Relative hypo- and hypercortisolism are both associated with depression and lower quality of life in bipolar disorder: a cross-sectional study.
Relative hypo- and hypercortisolism are both associated with depression and lower quality of life in bipolar disorder: a cross-sectional study.
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相对缺乏症和高皮层化学既与抑郁症和躁郁症的生活质量较低有关：一项横断面研究。
DOI：
10.1371/journal.pone.0098682
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Norrback KF
中科院分区：
文献类型：
--
作者：
Maripuu M;Wikgren M;Karling P;Adolfsson R;Norrback KF
单相和双相情感障碍的抑郁与下丘脑-垂体-肾上腺轴（HPA轴）活动过度有关。此外，单相障碍最近已被证明表现出HPA轴功能减退。我们第一次研究了HPA轴的低活动和高活动与双相情感障碍的抑郁和疾病负担的关系。我们有兴趣研究低皮质醇症，其特征是增加HPA轴负反馈敏感性和较低的基础皮质醇水平，以及相反的HPA轴调节模式的高皮质醇症。这项横断面研究包括145名1型和2型双相门诊患者和145名匹配的对照。地塞米松抑制试验（DST）测量负反馈敏感性，并采用体重调整的极低剂量DST，这是敏感的识别皮质醇减少和皮质醇增多。第25次和第75次对照DST后值被用作确定患者表现出相对低皮质醇血症和高皮质醇血症的截止值。采用贝克抑郁量表（BDI）、蒙哥马利抑郁量表（MADRS-S）、世界卫生组织生活质量评定量表（WHO-100）和功能总评量表（GFA）。表现出相对低皮质醇血症的患者表现出较低的基础皮质醇水平（p = 0.046）。 表现出相对皮质醇增多症的患者表现出基础水平升高（p<0.001）。表现出相对低皮质醇症的患者与表现出中等DST后值（真皮质醇症）的患者相比，抑郁和总体生活质量低的频率增加了1.9-2.0倍（BDI，p = 0.017，MADRS-S，p =0.37）和6.0倍（p<0.001）。 抑郁症的校正比值比（OR：s）范围为3.8-4.1（BDI，p = 0.006，MADRS-S，p = 0.011），生活质量为23.4（p<0.001）。 与表现出皮质醇增多症的患者相比，表现出相对皮质醇增多症的患者显示出1.9-2.4倍（BDI，p = 0.017，MADRS-S，p =0.003）和4.7倍（p<0.001）的抑郁频率和低总体生活质量。 抑郁症的校正OR：s范围为2.2-2.7（BDI，p = 0.068，MADRS-S，p = 0.045），生活质量为6.3（p = 0.008）。 横断面设计和缺乏预先建立的参考值的DST雇用。相对低皮质醇症和相对高皮质醇症与抑郁症和生活质量降低有关，为双相情感障碍中压力的有害作用提供了新的见解。
Depression in unipolar and bipolar disorders is associated with hypothalamic-pituitary-adrenal-axis (HPA-axis) hyperactivity. Also, unipolar disorder has recently been shown to exhibit HPA-axis hypoactivity. We studied for the first time how HPA-axis hypo- and hyperactivity relate to depression and disease burden in bipolar disorder. We were interested in studying hypocortisolism; characterized by increased HPA-axis negative feedback sensitivity and lower basal cortisol levels together with the opposite HPA-axis regulatory pattern of hypercortisolism. This cross-sectional study includes 145 type 1 and 2 bipolar outpatients and 145 matched controls. A dexamethasone-suppression-test (DST) measures the negative feedback sensitivity and a weight-adjusted very-low-dose DST was employed, which is sensitive in identifying hypocortisolism and hypercortisolism. The 25th and 75th percentiles of control post-DST values were used as cut-offs identifying patients exhibiting relative hypo-, and hypercortisolism. Self-report questionnaires were employed: Beck-Depression-Inventory (BDI), Montgomery-Åsberg-Depression-Rating-Scale (MADRS-S), World-Health-Organization-Quality-of-Life-Assessment–100 and Global-Assessment-of-Functioning. Patients exhibiting relative hypocortisolism expectedly exhibited lowered basal cortisol levels (p = 0.046). Patients exhibiting relative hypercortisolism expectedly exhibited elevated basal levels (p<0.001). Patients exhibiting relative hypocortisolism showed 1.9–2.0 (BDI, p = 0.017, MADRS-S, p = 0.37) and 6.0 (p<0.001) times increased frequencies of depression and low overall life quality compared with patients exhibiting mid post-DST values (eucortisolism). Adjusted Odds Ratios (OR:s) for depression ranged from 3.8–4.1 (BDI, p = 0.006, MADRS-S, p = 0.011) and was 23.4 (p<0.001) for life quality. Patients exhibiting relative hypercortisolism showed 1.9–2.4 (BDI, p = 0.017, MADRS-S, p = 0.003) and 4.7 (p<0.001) times higher frequencies of depression and low overall life quality compared with patients exhibiting eucortisolism. Adjusted OR:s for depression ranged from 2.2–2.7 (BDI, p = 0.068, MADRS-S, p = 0.045) and was 6.3 (p = 0.008) for life quality. The cross-sectional design and lack of pre-established reference values of the DST employed. Relative hypocortisolism and relative hypercortisolism were associated with depression and lower life quality, providing novel insights into the detrimental role of stress in bipolar disorder.
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