精神医学49巻3号

2007年03月発行

特集 統合失調症と感情障害の補助診断法の最近の進歩

気分障害におけるDEX/CRH試験

著者： 尾鷲登志美¹² 大坪天平¹

所属機関： ¹昭和大学医学部精神医学教室 ²マックス・プランク精神医学研究所

ページ範囲：P.273 - P.277

はじめに

　気分障害の薬物療法は多岐にわたる。しかし，その奏効率や効果発現までの時間に薬物療法による差はあまりないのが現状である。通常，抗うつ薬の効果発現には数週間を要するため，最初の抗うつ薬が奏効しない場合，患者は長期間病状に耐えなくてはならない。そのため，治療早期に治療反応性が予測できるマーカーが望まれる。DEX/CRH（dexamethasone/corticotrophin-releasing hormone）試験が，その生物学的マーカーになり得るとの知見が近年蓄積されてきている。

　抗うつ薬の作用機序からうつ病のセロトニン仮説が登場したが，DEX抑制試験（DST）から視床下部-下垂体-副腎皮質（hypothalamus-pituitary-adrenal；HPA）系の気分障害への関与が知られるようになった。HPA系はストレスに関与する生体反応系であり，グルココルチコイド受容体を介したフィードバック機構を有している。本稿では，現段階でHPA系を最も反映する臨床検査であるDEX/CRH試験について，うつ病を対象とした研究を中心に概説する。

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