Elevated cerebrospinal fluid 5-hydroxyindoleacetic acid levels in women with comorbid depression and panic disorder.
Elevated cerebrospinal fluid 5-hydroxyindoleacetic acid levels in women with comorbid depression and panic disorder.
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患有抑郁症和惊恐障碍的女性脑脊液 5-羟基吲哚乙酸水平升高。
DOI：
10.1017/s1461145705006231
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Mann,JJohn
中科院分区：
文献类型：
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作者：
Sullivan,GregoryM;Oquendo,MariaA;Huang,Yung-yu;Mann,JJohn
重度抑郁症合并惊恐障碍的临床表现和不良病程比单独的任何一种疾病都要严重，这两种疾病都与血清素系统的异常有关。因此，我们推测，与单独的抑郁症相比，共病惊恐障碍患者的中枢神经系统功能受到更大的干扰。采用高压液相色谱法测定了脑脊液（CSF）中5-羟色胺、去甲肾上腺素和多巴胺的单胺代谢产物的浓度，并在患有DSM-IV诊断的重度抑郁症和终身诊断的惊恐障碍（MDD+PD，n=13）、重度抑郁症和无终身惊恐障碍（MDD-，n=35）的女性受试者和健康志愿者（HV，n=15）组中进行了比较。所有受试者在腰椎穿刺手术前至少14天内未使用抗抑郁药物。与MDD-组（100.1±28.8 nmol/l，p=0.03）和HV组（93.3±33.6 nmol/l，p=0.02）相比，MDD+PD组（124.0±43.0 nmol/l）的CSF 5-羟基吲哚乙酸（5-HIAA）较高。MDD−组和HV组的CSF 5-HIAA无差异。CSF代谢产物去甲肾上腺素和多巴胺、3-甲氧基-4-羟基苯乙二醇和高香草酸分别无组间差异。患有重度抑郁症和终生惊恐障碍共病的女性的CSF 5-HIAA较高，表明该组中5-羟色胺释放量增加、5-羟色胺代谢增加和/或5-HIAA清除率降低。这种病理生理学差异可能与该组的发病率较高和治疗反应较差有关。
Major depression comorbid with panic disorder has a more severe clinical picture and adverse course than either disorder alone, and both conditions are associated with abnormalities in the serotonin system. Therefore, we hypothesized that central serotonergic function in the patients with comorbid panic disorder would be more disturbed than in major depression alone. Concentrations of cerebrospinal fluid (CSF) monoamine metabolites of serotonin, norepinephrine, and dopamine were assayed by high-pressure liquid chromatography, and compared in female subjects with DSM-IV-diagnosed major depressive disorder and a lifetime diagnosis of panic disorder (MDD+PD,n=13), major depressive disorder and no lifetime panic disorder (MDD−,n=35), and a healthy volunteer (HV,n=15) group. All subjects were free of antidepressant medication for at least 14 d prior to the lumbar puncture procedure. CSF 5-hydroxylindoleacetic acid (5-HIAA) was higher in the MDD+PD group (124.0±43.0 nmol/l) compared with the MDD− group (100.1±28.8 nmol/l,p=0.03) and the HV group (93.3±33.6 nmol/l,p=0.02). The MDD− group and HV group did not differ in CSF 5-HIAA. There were no group differences in the CSF metabolites of norepinephrine and dopamine, 3-methoxy-4-hydroxyphenylglycol and homovanillic acid respectively. Higher CSF 5-HIAA in women with comorbid major depressive disorder and lifetime panic disorder is indicative of greater serotonin release, increased serotonin metabolism, and/or decreased 5-HIAA clearance in this group. This difference in pathophysiology is potentially related to the greater morbidity and poorer treatment response of this group.