공황장애 환자에서 성별에 따른 베타아드레날린 수용체 기능 민감도의 차이

Abstract

[한글]

본 연구의 목적은 공황장애 남녀 환자들을 대상으로 공황장애의 병태 생리와 밀접한 관련성이 있다고 알려진 생체 내 베타아드레날린 수용체 활동성을 측정하여 비교함으로써 공황장애의 생물학적 병태 생리의 남녀간 차이를 규명하고, 나아가 여성에서 공황장애의 생물학적 기전을 밝혀보고자 하는 것이다. 연구 대상은 공황장애로 진단이 내려진 환자 35명(여자 13명, 남자 22명) 및 건강한 사람 35명(여자 13명, 남자 22명)으로 총 70명이었다. 여성들의 경우 menstruation 기간 및 후 1주일을 피하도록 하여 가급적 황체기에 연구자료를 얻었다. 모든 연구 대상자들에서 생체 내 베타아드레날린 수용체의 민감도를 나타내는 CD₂₅/wt를 구하고자 isoproterenol stimulation test를 시행하였다. 또한 베타아드레날린 수용체 민감도 저하와 카테콜아민 level 및 공황장애의 심각도 사이의 상관관계를 알아보고자 혈장 카테콜아민(노어에피네프린 및 에피네프린) levels을 측정하였다. 임상상태는 Acute Panic Inventory(API), Clinical Global Impression(CGI), Beck Depression Inventory(BDI), Hamilton Anxiety Rating Scale(HAMA), Hamilton Depression Rating Scale(HAMD), Spielberger State and Trait Anxiety Inventory(STAI-S, STAI-T), Anxiety Sensitivity Index(ASI) 등으로 평가하였다. 연구 결과 공황장애 여성군에서 정상 여성 대조군에 비해 CD₂₅/wt 값이 유의하게 증가해 있었으나(t=3.00, p<0.01), 공황장애 남성군에서는 정상 남성 대조군과 비교하여 차이가 없었다(t=-1.19, p=0.24). 공황장애 남녀 환자군 모두에서 CD₂₅/wt 와 혈장 카테콜아민 levels 및 여러 임상적 측정변수사이에는 유의한 상관관계를 보이지 않았다. 본 연구의 결과 공황장애 여성에서 베타아드레날린 수용체의 민감도가 저하되어 있고, 또한 공황장애에서 성별에 따른 병태 생리에 차이가 있었다.

[영문]

This study was conducted on patients with panic disorder to examine the gender difference in biological mechanisms of panic disorder by evaluating and comparing in vivo beta-adrenergic receptor sensitivity which is known to be closely related to the pathophysiology of panic disorder. This study included a total of 70 subjects which consisted of 35 patients (female: 13, male: 22) who were diagnosed as panic disorder along with 35 healthy control subjects (female: 13, male: 22). As lymphocyte beta-adrenergic receptors are regulated under the influence of ovarian sex steroid hormones during menstrual cycle, female subjects were studied, avoiding the menstruation period and the week following menstruation in order to collect data as best we could during the luteal phase. The dose of the isoproterenol which is termed CD25 is the chronotropic dose required for a 25 beat per minute increase of heart rate, and is an in vivo index of beta-adrenergic receptor sensitivity. To obtain CD+ADw-sub+AD4-25+ADw-/sub+AD4-/wt(+AKUA7A-g/kg) from all the subjects, isoproterenol stimulation test was conducted. Moreover, the serum norepinephrine and epinephrine levels were also evaluated. The clinical states of the patients were assessed with the use of Acute Panic Inventory(API), Clinical Global Impression(CGI), Beck Depression Inventory(BDI), Hamilton Anxiety Rating Scale(HAMA), Hamilton Depression Rating Scale (HAMD), Spielberger State and Trait Anxiety Inventory(STAI-S, STAI-T) and Anxiety Sensitivity Index(ASI). There were no statistically significant gender related differences in various clinical variables and serum catecholamine levels in panic disorder patients, except BDI(female patients 19.1+AKIArg-3/46.8 vs. male patients 10.7+AKIArg-3/46.5, p+ADw-0.01). CD+ADw-sub+AD4-25+ADw-/sub+AD4-/wt in female panic patients was 0.073+AKIArg-3/40.045(+AKUA7A-g/kg), which was significantly higher than 0.032+AKIArg-3/40.019(+AKEAzQ-ig/kg) in healthy female control subjects(p+ADw-0.01). However, CD+ADw-sub+AD4-25+ADw-/sub+AD4-/wt in male panic patients was 0.091+AKIArg-3/40.090(+AKUA7A-g/kg), which was not different from that of healthy male control subjects. In both male and female panic patients, no statistically significant correlation was found among CD+ADw-sub+AD4-25+ADw-/sub+AD4-/wt, catecholamine levels and various clinical variables. We found that the beta-adrenergic receptor sensitivity using isoproterenol stimulation test in female panic patients has decreased compared to that of healthy female control subjects, whereas there was no difference in beta-adrenergic receptor sensitivity between male patients and control subjects. The results of this study demonstrate that beta-adrenergic receptor sensitivity decreases in female panic patients, which suggests that there may be a gender difference in the pathophysiology of panic disorder.