精神分裂症患者 HPA 轴释放功能与自杀行为相关性研究

摘要

Objective To explore the correlations between the release function of hypothalamus-pituitary-adrenal ( HPA) axis and the suicide behaviors in patients with schizophrenia.Methods A total of 26 schizophrenic patients with suicide behavior in study group and 28 schizophrenic patients without suicide behavior in control group were tested with electrochemistry luminescence for plasma cortisol and morning-night secretion rhythm, and with 24 h urine 17-OH cortisol, 24 h urine free corticosterone, dexamethasone suppression test ( DST) for the release function of HPA axis in two groups.The two groups were assessed with the Positive and Negative Symptom Scale (PANSS) and Hamilton Depression Scale (HAMD-17) for the symptoms of the patients.After 6 weeks treatment of anti-psychotic drug, the two groups were tested and assessed with all examination and scales once more and the results of examinations were compared with those of 25 healthy people in health group.Results The plasma cortisol level in the study group before and after treatment were all significantly higher than those in healthy group ( P<0.05)and control group(P<0.05), but there was no difference between control group and healthy group(P>0.05).Before and after treatment, the plasma cortisol level in the study group at 0AM and 8PM were all significantly lower than those at other time point(P<0.05), but in control group at 0AM was significantly lower than those at other time point(P<0.05).The 24 h urine free corticosterone in two groups before treatment were all significantly higher than those after treatment(P<0.05), and the 24 h urine free corticosterone in study group before and after treatment were all significantly higher than those in control group( P<0.05).The positive rates of DST in study group were significantly higher than those in control group(P<0.05).After 6 months, the rates of relapse suicide in study group were significantly higher than those in control group( P>0.05) .Conclussion There is extent over-release function of HPA axis in patients with schizophrenia.%目的：探讨精神分裂症患者下丘脑-垂体-肾上腺（ HPA）轴释放功能与自杀行为的关系。方法对26例伴自杀行为（研究组）和28例不伴自杀行为（对照组）的精神分裂症患者，以电化学发光法测定血浆皮质醇和昼夜分泌节律，同步测定24 h尿17-羟皮质醇、24 h尿游离皮质酮、地塞米松抑制试验（ DST），评估HPA轴释放功能，应用阳性和阴性综合征量表（ PANSS）、汉密尔顿抑郁量表（ HAMD-17）评定病情。常规抗精神病药治疗6周后复查所有检查项目及量表，并与25名健康者（健康组）对照。结果研究组血浆皮质醇浓度在治疗前后上午8点均高于健康组（P＜0．05），也高于对照组（P＜0．05），而对照组则与健康组比较差异无统计学意义（P＞0．05）。研究组在治疗前后及治疗后下午8点和夜间0点血浆皮质醇浓度均低于其他采血时点（P＜0．05）。对照组治疗前后夜间0点浓度低于其他采血时点（P＜0．05）。两组的24 h尿游离皮质酮浓度在治疗前均高于治疗后（P＜0．05），治疗前后研究组高于对照组（P＜0．05）。研究组DST阳性率高于对照组（P＜0．05）。出院后半年研究组再次自杀率高于对照组（P＜0．05）。结论伴自杀行为的精神分裂症患者存在HPA轴功能过度释放现象。