摘要

OBJECTIVE:The purpose of the study was to determine whether the dexamethasone suppression test (DST) would discriminate between outpatient adolescents with major depressive disorder and normal adolescent comparison subjects.
METHOD:Depressed patients were accepted into the study only if they fulfilled the Research Diagnostic Criteria for major depressive disorder. The depressed subjects (N = 44) and the normal subjects (N = 38) were studied in the same environment and under the same conditions. The subjects received 1 mg of dexamethasone at 11:00 p.m. The next day, blood for determining plasma cortisol concentrations was drawn through an indwelling catheter every 60 minutes from 8:00 a.m. until 11 p.m.
RESULTS:After dexamethasone, the cortisol levels of the adolescents with major depressive disorder and the normal subjects were not significantly different. Only six (14%) of the depressed subjects and one (3%) of the normal subjects showed evidence of nonsuppression (cortisol value greater than 5 micrograms/dl). Analyses of subgroups of the depressed patients based on suicidal tendencies and endogenous subtype also failed to reveal significant differences in cortisol values. Estimates of the severity of depression showed significant negative correlations with cortisol values among the depressed patients.
CONCLUSIONS:In contrast with previous studies of adolescent inpatients, the DST did not discriminate between the adolescent outpatients with major depressive disorder and the normal comparison subjects in this study. Possible reasons for the discrepancies, such as severity of the depression and inpatient status, are discussed.

译文

目的: 本研究的目的是确定地塞米松抑制试验 (DST) 是否能区分患有重度抑郁症的门诊青少年和正常青少年比较对象。
方法: 只有符合重度抑郁症研究诊断标准的抑郁症患者才被纳入研究。抑郁受试者 (N = 44) 和正常受试者 (N = 38) 在相同的环境和相同的条件下进行研究。受试者在第二天下午11:00 接受 1 毫克地塞米松，从上午8:00 到晚上 11 点每 60 分钟通过留置导管抽取血液测定血浆皮质醇浓度
结果: 服用地塞米松后，青少年重性抑郁障碍患者和正常人的皮质醇水平差异无统计学意义。只有 6 个 (14%) 的抑郁症受试者和 1 个 (3%) 的正常受试者显示出非抑制的证据 (皮质醇值大于 5 微克/分升)。基于自杀倾向和内源性亚型的抑郁患者亚组分析也未能揭示皮质醇值的显著差异。抑郁症严重程度的估计显示，在抑郁症患者中，皮质醇值呈显著负相关。
结论: 与之前对青少年住院患者的研究相比，DST 没有区分患有重度抑郁症的青少年门诊患者和本研究中的正常对照受试者。讨论了差异的可能原因，如抑郁的严重程度和住院状态。