Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Psychiatry Res. 2018 Dec;270:246-252. doi: 10.1016/j.psychres.2018.09.047. Epub 2018 Sep 21.
Previous studies have reported dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis in patients with major depressive disorder (MDD). Outpatients diagnosed with MDD (n = 199) underwent psychological evaluation, and were followed up with a phone interview after 6 months, using the Patient Health Questionnaire (PHQ-9). At 6-month follow-up, 59 out of 199 patients with MDD were still depressed (29.5%), as shown by scores ≥ 10 on the PHQ-9. The depressed group at follow-up showed significantly higher anxiety and suicidality levels at baseline than the non-depressed group at follow-up. Among the complete blood counts, lipid profiles, and hormone levels, adrenocorticotropic hormone (ACTH) was the only parameter that was significantly increased in the still depressed group. Levels higher than 40 pg/mL of ACTH at baseline were associated with higher depression scores at follow-up. Multiple linear regression analyses revealed that ACTH and cortisol predicted depression scores at follow-up, after controlling for baseline depression scores. Increased ACTH level at baseline may predict ongoing symptoms and severity of depression at follow-up, suggesting the role of dysfunctional HPA axis in MDD prognosis.
先前的研究报告显示，患有重度抑郁症（MDD）的患者其下丘脑-垂体-肾上腺（HPA）轴功能失调。199 名被诊断为 MDD 的门诊患者接受了心理评估，并在 6 个月后通过电话访谈进行了随访，使用的是患者健康问卷（PHQ-9）。在 6 个月的随访中，199 名 MDD 患者中有 59 名（29.5%）仍处于抑郁状态，PHQ-9 得分≥10。与随访时未抑郁的患者相比，随访时仍抑郁的患者在基线时表现出明显更高的焦虑和自杀倾向水平。在完整的血细胞计数、血脂谱和激素水平中，促肾上腺皮质激素（ACTH）是唯一在持续抑郁组中明显升高的参数。基线时 ACTH 水平高于 40 pg/mL 与随访时更高的抑郁评分相关。多元线性回归分析显示，在控制基线抑郁评分后，ACTH 和皮质醇可预测随访时的抑郁评分。基线时 ACTH 水平升高可能预示着随访时持续症状和抑郁严重程度，表明 HPA 轴功能失调在 MDD 预后中的作用。
