Coffey C E, Wilkinson W E, Weiner R D, Ritchie J C, Aque M
Department of Psychiatry (Neuropsychiatry), Medical College of Pennsylvania, Pittsburgh.
Biol Psychiatry. 1993 Mar 15;33(6):442-9. doi: 10.1016/0006-3223(93)90172-a.
To determine whether structural brain abnormalities in patients with depression are related to cortisol state, we examined the relationship between the dexamethasone suppression test (DST) and brain magnetic resonance imaging (MRI) in 40 inpatients with severe depression referred for electroconvulsive therapy (ECT). Prior to ECT, 27 (68%) of the patients exhibited nonsuppression on the DST. Frontal lobe volume was negatively correlated with peak post-dexamethasone cortisone (r = -0.37) and was 13% smaller in DST nonsuppressors than suppressors; these findings were no longer significant after adjustments for age, gender, and cranial size. Lateral and third ventricular volumes were also correlated with peak postdexamethasone cortisol (r = 0.34 and 0.33, respectively), but not after adjustments for age, gender, and cranial size. Subcortical hyperintensity was associated with peak postdexamethasone cortisol and was more common in DST nonsuppressors than suppressors. Again these findings were no longer significant after adjustments for age. Finally, longitudinal DST and brain MRI studies in 11 of these patients revealed no changes in regional brain volumes nor in postdexamethasone cortisol up to six months after ECT. However, within individual patients, postdexamethasone cortisol was positively (and significantly) correlated with frontal lobe volume.
为了确定抑郁症患者的大脑结构异常是否与皮质醇状态有关，我们对40名因接受电休克治疗（ECT）而转诊的重度抑郁症住院患者进行了地塞米松抑制试验（DST）与脑磁共振成像（MRI）之间关系的研究。在ECT治疗前，27名（68%）患者的DST表现为不被抑制。额叶体积与地塞米松给药后皮质醇峰值呈负相关（r = -0.37），DST不被抑制者的额叶体积比被抑制者小13%；在对年龄、性别和头颅大小进行校正后，这些发现不再具有统计学意义。侧脑室和第三脑室体积也与地塞米松给药后皮质醇峰值相关（分别为r = 0.34和0.33），但在对年龄、性别和头颅大小进行校正后则不再相关。皮质下高信号与地塞米松给药后皮质醇峰值相关，且在DST不被抑制者中比被抑制者更常见。同样，在对年龄进行校正后，这些发现不再具有统计学意义。最后，对其中11名患者进行的DST和脑MRI纵向研究显示，在ECT治疗后的6个月内，脑区体积和地塞米松给药后皮质醇均无变化。然而，在个体患者中，地塞米松给药后皮质醇与额叶体积呈正（且显著）相关。
