Pôle 8/9 Psychiatry, APF2R, Centre Hospitalier, Rouffach, France.
Pôle 8/9 Psychiatry, APF2R, Centre Hospitalier, Rouffach, France.
Psychoneuroendocrinology. 2017 Nov;85:100-109. doi: 10.1016/j.psyneuen.2017.07.488. Epub 2017 Jul 28.
So far, investigations of the relationships between suicidality and the activity of the thyrotropic and lactotropic axes are scarce and have yielded conflicting results.
We studied the thyrotropin (TSH) and prolactin (PRL) responses to 0800h and 2300h protirelin (TRH) stimulation tests, carried out on the same day, in 122 euthyroid DSM-5 major depressed inpatients with suicidal behavior disorder (SBD) (either current [n=71], or in early remission [n=51]); and 50 healthy hospitalized controls.
Baseline TSH and PRL measurements did not differ across the 3 groups. In SBDs in early remission, the TSH and PRL responses to TRH tests (expressed as the maximum increment above baseline value after TRH [Δ]) were indistinguishable from controls. Current SBDs showed (1) lower 2300h-ΔTSH and lower ΔΔTSH values (differences between 2300h-ΔTSH and 0800h-ΔTSH) than controls and SBDs in early remission; and (2) lower baseline free thyroxine (FT) levels than controls. In the current SBD group, ΔΔPRL values (differences between 2300h-ΔPRL and 0800h-ΔPRL) were correlated negatively with lethality. Moreover, in current SBDs (1) violent suicide attempters (n=15) showed lower FT levels, lower TSH-TRH responses (both at 0800h and 2300h), and lower ΔΔTSH and ΔΔPRL values than controls, while (2) non-violent suicide attempters (n=56) showed lower ΔΔTSH values than controls and higher TSH-TRH responses (both at 0800h and 2300h) than violent suicide attempters.
Our results suggest that central TRH secretion is not altered in depressed patients with SBD in early remission. The findings that current SBDs exhibit both decreased FT levels and decreased evening TSH responses (and consequently, decreased ΔΔTSH values) support the hypothesis that hypothalamic TRH drive is reduced-leading to an impaired TSH resynthesis in the pituitary during the day after the morning TRH challenge. In violent suicide attempters, the marked abnormalities of TRH test responses might indicate a greatest reduction in hypothalamic TRH drive. These results further strengthen the possibility that a deficit in central TRH function may play a key role in the pathogenesis of suicidal behavior.
迄今为止，关于自杀倾向与促甲状腺素和催乳素轴活性之间的关系的研究很少，且研究结果相互矛盾。
我们研究了同日进行的 0800h 和 2300h 促甲状腺素释放激素（TRH）刺激试验中 122 例有自杀行为障碍（SBD）的甲状腺功能正常的 DSM-5 重度抑郁症住院患者（当前[ n =71]或早期缓解[ n =51]）和 50 名健康住院对照者的促甲状腺素（TSH）和催乳素（PRL）反应。
3 组间的基础 TSH 和 PRL 测量值无差异。在早期缓解的 SBD 中，TRH 试验后的 TSH 和 PRL 反应（表示为 TRH 后基础值以上的最大增量[Δ]）与对照组无差异。当前的 SBD 表现出（1）较低的 2300h-ΔTSH 和较低的 ΔΔTSH 值（2300h-ΔTSH 与 0800h-ΔTSH 之间的差异），低于对照组和早期缓解的 SBD；和（2）较低的基础游离甲状腺素（FT）水平低于对照组。在当前的 SBD 组中，ΔΔPRL 值（2300h-ΔPRL 与 0800h-ΔPRL 之间的差异）与致命性呈负相关。此外，在当前的 SBD 中（1）暴力自杀企图者（n=15）的 FT 水平较低，TSH-TRH 反应（0800h 和 2300h 时）均较低，且 ΔΔTSH 和 ΔΔPRL 值较低，而（2）非暴力自杀企图者（n=56）的 ΔΔTSH 值低于对照组，TSH-TRH 反应（0800h 和 2300h 时）高于暴力自杀企图者。
我们的结果表明，在早期缓解的有 SBD 的抑郁患者中，中枢 TRH 分泌没有改变。当前 SBD 表现出（1）FT 水平降低和傍晚 TSH 反应降低（因此，ΔΔTSH 值降低），支持下丘脑 TRH 驱动降低的假说，导致在早晨 TRH 挑战后的白天垂体中 TSH 的重新合成受损。在暴力自杀企图者中，TRH 试验反应的明显异常可能表明下丘脑 TRH 驱动的最大减少。这些结果进一步加强了中枢 TRH 功能缺陷可能在自杀行为发病机制中起关键作用的可能性。
