Background: There have been few neuroendocrinology studies of suicidal behaviors among patients with depression and the results of these studies have been inconsistent.
Aim: To explore the association between the function of the hypothalamus-pituitary-adrenal (HPA) axis and suicidal behaviors in Chinese patients with depression.
Methods: Several measures of HPA functioning in 14 depressed patients who had had suicidal behaviors in the two prior months ('depressed cases') were compared to those of 15 depressed inpatients who did not have prior suicidal behaviors ('depressed controls'): a dexamethasone suppression test (DST), the diurnal changes in serum cortisol levels during a single day before and after 6 weeks of treatment with paroxetine; and 24 h urinary 17-OH cortisol and free corticosterone before and after treatment. The Hamilton Depression Scale (HAMD) was used to measure the severity of depression. Daytime cortisol levels were also assessed in 15 non-depressed controls selected from individuals who had a routine health exam.
Results: There were no statistically significant differences in the 24 h urinary measures of cortisol and corticosterone between depressed cases and depressed controls. In both groups the normal midnight drop in serum cortisol was nonsignificant prior to treatment but after treatment it became more pronounced. The DST was positive in more of the depressed cases than depressed controls (57% v. 20%, χ(2)=4.24, p=0.039). The correlation of cortisol serum levels with the HAMD total score and the item scores for hopelessness and suicidal ideation were statistically significant in the depressed case group both before and after treatment, but in the depressed control group these correlation coefficients did not reach statistical significance. The 08.00 h serum cortisol level in depressed cases was significantly greater than the level in non-depressed controls both before and after treatment, but the level in depressed controls was not significantly greater than that in non-depressed controls.
Conclusion: These findings are broadly consistent with those of prior studies about the relationship of depression and the functioning of the HPA axis. There were, however, some differences between depressed patients that did and did not report prior suicidal behavior which may indicate suicide-specific characteristics of HPA axis dysfunction. These differences merit further assessment in larger studies that distinguish patients who have made suicide attempts from those who only report prior suicidal ideation.
背景: 目前对抑郁障碍患者自杀行为的神经-内分泌研究仍较少，且结果多不一致。
目的: 探讨国内抑郁障碍患者下丘脑-垂体-肾上腺（hypothalamus-pituitary-adrenal, HPA）轴释放功能与自杀行为的关系。
方法: 比较 14 例 2 个月内有过自杀行为的抑郁障碍患者（抑郁研究组）和 15 例不伴自杀行为的抑郁障碍患者 （抑郁对照组）的HPA轴功能。以地塞米松抑制试验（dexamethasone suppression test, DST）、一天中血浆皮质醇浓度的昼夜变化（在帕罗西汀治疗前及治疗 6 周后评估）以及治疗前和治疗后的 24 小时尿 17-羟皮质醇和 24 小时尿游离皮质酮，评估HPA轴释放功能。同时以汉密顿抑郁量表（Hamilton Depression Rating Scale, HAMD）评定抑郁严重程度。另外测定 15 名无抑郁障碍的健康体检者的白天皮质醇浓度。
结果: 抑郁研究组与抑郁对照组之间24h尿皮质醇浓度的差异无统计学意义,尿皮质醇浓度差异也无统计学意义。治疗前两组血浆皮质醇的午夜分泌低谷均不明显，而治疗后的分泌低谷变得明显。抑郁研究组DST阳性率显著高于对照组（57% 对 20%，χ2=4.24，p=0.039）。无论治疗前后，抑郁研究组患者血浆皮质醇水平与HAMD量表总分及绝望感和自杀观念的因子分呈显著正相关，但是抑郁对照组中这些相关系数无统计学意义。抑郁研究组早晨8点的血浆皮质醇浓度在治疗前后均显著高于健康对照组，而抑郁对照组的这一浓度并不比健康对照组高。
结论: 本研究结果与先前关于抑郁症与HPA轴功能关系的研究结果大致相同。尽管如此，有自杀行为与无自杀行为的抑郁症患者之间还是存在某些差异。这些差异提示可能存在特定的自杀相关的HPA轴功能紊乱。有必要在大样本研究中进一步验证这些差异，以期能够在只报告有过自杀观念的人群中鉴别出实际有过自杀行为的个体。