Sahu Manoj K, Dubey Rajesh K, Chandrakar Alka, Kumar Mahesh, Kumar Mahendra
Department of Psychiatry, Pt. J.N.M. Medical College, Raipur, Chhattisgarh, India.
Department of Statistics, Govt. Aggriculture College, Baikunthpur, Chhattisgarh, India.
Indian J Psychiatry. 2022 Sep-Oct;64(5):440-448. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_561_21. Epub 2022 Oct 12.
Depression is associated with hyperactivity of the hypothalamo pituitary adrenal axis. Cortisol is a steroid hormone, released from the adrenal gland and is considered to be a biological marker of stress and anxiety. Serum or plasma cortisol levels have been previously studied in depressive patients but reported contradictory results. The present meta analysis aims to assess the serum or plasma concentration of cortisol in depressive patients compared with controls. We have conducted a systematic review with sequential meta analysis according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Web of Science, PubMed, Scopus, and PsycINFO databases, and published reference lists were searched up to January 2021. We have conducted a systematic review on PubMed for the following search (MeSH) terms ("Hydrocortisone"[Mesh]) AND "Depressive Disorder"[Mesh]). The RevMan 5.3 and Open Meta Analyst software was used with the standard mean difference (SMD) and 95% confidence intervals (CIs). The Jamovi and Open Meta Analyst Software were used to evaluate the publication bias, sensitivity analysis, and meta regression as possible sources of heterogeneity. Seventeen studies having a combined population (n) of 1400 (743 depressive patients and 657 controls) had satisfied the inclusion criteria for serum or plasma cortisol. The pooled SMD of the serum or plasma cortisol levels in depressive patients compared with controls was 1.18, (95% CI: 0.84, 1.52; P < 0.00001) with I2 = 85% (Ph < 0.00001). This meta analysis indicates a statistically significant mean difference in serum or plasma cortisol between depressed patients and controls. Meta analysis concluded that serum or plasma cortisol can differentiate depressed patients from nondepressed controls.
抑郁症与下丘脑 - 垂体 - 肾上腺轴的功能亢进有关。皮质醇是一种类固醇激素，由肾上腺释放，被认为是应激和焦虑的生物学标志物。此前已有研究对抑郁症患者的血清或血浆皮质醇水平进行过研究，但结果相互矛盾。本荟萃分析旨在评估抑郁症患者与对照组相比的血清或血浆皮质醇浓度。我们根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了一项带有序贯荟萃分析的系统评价。检索了Web of Science、PubMed、Scopus和PsycINFO数据库以及截至2021年1月已发表的参考文献列表。我们在PubMed上针对以下检索（医学主题词）术语进行了系统评价：（“氢化可的松”[医学主题词]） AND “抑郁症”[医学主题词]）。使用RevMan 5.3和Open Meta Analyst软件计算标准化均数差（SMD）和95%置信区间（CIs）。使用Jamovi和Open Meta Analyst软件评估发表偏倚、敏感性分析和元回归，将其作为异质性的可能来源。17项研究纳入了总计1400名受试者（743名抑郁症患者和657名对照），这些研究符合血清或血浆皮质醇的纳入标准。抑郁症患者与对照组相比，血清或血浆皮质醇水平的合并SMD为1.18，（95% CI：0.84，1.52；P < 0.00001），I2 = 85%（Ph < 0.00001）。该荟萃分析表明，抑郁症患者与对照组之间血清或血浆皮质醇的平均差异具有统计学意义。荟萃分析得出结论，血清或血浆皮质醇可区分抑郁症患者与非抑郁症对照。
