抑郁症未用药患者唾液皮质醇觉醒反应与自杀意念的关系

摘要

Objective:To investigate the suicide idea and cortisol awakening response(CAR)in patients with major depressive disorder(MDD) and to explore the relationship between those two aspects.Method:A total of 30 treatment free patients with MDD meeting DSM-IV diagnostic criteria were recruited,thirty age-and gender-matched healthy controls were involved in this study as well.All the subjects were evaluated with the self-rating idea of suicide scale(SIOSS) and were arranged to collect salivary cortisol samples at four time point throughout the morning:immediately upon awakening,30,45,and 60 min following awakening to assess the CAR.Salivary cortisol concentration was analyzed using a commercial available enzyme immunoassay.Results:As compared with healthy controls,MDD patients showed an increased SIOSS score,elevated cortisol levels at 0,30,45 min following awakening,and a greater CAR area under the curve relative to ground(t=2.892,t=3.209,t=2.350,t=3.418;P<0.05 or P<0.01).Scores of the Hamilton depression scale(HAMD),cortisol levels at 0,30,45 min following awakening,and the CAR AUC gwere associated with scores of SIOSS.Conclusion:MDD patients have increased suicide idea and enhanced CAR,the CAR level could be a biomarker to predict suicide idea in MDD patients.%目的:探讨抑郁症未用药患者的自杀意念与唾液皮质醇觉醒反应(CAR)的关系. 方法:对30例未服药的抑郁症患者(抑郁症组)及30名健康志愿者(健康对照组)进行自杀意念自评量表(SIOSS)评估及早晨觉醒后0、30、45及60 min时的唾液皮质醇水平检测;分析影响SIOSS评分的相关因素. 结果:抑郁症组SIOSS总分及各因子评分(P均<0.01)、觉醒后0、30、45 min时唾液皮质醇浓度及CAR曲线下面积(AUCg)显著高于健康对照组(t=2.892,t=3.209,t=2.350,t=3.418;P<0.05或P<0.01);以年龄、性别、体质量指数、睡眠时间以及觉醒时间作为协变量分析发现,其对皮质醇浓度既无主效应也无交互作用. 结论:抑郁症患者存在较强的自杀意念及CAR水平显著升高;CAR可能是预测抑郁症患者自杀意念强度的生物学指标.