Holsboer F, Wiedemann K, Gerken A, Boll E
Psychiatry Res. 1986 Feb;17(2):97-103. doi: 10.1016/0165-1781(86)90064-8.
A dexamethasone suppression test (DST) was performed in 45 patients during depressive illness and after recovery. Thirty-one samples from patients in whom plasma cortisol was resistant to the suppressive action of dexamethasone contained significantly lower mean (+/- SD) concentrations of the test drug (0.63 +/- 0.39 ng/ml vs 1.10 +/- 0.53 ng/ml) during illness than after recovery and normalization of the DST. In a control group of 14 patients who exhibited adequate DST suppression during the depressive state and after recovery, the dexamethasone concentrations were unchanged (1.54 +/- 0.91 ng/ml vs. 1.30 +/- 0.92 ng/ml). To investigate further the influence of bioavailability or pharmacokinetics of the test drug on DST results, we conducted a catheter study during sleep in 11 endogenously depressed patients who received an oral 1.5 mg dose of dexamethasone at 11 p.m. The half-life of dexamethasone was markedly lower in five DST nonsuppressors (t1/2 = 160 +/- 33 minutes) than in six DST suppressors (t1/2 = 422 +/- 172 minutes). These preliminary results indicate that metabolism of dexamethasone should be controlled in studies evaluating the clinical utility of the DST.
对45名抑郁症患者在患病期间及康复后进行了地塞米松抑制试验（DST）。31名患者的血浆皮质醇对地塞米松的抑制作用有抵抗，这些患者在患病期间试验药物的平均（±标准差）浓度（0.63±0.39纳克/毫升）显著低于康复后及DST恢复正常时的浓度（1.10±0.53纳克/毫升）。在一个由14名患者组成的对照组中，这些患者在抑郁状态期间及康复后DST抑制充分，地塞米松浓度没有变化（1.54±0.91纳克/毫升对1.30±0.92纳克/毫升）。为了进一步研究试验药物的生物利用度或药代动力学对DST结果的影响，我们对11名内源性抑郁症患者进行了一项睡眠期间的导管研究，这些患者在晚上11点口服1.5毫克地塞米松。5名DST非抑制者地塞米松的半衰期（t1/2 = 160±33分钟）明显低于6名DST抑制者（t1/2 = 422±172分钟）。这些初步结果表明，在评估DST临床效用的研究中应控制地塞米松的代谢。
