• 作者： 胡海國; 林信男; 陸汝斌
• 作者服務機構： 國立臺灣大學醫學院精神科; 國防醫學院三軍總醫院精神科
• 中文摘要： 本研究運用不同研究樣本、不同診斷別與不同之採血樣本時間，分析不正常迪皮醇壓抑試驗出現率。不同研究樣本出現不同之不正常迪皮醇壓抑試驗率乃因不同診斷別之組合與採血時間不同所致。總合所有研究樣本，利用下午4點與11點之標準採血時間表，嚴重憂鬱症在所有診斷別中有最高之不正常迪皮醇壓抑試驗率(58.5%)。研究結果顯示在一般臨床醫療中因為嚴重憂鬱症之出現率不高，所以迪皮醇壓抑試驗不實用於做為臨床上鑑別診斷。然而，它可以做為憂鬱精神病理研究之一個良好變數。本研究建議迪皮醇壓抑試驗若要用單一採血時間表則以下午4點為佳，若要用二個採血時間表則以上午8點與下午4點較實用。 本研究發現不正常迪皮醇壓抑試驗在所有診斷別之出現率與憂鬱之整體性嚴重度成正比關係。然而對各類診斷別來說，不正常迪皮醇壓抑試驗不能區分特異之憂鬱分項症狀。各診斷別有其特定之憂鬱分項症狀與不正常迪皮醇壓抑試驗相關。由不正常迪皮醇壓抑試驗之持久性與服用迪皮醇後、腎上腺皮質素醇之濃度判定，下視丘－腦下垂體－腎上腺皮質功能之異常程度與憂鬱病理之關係並不單純，在精神分裂症與躁症，其憂鬱程度呈正相關，然而在精神官能症與其他類別精神病則可能有倒U型的關係，而在憂鬱程度嚴重之重鬱症患者卻與其憂鬱程度沒有相關性。由此，作者認為不正常迪皮醇壓抑試驗之出現，除了憂鬱以外，可能有其他精神病理與病理生理機轉參與其中。
• 英文摘要： The rate of abnormal dexamethasone suppression test (AbDST, post-dexamethasone cortisol ＞ 5.0μg/dl) was analyzed in different psychiatric samples, diagnostic categories and different time points ofblood sampling. Differences in the AbDST rate in different samples were largely due to different composi-tion of diagnostic categories and time points of samplings. By standard DST protocol (using 4PM and11PM as sampling time points), melancholics had the highest AbDST rate (58.5%) among all diagnosticgroups. DST was not a practical technique for differential diagnosis in psychiatric practice because of lowprevalence of melancholia in the total patient population. However, it could be a promising variable forpsychopathological study. The rate of AbDST was higher at the sampling time of 4PM than any others.For one time point sampling, the 4PM one was suggested. 8AM and 4PM sampling times were suggested asa practical 2-time-point sampling for DST. The rate of AbDST in different diagnostic groups had a positive relation with the severity of de-pressive psychopathology in a global sense. There was not any single item or any cluster of depressivesymptomatology consistently related to AbDST among all diagnostic categories. Each diagnostic categoryhad its own specific depressive symptoms in relation to AbDST, either positively or negatively. The severi-ty of hypothalamic-pituitary-adrenal axis dysfunction, as shown in persistent AbDST and a high level ofpost-dexamethasone cortisol level, showed heterogeneous relation with depressive psychopathology. Therelation was positive in schizophrenia and mania, was nill in melancholia, and probably reversed U relationin other psychotics and neurotics. Multiple psychopathological and pathophysiological mechanisms respon-sible for AbDST were suggested.
• 中文關鍵字： dexamethasone suppression test (DST), hypothalamic-pituitary-adrenal function; psy-chiatric diagnostic groups; time point; depressive psychopathology; Hamilton Depression Rating Scale (HDRS)
• 英文關鍵字： --