中国心理卫生杂志2012，Vol.26Issue(8)：595-600,6.DOI:10.3969/j.issn.1000-6729.2012.08.007
抑郁症共病糖尿病患者的皮质醇水平与帕罗西汀治疗的疗效
Higher level of serum cortisol associated with less responses of 8 week paroxetine treatment in patients with depression comorbid type 2 diabetes
摘要
Abstract
Objective: To study the related factors of cortisol increasing and effect of paroxetine treatment in patients with diabetes. Methods: Totally 200 patients with comorbid depression and type 2 diabetes were included. The depression diagnosis was made according to the Chinese Classification and Diagnostic Criteria of Mental Disorders, Third Edition (CCMD-3). The patients were divided into high cortisol group and normal cortisol group according to the serum concentration of cortisol. They were assessed with the Hamilton Depression Scale (HAMD) for severity of depression symptom and assessed with a self-made questionnaire for demographic data, living habits, and course of disease. Their body mass indices were calculated and the levels of glycosylated hemoglobin were measured. The two groups both received 8-week treatment of paroxetine, and the treatment effect was evaluated with the HAMD score-reducing rate. Results: Logistic regression analysis showed that higher level of glycosylated hemoglobin (HbAlc ≥6. 5% , OR = 2. 72; HbAlc ≥8. 0% , Off = 5.69), HAMD score of ≥20 (Off =3.31), body mass index of 3:25 ( OR = 3. 56), and age of 35 - 50 (OR - 2. 37) were risk factors of higher cortisol level. The exercise time of ≥ 4 h per week (Off =0. 28) and depression course of > 12 months (OR =0. 10) were protective factors. After 8-week treatment with paroxetine, the HAMD score-reducing rates were higher in high cortisol group than in normal cortisol group [ (0. 66 ± 0. 11) vs. (0. 86 ± 0. 05), P < 0. 01 ]. The HAMD score-reducing rates were negatively correlated with the levels of glycosylated hemoglobin (β = - 0. 26, P < 0. 05) and cortisol (β = - 0. 17, P <0. 05). Conclusion: It suggests that higher level of glycosylated hemoglobin, more severe symptom of depression, higher body mass index, age of 35 - 50 years may be the risk factors of increasing cortisol; longer exercise time and longer course of depression may be the protective factors. The patients with higher levels of cortisol and glycosylated hemoglobin may have poorer response to paroxetine treatment.关键词
抑郁症/糖尿病/共病/皮质醇/帕罗西汀Key words
depression/ diabetes/ comorbidity/ cortisol/ paroxetine分类
医药卫生引用本文复制引用
任会鹏,王育梅,宋美,王学义..抑郁症共病糖尿病患者的皮质醇水平与帕罗西汀治疗的疗效[J].中国心理卫生杂志,2012,26(8):595-600,6.基金项目
2010年河北省卫生厅医学科学研究课题计划(20100264) （20100264）
