女性青少年非自杀性自伤中下丘脑-垂体-甲状腺轴功能及其与共病边缘性人格障碍和抑郁的关系。
Hypothalamic-pituitary-thyroid axis function in female adolescent nonsuicidal self-injury and its association with comorbid borderline personality disorder and depression.
机构信息
Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.
Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University Psychiatric Department (UPD), University of Bern, Bern, Switzerland.
出版信息
Prog Neuropsychopharmacol Biol Psychiatry. 2021 Dec 20;111:110345. doi: 10.1016/j.pnpbp.2021.110345. Epub 2021 May 6.
OBJECTIVES
Behavioral disturbances in adolescence are potentially linked to aberrant functioning of the thyroid gland. Accordingly, alterations of the hypothalamic-pituitary-thyroid (HPT) axis might impact psychopathological development. Yet corresponding research in adolescents with nonsuicidal self-injury (NSSI) and comorbid mental disorders is scarce.
METHODS
The present study examined HPT axis functioning in adolescents with NSSI compared to healthy controls (HC) using blood-based assays of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and the ratio of these hormones (fT3/fT4 ratio). Cortisol was additionally examined to contrast HPT axis functioning with a well-established biomarker of stress responsivity. Moreover, associations between clinical characteristics, HPT axis and HPA axis functioning were investigated. Female adolescents meeting NSSI criteria according to DSM-5 criteria (n = 117) were compared to adolescent HC (n = 41). Standardized serum-based endocrinological assays and interview- and questionnaire-based psychiatric assessments were used. Smoking status was included as covariate for all analyses.
RESULTS
NSSI patients displayed altered HPT axis functioning as fT3/fT4 ratio values were blunted in comparison to HC. Negative correlations were further present between fT3, fT3/fT4 ratio and severity of BPD symptoms, depression scores and symptomatic distress. TSH correlated negatively with severity of BPD symptoms and symptomatic distress exclusively. Cortisol values differed neither significantly between experimental groups nor correlated significantly with clinical characteristics.
CONCLUSIONS
Longitudinal examinations, assessing links between psychopathology and endocrinological alterations, are warranted to address potential clinical implications of thyroid markers in child and adolescent psychiatry.
目的
青春期的行为障碍可能与甲状腺功能异常有关。因此，下丘脑-垂体-甲状腺（HPT）轴的改变可能会影响精神病理学的发展。然而，对于有非自杀性自伤（NSSI）和共病精神障碍的青少年，相应的研究很少。
方法
本研究使用基于血液的促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（fT3）、游离甲状腺素（fT4）和这些激素的比值（fT3/fT4 比值）的检测，比较了 NSSI 青少年与健康对照组（HC）的 HPT 轴功能。另外还检查了皮质醇，以对比 HPT 轴功能与应激反应的既定生物标志物。此外，还研究了临床特征、HPT 轴和 HPA 轴功能之间的相关性。根据 DSM-5 标准，符合 NSSI 标准的女性青少年（n=117）与青少年 HC（n=41）进行比较。使用标准化的基于血清的内分泌学检测和基于访谈和问卷调查的精神病学评估。所有分析均将吸烟状况作为协变量。
结果
与 HC 相比，NSSI 患者的 HPT 轴功能发生改变，fT3/fT4 比值降低。进一步的负相关存在于 fT3、fT3/fT4 比值与 BPD 症状严重程度、抑郁评分和症状困扰之间。TSH 仅与 BPD 症状严重程度和症状困扰呈负相关。皮质醇值在实验组之间没有显著差异，也与临床特征没有显著相关性。
结论
需要进行纵向研究，评估精神病理学和内分泌改变之间的联系，以解决儿童和青少年精神病学中甲状腺标志物的潜在临床意义。
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