Olsson T, Aström M, Eriksson S, Forssell A
Department of Internal Medicine, Umeå University Hospital, Sweden.
Stroke. 1989 Dec;20(12):1685-90. doi: 10.1161/01.str.20.12.1685.
Using the dexamethasone suppression test, we studied the activity of the hypothalamic-pituitary-adrenal axis within the first week after onset in 62 patients with acute ischemic stroke. Compared with two control groups (one comprising 25 elderly patients with various acute medical disorders and the other comprising 33 80-year-old volunteers), stroke patients had higher postdexamethasone cortisol levels (p = 0.08 and p = 0.001, respectively). By multiple regression analysis, high postdexamethasone cortisol levels in the stroke patients were significantly associated with proximity of the lesion to the frontal pole of the brain (p = 0.008) and with disorientation (p = 0.03), whereas no association with major depression was seen. Many stroke patients are exposed to hypercortisolism, which may have negative consequences upon organ functions. The extent to which dexamethasone administration suppresses cortisol levels seems to be determined mainly by the site of brain lesion and cannot be used as an indicator of major depression early after stroke.
我们采用地塞米松抑制试验，对62例急性缺血性脑卒中患者发病后第一周内的下丘脑 - 垂体 - 肾上腺轴活性进行了研究。与两个对照组（一组为25例患有各种急性内科疾病的老年患者，另一组为33例80岁的志愿者）相比，脑卒中患者地塞米松给药后的皮质醇水平更高（p值分别为0.08和0.001）。通过多元回归分析，脑卒中患者地塞米松给药后较高的皮质醇水平与病变靠近脑额叶极显著相关（p = 0.008），与定向障碍也显著相关（p = 0.03），而与重度抑郁无关。许多脑卒中患者存在皮质醇增多症，这可能对器官功能产生负面影响。地塞米松给药抑制皮质醇水平的程度似乎主要由脑损伤部位决定，不能作为脑卒中后早期重度抑郁的指标。
