【摘要】 目的探讨儿童期忽略对抑郁症HPA轴功能活性水平的影响。方法采用CTQ(童年创伤问卷)作为评估童年创伤的工具。评估随机入组18～45岁抑郁症病人,童年忽略包括情绪忽略及或躯体忽略,以情绪忽略分≥15、躯体忽略分≥10或二者总分≥20为界,入组伴儿童忽略抑郁症19例,不伴任何形式童年忽略抑郁症患者21例(CTQ任何分量表得分均低于8),年龄、性别、匹配的正常对照组20例,采用CAR(皮质醇醒觉反应)作为检测HPA轴活性的方法,收集连续两个早晨刚醒及醒后30分钟两个时间点唾液,采用酶联免疫的方法检测皮质醇浓度,取连续两天皮质醇浓度的均值。HPA轴功能活性定义为醒后30分钟皮质醇浓度与刚醒时的浓度差。在童年创伤分与HPA轴功能活性及抑郁症严重程度之间求相关。结果正常对照组与伴儿童忽略抑郁症相比在觉醒时皮质醇浓度、醒后30分钟皮质醇浓度、HPA轴活性、HAMD抑郁分等均存在显著差异;正常组与不伴任何类型童年虐待抑郁症相比,觉醒时皮质醇浓度、醒后30分钟皮质醇浓度、HAMD抑郁分存在显著性差异,而在CTQ、HPA轴功能活性上无显著性差异;伴儿童忽略抑郁与不伴任何类型儿童虐待抑郁症在抑郁症症状上无显著性差异,HPA轴功能活性有差异性倾向(P=0.07),在觉醒时皮质醇浓度及醒后30分钟皮质醇浓度上存显著性差异。HPA轴活性与童年创伤总分及抑郁症严重程度均无显著相关,但与忽略总分显著相关;CTQ总分与忽略总分均与HAMD抑郁分呈正相关。结论儿童忽略对抑郁症HPA轴功能及抑郁症的严重程度均有影响。更多还原

【Abstract】 Objective To explore the relationship between child neglect and HPA axis activity in patients with depression. Methods The CTQ (childhood trauma questionnaire) was used to assess childhood trauma. Childhood neglect included emotional neglect and physical neglect. With emotional neglect scores ≥15 or physical neglect scores ≥10, or the total scores of both neglects ≥20 as the standard of diagnosis, 19 depressive patients with child neglect and 21 depressive patients without any form of childhood neglect (any subscale in CTQ was lower than 8) were included. 20 age, gendermatched normal people were as control group. Cortisol awakening response (CAR) was used as an indicator of measurement of HPA axis activity, and HPA axis activity was defined as the difference between the concentration at 30 minutes after awakening and the one at awakening. The relationships between childhood trauma score and HPA axis activity, severity of depression were analyzed. Results There were significant differences among cortisol concentrations at awakening, 30 minutes after awakening, HPA axis activity, HAMD scales between normal group and depressive patients with childhood neglect. There were only significant differences among cortisol concentrations at awakening, 30 minutes after awakening, and HAMD scales, and there were no significant difference among CTQ and HPA between normal group and depressive patients without any form of childhood maltreatment. There was different trend in HPA axis activity (P = 0.07) and significant difference in cortisol concentrations at awakening, 30 minutes after awakening between depression with childhood neglect and depression without any form of childhood maltreatment. HPA axis activity in depression with childhood trauma were not related to severity of depression and total scores of CTQ, but significantly correlated with total scores of neglects. The total scores of CTQ and the total scores of neglect were positively related to HAMD scores of depression. Conclusions Childhood neglect is related to the HPA axis activity and the severity of depression.更多还原