Abstract: Background　The pathogenesis，pathophysiological changes and early diagnosis of generalized anxiety disorder（GAD） remain unclear.Current research on cortisol concentrations in generalized anxiety disorder is inconsistent.Objective　To investigate whether the changes in plasma and salivary cortisol in GAD are associated with the severity of the disease.Methods　This study was conducted from October 2017 to May 2018 among participants recruited from the Affiliated Hospital of Guizhou Medical University，including 30 GAD outpatients and inpatients（GAD group） from psychological clinic and ward，and 30 healthy people（control group） from physical examination center and consultation clinic.Hamilton Anxiety Scale （HAMA） was used to assess the level of anxiety in GAD group and control group.Plasma and salivary cortisol levels were measured in the morning in all participants.The above indices were measured again in the GAD group after 6 weeks of paroxetine treatment.Analysis was performed to explore the correlation of changes in cortisol levels with the severity of GAD.Results　Mean plasma and salivary cortisol levels as well as mean HAMA score in GAD patients before paroxetine treatment were all higher than those of the controls（P<0.05）.Post-treatment mean plasma and salivary cortisol levels as well as mean HAMA score in GAD patients decreased significantly compared with the baseline levels（P<0.05）.Pearson's correlation analysis showed that plasma and salivary cortisol levels were positively correlated with HAMA score before treatment in the GAD patients（r=0.59，P<0.01；r=0.78，P<0.01）.Conclusion　Plasma and salivary cortisol levels were elevated in GAD，and were positively correlated with the severity of the disease.Detection of salivary and plasma cortisol levels have a certain guiding significance for early identification and severity determination of GAD.

Key words: Generalized anxiety disorder, Anxiety, Plasma cortisol, Salivary cortisol, Hydrocortisone, Paroxetine, Correlation analysis

摘要： 背景　广泛性焦虑障碍的发病原因、病理生理变化及早期诊断尚不明确。目前对皮质醇在广泛性焦虑障碍中的水平变化研究不一致。目的　探讨血浆及唾液皮质醇在广泛性焦虑障碍中的水平变化及与病情严重程度是否相关。方法　选取2017年10月—2018年5月就诊于贵州医科大学附属医院心理科门诊或病房的30例广泛性焦虑障碍患者作为患者组。另选取同期贵州医科大学附属医院体检中心和咨询门诊的健康人群30例作为对照组。采用汉密尔顿焦虑量表（HAMA）评定受试者，并分别测定受试者清晨血浆、唾液皮质醇水平。患者组服用盐酸帕罗西汀6周后再次测定上述指标，对比治疗前后皮质醇水平变化并进行相关性分析。结果　治疗前，患者组血浆皮质醇、唾液皮质醇、HAMA评分均高于对照组（P<0.05）；患者组治疗后血浆皮质醇、唾液皮质醇、HAMA评分均低于治疗前（P<0.05）。Pearson直线相关分析结果显示，患者组治疗前血浆皮质醇水平、唾液皮质醇水平与HAMA评分呈正相关（r=0.59，P<0.01；r=0.78，P<0.01）。结论　血浆皮质醇和唾液皮质醇水平在广泛性焦虑障碍中升高，皮质醇水平与广泛性焦虑病情严重程度呈正相关。检测血浆、唾液皮质醇水平对早期识别广泛性焦虑障碍及判断病情严重程度有一定指导
意义。

关键词: 广泛性焦虑障碍, 焦虑, 血浆皮质醇, 唾液皮质醇, 氢化可的松, 帕罗西汀, 相关性分析