Salivary cortisol measurement in normal-weight, obese and anorexic women: comparison with plasma cortisol
Salivary cortisol measurement in normal-weight, obese and anorexic women: comparison with plasma cortisol
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DOI：
10.1530/eje.0.1450165
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发表时间：
2001-08-01
影响因子：
5.8
通讯作者：
Cavagnini, F
中科院分区：
文献类型：
--
作者：
Putignano, P;Dubini, A;Cavagnini, F
目的：比较神经性厌食症患者唾液、血浆和尿液中游离皮质醇(UFC)的变化。受试者和实验设计：唾液皮质醇的测量为评估不同生理病理环境下血浆中游离的、生物活性的皮质醇浓度提供了一种方便的方法。47名新诊断为主动限制性神经性厌食症的非药物女性、30名接受慢性精神药物治疗的限制性厌食症女性、47名轻度至中度内脏肥胖女性、103名重度中心性肥胖女性和63名正常体重的健康女性进入研究。分别于0800h、1700h、2400h采集唾液和血液标本，同时采集连续3个24 h尿标本进行UFC测定。在对照组和神经性厌食症患者(n=83)，在1 mg隔夜地塞米松抑制试验(DST)后，还测定了唾液和血浆皮质醇。结果：未经治疗的神经性厌食症患者血浆、唾液皮质醇和游离纤维蛋白原浓度较对照组升高(均P<；0.001)，DST后血浆和唾液皮质醇抑制率较对照组降低(P<；0.0001和P<；0.005)。在接受治疗的神经性厌食症患者中，这些变化不那么明显，尽管在统计学上仍然显著。在整个人群中，唾液皮质醇与配对的血浆皮质醇高度相关(P<；0.0001)。然而。当血浆皮质醇值超过500nmol/L(皮质类固醇结合球蛋白饱和点)时，这种平行关系就消失了。以血浆皮质醇为参照，抑制者中地塞米松治疗后唾液与血浆皮质醇的符合率为58.9%，非抑制者为77.8%(卡方检验：P<；0.01)。非药物治疗的神经性厌食症患者血浆和唾液中的皮质醇比值低于对照组(P<；0.005和P<；0.05)，重度肥胖者的唾液中皮质醇比值低于对照组(P<；0.05)。结论：唾液皮质醇测定是替代血浆皮质醇测定的一种有价值且方便的替代方法。它能够显示神经性厌食症患者HPA轴的过度驱动，以及内脏肥胖女性皮质醇昼夜节律的微妙扰动。随着更具体和更广泛接受的动态检测界值的建立，唾液皮质醇的测定在很大程度上可以取代血浆皮质醇的测定。
Objective: To compare salivary, plasma and urinary free cortisol (UFC) measurements in patients with anorexia nervosa. in whom an overdrive of the hypothalamic-pituitary-adrenal (HPA) axis is well established but information on salivary cortisol is lacking, in viscerally obese patients in whom subtle abnormalities of cortisol secretion and metabolism are postulated, and in normal-weight healthy women.Participants and experimental design: Measurement of salivary cortisol offers a convenient way to assess the concentrations of free, biologically active cortisol in plasma in different physiopathological settings. Forty-seven drug-free, newly diagnosed women with active restrictive anorexia nervosa, 30 restrictive anorexic women undergoing chronic psychopharmacological treatment, 47 women with mild-to-moderate visceral obesity, 103 women with severe central obesity and 63 normal-weight healthy women entered the study. Salivary and blood samples were collected at 0800 h, 1700 h and 2400 h, together with three consecutive 24-h urine specimens for UFC determination. In controls and patients with anorexia nervosa (n = 83), salivary and plasma cortisol were also measured after a 1-mg overnight dexamethasone suppression test (DST). In patients with anorexia nervosa, mood was rated by the Hamilton scale for anxiety and depression.Results: Untreated patients with anorexia nervosa showed increased plasma and salivary cortisol and UFC concentrations (all P < 0.001 compared with controls), and decreased cortisol suppression after DST in plasma and saliva (P < 0.0001 and P < 0.005 respectively compared with controls). These alterations were less pronounced, although still statistically significant, in treated patients with anorexia nervosa. Salivary cortisol was highly correlated with paired plasma cortisol in the whole population and after splitting the participants by group (P < 0.0001). However. for plasma cortisol values greater than 500 nmol/l (the corticosteroid-binding globulin saturation point), this parallelism was lost. Taking plasma cortisol as a reference, the level of agreement for post-dexamethasone salivary and plasma cortisol was 58.9% among suppressors and 77.8% among non-suppressors (chi (2) test: P < 0.01). Decreased 0800 h/2400 h cortisol ratios were observed in plasma and saliva in drug-free patients with anorexia nervosa (P < 0.005 and P < 0.05 respectively compared with controls), and in saliva in severely obese patients (P < 0.05 compared with controls). Depression and anxiety scores were unrelated to cortisol concentrations in any compartment.Conclusions: Salivary cortisol measurement is a valuable and convenient alternative to plasma cortisol measurement. It enables demonstration of the overdrive of the HPA axis in anorexia nervosa and subtle perturbations of the cortisol diurnal rhythm in women with visceral obesity. With the establishment of more specific and widely acceptable cut-off values for dynamic testing, measurement of salivary cortisol could largely replace plasma cortisol measurement.