Hypothalamic-pituitary-adrenal axis dysregulation in depressed children and adolescents: a meta-analysis.
Hypothalamic-pituitary-adrenal axis dysregulation in depressed children and adolescents: a meta-analysis.
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DOI：
10.1016/j.psyneuen.2009.03.016
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发表时间：
2009-10
影响因子：
3.7
通讯作者：
George, Charles J.
中科院分区：
文献类型：
--
作者：
Lopez-Duran, Nestor L.;Kovacs, Maria;George, Charles J.
下丘脑-垂体-肾上腺（HPA）轴和儿童抑郁症的研究结果反映了各种方法的方法，挖掘HPA轴功能的不同方面。部分由于研究方法的多样性，对这一领域的描述性审查得出了不一致的结论。因此，我们对相关研究进行了正式的荟萃分析，以促进我们对儿童抑郁症HPA轴失调的理解。我们检查了：a）17项已发表的抑郁青年对地塞米松抑制试验的HPA轴反应研究（DST; N=926）和B）17项基础HPA轴功能研究（N= 1，332）。我们还回顾了使用促肾上腺皮质激素释放激素（CRH）输注的研究，以及使用HPA轴心理探针的研究。抑郁和非抑郁青年之间对DST的HPA轴反应的总体标准化平均效应量差异为0.57，z = 4.18 p<0.01。基础HPA轴功能的总体标准化平均差异效应量为0.20，z = 4.53，p <0.01。年龄、性别、采样时间、地塞米松剂量或对照组类型不是DST或基础研究变异性的重要来源。此外，当与非抑郁的同龄人相比，抑郁的青年有一个规范的反应CRH输液，但过度活跃的心理应激反应。总之，HPA轴系统往往是失调的抑郁症青年，证明了非典型的反应DST，较高的基线皮质醇值，和过度活跃的心理应激反应。这种失调的模式表明轴的负反馈系统和CRH产生异常，但完整的垂体和肾上腺敏感性。
Research findings on the hypothalamic-pituitary-adrenal (HPA) axis and pediatric depression reflect a variety of methodological approaches that tap different facets of HPA-axis functions. Partly owing to the methodological heterogeneity of studies, descriptive reviews of this area have produced inconsistent conclusions. Therefore, we conducted formal meta-analyses of pertinent studies in order to advance our understanding of HPA-axis dysregulation in pediatric depression. We examined: a) 17 published studies of HPA-axis response to the dexamethasone suppression test in depressed youth (DST; N=926) and b) 17 studies of basal HPA-axis functioning (N=1,332). We also examined descriptively studies that used corticotropin releasing hormone (CRH) infusion, and those that used psychological probes of the HPA-axis. The global standardized mean effect size difference in HPA-axis response to the DST between depressed and non-depressed youth was .57, z = 4.18 p< .01. The global standardized mean difference effect size in basal HPA-axis functioning was .20, z = 4.53, p < .01. Age, sex, timing of sampling, dexamethasone dosage, or type of control group was not a significant source of variability for the DST or basal studies. In addition, when compared to non-depressed peers, depressed youth have a normative response to CRH infusion but an overactive response to psychological stressors. In conclusion, the HPA-axis system tends to be dysregulated in depressed youth, as evidenced by atypical responses to the DST, higher baseline cortisol values, and an overactive response to psychological stressors. This pattern of dysregulation suggests anomalies within the axis's negative feedback system and CRH production, but intact pituitary and adrenal sensitivity.
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影响因子：
1.9
作者：
Duval, S;Tweedie, R
通讯作者：
Tweedie, R
影响因子：
10.6
作者：
DAHL, RE;KAUFMAN, J;PUIGANTICH, J
通讯作者：
PUIGANTICH, J
DOI：
10.1016/s0002-7138(09)60263-6
发表时间：
1986-05-01
影响因子：
13.3
作者：
DOHERTY, MB;MADANSKY, D;COUGHLIN, BF
通讯作者：
COUGHLIN, BF
影响因子：
11.3
作者：
GOODYER, I;HERBERT, J;ALTHAM, P
通讯作者：
ALTHAM, P
影响因子：
3.3
作者：
Gillespie, CF;Nemeroff, CB
通讯作者：
Nemeroff, CB