Maripuu Martin, Wikgren Mikael, Karling Pontus, Adolfsson Rolf, Norrback Karl-Fredrik
Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
J Affect Disord. 2016 Nov 1;204:187-96. doi: 10.1016/j.jad.2016.06.024. Epub 2016 Jun 21.
Cardiovascular disease (CVD) is one of the main causes of excess deaths in affective disorders. Affective disorders are associated with increased frequencies of CVD risk-factors such as obesity, dyslipidemia, and metabolic syndrome. Stress-induced chronic cortisol excess has been suggested to promote obesity and metabolic syndrome. Chronic stress with frequent or persisting hypothalamic-pituitary-adrenal-axis (HPA-axis) hyperactivity may, over time, lead to a state of low HPA-axis activity, also denoted hypocortisolism. A low-dose weight-adjusted dexamethasone-suppression-test (DST) is considered to be a sensitive measure of hypocortisolism.
245 patients with recurrent depression or bipolar disorder and 258 controls participated in a low-dose DST and were also examined with regard to metabolic status.
Patients with hypocortisolism (low post-DST cortisol) compared with patients without hypocortisolism (normal or high post-DST cortisol) exhibited increased odds ratios (OR) for obesity (OR=4.0), overweight (OR=4.0), large waist (OR=2.7), high LDL (OR=4.2), low HDL (OR=2.4), high LDL/HDL ratio (OR=3.3), high TC/HDL ratio (OR=3.4) and metabolic syndrome (OR=2.0). A similar pattern but less pronounced was also found in the control sample.
The cross sectional study design and absence of analyses addressing lifestyle factors.
Our findings suggest that a substantial portion of the metabolic disorders and cardiovascular risk factors seen in recurrent affective disorders are found among individuals exhibiting hypocortisolism. This might indicate that long-term stress is a central contributor to metabolic abnormalities and CVD mortality in recurrent affective disorders.
心血管疾病（CVD）是情感障碍患者超额死亡的主要原因之一。情感障碍与肥胖、血脂异常和代谢综合征等心血管疾病风险因素的发生率增加有关。应激诱导的慢性皮质醇过量被认为会促进肥胖和代谢综合征。频繁或持续的下丘脑 - 垂体 - 肾上腺轴（HPA轴）功能亢进引起的慢性应激，随着时间的推移，可能会导致HPA轴活动低下的状态，也称为皮质醇减退。低剂量体重调整地塞米松抑制试验（DST）被认为是皮质醇减退的敏感指标。
245例复发性抑郁症或双相情感障碍患者和258名对照者参与了低剂量DST，并接受了代谢状况检查。
与无皮质醇减退（DST后皮质醇正常或升高）的患者相比，皮质醇减退患者（DST后皮质醇低）肥胖（比值比[OR]=4.0）、超重（OR=4.0）、腰围大（OR=2.7）、低密度脂蛋白高（OR=4.2）、高密度脂蛋白低（OR=2.4）、低密度脂蛋白/高密度脂蛋白比值高（OR=3.3）、总胆固醇/高密度脂蛋白比值高（OR=3.4）和代谢综合征（OR=2.0）的比值比增加。在对照样本中也发现了类似但不太明显的模式。
横断面研究设计以及未对生活方式因素进行分析。
我们的研究结果表明，复发性情感障碍患者中出现的大部分代谢紊乱和心血管危险因素存在于表现出皮质醇减退的个体中。这可能表明长期应激是复发性情感障碍患者代谢异常和心血管疾病死亡率的主要促成因素。
