Institute of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
Psychoneuroendocrinology. 2012 Aug;37(8):1199-208. doi: 10.1016/j.psyneuen.2011.12.013. Epub 2012 Jan 23.
Panic disorder (PD) has been associated with the altered circadian rhythm of the hypothalamic-pituitary-adrenocortical (HPA) axis. The findings regarding the stress-specific functioning of the HPA-system are inconsistent. It is also unclear whether the HPA-system response after the Corticotropin-Releasing-Hormone (CRH) challenge becomes altered.
For this study, the dexamethasone-corticotropin-releasing-hormone (DEX-CRH) test was implemented to assess the HPA-axis reactivity indicated by the plasma adreno-corticotropin-hormone (ACTH) and the cortisol release. The sample included 32 patients diagnosed with PD in a Structured Clinical Interview (SCID). Fourteen male and eighteen female patients, [mean age = 33.50 years, SD = 12.76] were matched with 32 healthy controls by age and gender. Moreover, a sample of patients with unipolar depression (n = 21, ten females) was examined as a clinical control group.
In healthy controls as well as in patients with PD and patients with unipolar depression, the ACTH and the cortisol response increased significantly due to the CRH injection after dexamethasone pre-treatment. There were differences between the healthy controls and the patients with PD in the plasma cortisol response pattern, however, not in the ACTH. The patients with PD showed a decreased CRH-induced plasma cortisol response. A median-split gave evidence that patients suffering from PD longer than two years showed a remarkably higher HPA-axis reactivity under CRH-injection than patients suffering from PD two years or less.
These findings provide strong evidence that patients with PD show some dissociation between ACTH and cortisol response under the DEX-CRH test with strong indicators that the length of the duration of the psychopathology is a risk factor for an increased reactivity of the HPA-axis in patients with PD.
恐慌症 (PD) 与下丘脑-垂体-肾上腺皮质 (HPA) 轴的昼夜节律改变有关。关于 HPA 系统的应激特异性功能的研究结果不一致。目前尚不清楚 CRH 挑战后 HPA 系统的反应是否会发生改变。
在这项研究中，实施了地塞米松-促肾上腺皮质激素释放激素 (DEX-CRH) 测试，以评估血浆促肾上腺皮质激素激素 (ACTH) 和皮质醇释放所表明的 HPA 轴反应性。该样本包括通过结构临床访谈 (SCID) 诊断为 PD 的 32 名患者。14 名男性和 18 名女性患者，[平均年龄=33.50 岁，SD=12.76]按年龄和性别与 32 名健康对照者相匹配。此外，还检查了一组患有单相抑郁症的患者 (n=21，10 名女性) 作为临床对照组。
在健康对照组以及 PD 患者和单相抑郁症患者中，在 dexamethasone 预处理后，由于 CRH 注射，ACTH 和皮质醇反应均显著增加。在健康对照组和 PD 患者之间，血浆皮质醇反应模式存在差异，但 ACTH 无差异。PD 患者表现出 CRH 诱导的血浆皮质醇反应降低。中位数分割证明，患有 PD 超过两年的患者在 CRH 注射下的 HPA 轴反应性明显高于患有 PD 两年或更短时间的患者。
这些发现有力地证明，PD 患者在 DEX-CRH 测试下表现出 ACTH 和皮质醇反应之间的一些分离，并且强烈表明精神病理学持续时间的长短是 PD 患者 HPA 轴反应性增加的风险因素。
