Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood
Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood
复制标题
DOI：
10.1001/jama.284.5.592
复制
发表时间：
2000-08-02
影响因子：
120.7
通讯作者：
Nemeroff, CB
中科院分区：
文献类型：
--
作者：
Heim, C;Newport, DJ;Nemeroff, CB
背景证据表明，早期不良经历在情绪和焦虑障碍的发展中发挥着重要作用，促肾上腺皮质激素释放因子（CRF）系统可能介导这种关联。目的确定早期生活压力是否会导致下丘脑-垂体-肾上腺轴对成年后的轻度压力持续敏感，从而导致对精神病理状况的脆弱性。 这项研究于 1997 年 5 月至 1999 年 7 月在佐治亚州亚特兰大埃默里大学医院综合临床研究中心进行。 参与者 49 名年龄在 18 至 45 岁之间、月经规律、无躁狂或精神病史、6 个月内无活性物质滥用或饮食失调、未服用激素和精神药物的健康女性被招募到 4 个研究组（n = 12 人无儿童期虐待史或精神药物史）。精神障碍 [控制]； n = 13 名被诊断为当前重度抑郁症且在儿童时期遭受过性虐待或身体虐待的人； n = 14 名目前没有重度抑郁症且在儿童时期遭受过性虐待或身体虐待的人； n = 10 例，诊断为当前重度抑郁症且没有儿童期虐待史）。主要结果指标 4 项研究中比较的促肾上腺皮质激素 (ACTH) 和皮质醇水平以及对标准化心理社会实验室压力源的心率反应 结果与对照组相比，有童年虐待史的女性的垂体肾上腺和自主神经对压力的反应增强。对于目前有抑郁和焦虑症状的女性来说，这种效果尤其明显。有儿童虐待史且当前诊断为重度抑郁症的女性对压力的 ACTH 反应比年龄匹配的对照组高 6 倍以上（净峰值 9.0 pmol/L [41.0 pg/ml]；95% 置信区间 [CI]，4.7-13.3 pmol/L [21.6-60.4 pg/mL]；对比净峰值 1.4 pmol/L [6.19]皮克/毫升]； 95% CI，0.2-2.5 pmol/L [1.0-11.4 pg/mL]；差异，8.6 pmol/L [38.9 pg/ml]； 95% CI，4.6-12.6 pmol/L [20.8-57.1 pg/mL]； P < .001)。结论 我们的研究结果表明，下丘脑-垂体-肾上腺轴和自主神经系统的高反应性（可能是由于 CRF 分泌过多）是儿童期虐待的持续后果，可能导致成年后精神病理状况的素质。此外，这些结果表明 CRF 受体拮抗剂在预防和治疗与早期生活压力相关的精神病理状况中发挥作用。
Context Evidence suggests that early adverse experiences play a preeminent role in development of mood and anxiety disorders and that corticotropin-releasing factor (CRF) systems may mediate this association.Objective To determine whether early-life stress results in a persistent sensitization of the hypothalamic-pituitary-adrenal axis to mild stress in adulthood, thereby contributing to vulnerability to psychopathological conditions,Design and Setting Prospective controlled study conducted from May 1997 to July 1999 at the General Clinical Research Center of Emery University Hospital, Atlanta, Ga.Participants Forty-nine healthy women aged 18 to 45 years with regular menses, with no history of mania or psychosis, with no active substance abuse or eating disorder within 6 months, and who were free of hormonal and psychotropic medications were recruited into 4 study groups (n = 12 with no history of childhood abuse or psychiatric disorder [controls]; n =13 with diagnosis of current major depression who were sexually or physically abused as children; n = 14 without current major depression who were sexually or physically abused as children; and n = 10 with diagnosis of current major depression and no history of childhood abuse).Main Outcome Measures Adrenocorticotropic hormone (ACTH) and cortisol levels and heart rate responses to a standardized psychosocial laboratory stressor compared among the 4 study groups.Results Women with a history of childhood abuse exhibited increased pituitary-adrenal and autonomic responses to stress compared with controls. This effect was particularly robust in women with current symptoms of depression and anxiety. Women with a history of childhood abuse and a current major depression diagnosis exhibited a more than 6-fold greater ACTH response to stress than age-matched controls (net peak of 9.0 pmol/L [41.0 pg/ml]; 95% confidence interval [CI], 4.7-13.3 pmol/L [21.6-60.4 pg/mL]; vs net peak of 1.4 pmol/L [6.19 pg/ml]; 95% CI, 0.2-2.5 pmol/L [1.0-11.4 pg/mL]; difference, 8.6 pmol/L [38.9 pg/ml]; 95% CI, 4.6-12.6 pmol/L [20.8-57.1 pg/mL]; P < .001). Conclusions Our findings suggest that hypothalamic-pituitary-adrenal axis and autonomic nervous system hyperreactivity, presumably due to CRF hypersecretion, is a persistent consequence of childhood abuse that may contribute to the diathesis for adulthood psychopathological conditions. Furthermore, these results imply a role for CRF receptor antagonists in the prevention and treatment of psychopathological conditions related to early-life stress.