Maes M, Lin A, Bonaccorso S, van Hunsel F, Van Gastel A, Delmeire L, Biondi M, Bosmans E, Kenis G, Scharpé S
Clinical Research Center for Mental Health, Antwerp, Belgium.
Acta Psychiatr Scand. 1998 Oct;98(4):328-35. doi: 10.1111/j.1600-0447.1998.tb10092.x.
There is now firm evidence that major depression is accompanied by increased baseline activity of the hypothalamic-pituitary-adrenal (HPA) axis, as assessed by means of 24-h urinary cortisol (UC) excretion. Recently, there were some reports that fibromyalgia and post-traumatic stress disorder (PTSD), two disorders which show a significant amplitude of depressive symptoms, are associated with changes in the baseline activity of the HPA axis, such as low 24-h UC excretion. The aim of the present study was to examine 24-h UC excretion in fibromyalgia and PTSD patients compared to normal controls and patients with major depression. In the three patient groups, severity of depressive symptoms was measured by means of the Hamilton Depression Rating Scale (HDRS) score. Severity of fibromyalgia was measured using a dolorimetrically obtained myalgic score, and severity of PTSD was assessed by means of factor analytical scores computed on the items of the Composite International Diagnostic Interview (CIDI), PTSD Module. Patients with PTSD and major depression had significantly higher 24-h UC excretion than normal controls and fibromyalgia patients. At a threshold value of > or = 240 micrograms/24 h, 80% of PTSD patients and 80% of depressed patients had increased 24 h UC excretion with a specificity of 100%. There were no significant differences in 24-h UC excretion either between fibromyalgia patients and normal controls, or between patients with major depression and PTSD patients. In the three patient groups, no significant correlations were found between 24-h UC excretion and the HDRS score. In fibromyalgia, no significant correlations were found between 24-h UC excretion and the myalgic score. In PTSD, no significant correlations were found between 24-h UC excretion and severity of either depression-avoidance or anxiety-arousal symptoms. In conclusion, this study found increased 24-h UC excretion in patients with PTSD comparable to that in patients with major depression, whereas in fibromyalgia no significant changes in 24-h UC were found.
现在有确凿证据表明，通过24小时尿皮质醇（UC）排泄量评估，重度抑郁症伴有下丘脑 - 垂体 - 肾上腺（HPA）轴基线活动增加。最近，有一些报告称，纤维肌痛和创伤后应激障碍（PTSD）这两种表现出显著抑郁症状的疾病，与HPA轴基线活动的变化有关，如24小时UC排泄量低。本研究的目的是检查纤维肌痛和PTSD患者与正常对照组及重度抑郁症患者相比的24小时UC排泄量。在这三组患者中，通过汉密尔顿抑郁评定量表（HDRS）评分来衡量抑郁症状的严重程度。使用痛觉测量获得的肌痛评分来衡量纤维肌痛的严重程度，通过对综合国际诊断访谈（CIDI）PTSD模块项目计算的因子分析得分来评估PTSD的严重程度。PTSD患者和重度抑郁症患者的24小时UC排泄量显著高于正常对照组和纤维肌痛患者。在阈值≥240微克/24小时时，80%的PTSD患者和80%的抑郁症患者24小时UC排泄量增加，特异性为100%。纤维肌痛患者与正常对照组之间，以及重度抑郁症患者与PTSD患者之间的24小时UC排泄量均无显著差异。在这三组患者中，未发现24小时UC排泄量与HDRS评分之间存在显著相关性。在纤维肌痛中，未发现24小时UC排泄量与肌痛评分之间存在显著相关性。在PTSD中，未发现24小时UC排泄量与抑郁回避或焦虑唤醒症状的严重程度之间存在显著相关性。总之，本研究发现PTSD患者的24小时UC排泄量增加，与重度抑郁症患者相当，而在纤维肌痛中未发现24小时UC有显著变化。
