Abstract:

Objective　To explore the relationships between the levels of adrenocorticotropic hormone (ACTH) and cortisol (COR) and the suicide risk in patients with depressive episodes, and to provide clinical evidences for early identification and intervention of suicidal behaviors in patients with depressive episodes. Methods　In this study, 80 patients aged 18 - 65 years who were diagnosed with depressive episodes and visited Dongguan Seventh People's Hospital from August 2022 to May 2024 were selected as the research objects. A case-control study design was adopted. The Beck Scale for Suicide Ideation was used to assess the patients' suicide risk, and peripheral blood was collected to measure the levels of ACTH and COR. Among them, 40 patients with positive score on the suicide ideation scale were included in the study group, while 40 patients with negative score on the suicide ideation scale were included in the control group. There were 20 males and 20 females in the study group, aged 19-65 (42.87±2.98) years, and the course of disease was 1-10 (5.87±0.56) years. There were 21 males and 19 females in the control group, aged 19-64 (42.84±2.97) years, and the course of disease was 1-11 (5.89±0.59) years. The two groups received the same treatment. The ACTH level, COR level, Hamilton Depression Rating Scale (HAMD) score, and Beck score were compared between the two groups before and after treatment. t test was used for statistical analysis. Results　Before treatment, the ACTH and COR levels in the study group were higher than those in the control group [(25.41±11.84) ng/L vs. (20.14±7.45) ng/L, (268.41±66.52) nmol/L vs. (239.25±57.41) nmol/L], with statistically significant differences (t=2.38 and 2.10, both P<0.05). After antidepressant treatment, the ACTH level, COR level, HAMD score, and Beck score in the study group were higher than those in the control group (t=6.05,12.88,14.36 , and 38.11, all P<0.05). Conclusions　Among patients with depressive episodes, the higher the levels of ACTH and COR are, the higher the suicide risk is. Moreover, after antidepressant treatment, the levels of ACTH and COR are still higher than those in patients without suicide risk, suggesting that the blood levels of ACTH and COR may be potential biological indicators for assessing the suicide risk in patients with depressive episodes.

Key words:

Depressive episodes, Suicide risk, Adrenocorticotropic hormone, Cortisol, Case-control study

摘要：

目的　探讨血促肾上腺皮质激素（ACTH）及皮质醇（COR）水平与抑郁发作患者自杀风险的关系，为早期识别和干预抑郁发作患者自杀行为提供临床依据。方法　选取东莞市第七人民医院2022年8月至2024年5月就诊的80例抑郁发作患者为研究对象，采用病例对照研究设计，应用Beck自杀意念量表对患者进行自杀风险评估，并采取外周血测定ACTH及COR水平。其中，40例自杀意念评分阳性患者为研究组，40例自杀意念评分阴性患者为对照组。研究组：男20例、女20例，年龄19～65（42.87±2.98）岁，病程1～10（5.87±0.56）年。对照组：男21例、女19例，年龄19～64（42.84±2.97）岁，病程1～11（5.89±0.59）年。两组采用相同方法治疗6周。比较治疗前后两组ACTH水平、COR水平、汉密尔顿抑郁量表（HAMD）评分、Beck评分。统计学方法采用t检验。结果　治疗前，研究组患者ACTH与COR水平均高于对照组［（25.41±11.84）ng/L比（20.14±7.45）ng/L、（268.41±66.52）nmol/L比（239.25±57.41）nmol/L］，差异均有统计学意义（t=2.38、2.10，均P<0.05）；抗抑郁治疗后，研究组ACTH水平、COR水平、HAMD评分、Beck评分均高于对照组（t=6.05、12.88、14.36、38.11，均P<0.05）。结论　抑郁发作患者ACTH及COR水平越高，自杀风险就越高，且在抗抑郁治疗后ACTH及COR水平仍然高于无自杀风险患者，血ACTH及COR水平可作为评估抑郁发作患者自杀风险的潜在生物学指标。

关键词:

抑郁发作, 自杀风险, 促肾上腺皮质激素, 皮质醇, 病例对照研究