Risch S C, Janowsky D S, Judd L L, Gillin J C, Mott M A, Rausch J L, Huey L
Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla.
Acta Psychiatr Scand. 1987 Nov;76(5):535-40. doi: 10.1111/j.1600-0447.1987.tb02915.x.
Plasma concentrations of ACTH and prolactin were measured in psychiatric inpatients at 8 a.m. and 4 p.m. before and after the standard 1 mg overnight Dexamethasone Suppression Test (DST). Plasma concentrations of cortisol were measured at 8 a.m. and 4 p.m., and 11 p.m. before and after 1 mg dexamethasone. Dexamethasone suppressed plasma concentrations of ACTH, prolactin and cortisol in the subject group as a whole. "Cut Points" obtained using Fisher's Exact Test identified plasma ACTH values at 8 a.m. baseline, 4 p.m. baseline and 8 a.m. post-dexamethasone and plasma prolactin values at all four times that significantly differentiated patients with bipolar depressive disorder and major depressive disorder from other psychiatric patients. There were no cut points found at any of the six times for plasma levels of cortisol that significantly differentiated between these two diagnostic groups. Of interest in this subject population, basal (pre-dexamethasone) plasma concentrations were of more diagnostic information than post-dexamethasone values. These pilot findings suggest that monitoring plasma prolactin and ACTH concentrations before and after dexamethasone might increase the sensitivity and specificity of this laboratory test for depression.
在标准的1毫克过夜地塞米松抑制试验（DST）前后，于上午8点和下午4点测量了精神科住院患者血浆促肾上腺皮质激素（ACTH）和催乳素的浓度。在上午8点、下午4点以及晚上11点测量了1毫克地塞米松给药前后血浆皮质醇的浓度。地塞米松抑制了整个受试组血浆ACTH、催乳素和皮质醇的浓度。使用费舍尔精确检验得出的“切点”确定了上午8点基线、下午4点基线以及地塞米松给药后上午8点的血浆ACTH值，以及所有四个时间点的血浆催乳素值，这些值能显著区分双相抑郁障碍和重度抑郁障碍患者与其他精神科患者。在这六个时间点的任何一个时间点，均未发现能显著区分这两个诊断组的血浆皮质醇水平切点。在该受试人群中，有趣的是，基础（地塞米松给药前）血浆浓度比地塞米松给药后的值具有更多诊断信息。这些初步研究结果表明，监测地塞米松给药前后血浆催乳素和ACTH浓度可能会提高该实验室检测对抑郁症的敏感性和特异性。
