTH反应呈线性相关。
