Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents.
Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents.
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下丘脑 - 垂体 - 肾上腺应激轴功能以及与慢性广泛疼痛及其前因的关系。
DOI：
10.1186/ar1772
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发表时间：
2005
影响因子：
4.9
通讯作者：
Macfarlane, GJ
中科院分区：
文献类型：
--
作者：
McBeth, J;Chiu, YH;Silman, AJ;Ray, D;Morriss, R;Dickens, C;Gupta, A;Macfarlane, GJ
在临床研究中，下丘脑-垂体-肾上腺 (HPA) 轴功能的改变与纤维肌痛有关，纤维肌痛是一种以慢性全身疼痛为特征的综合征。这些结果可以通过相关的高心理困扰和躯体化发生率来解释。我们假设后者，而不是疼痛，可以解释 HPA 结果。一项人口研究确定了 25 至 65 岁受试者的疼痛和心理状态。从以下三组中随机抽取样本： 满足慢性广泛性疼痛标准；无慢性广泛疼痛，但有强烈的躯体化证据（“有风险”）；和参考组。通过测量清晨和晚上的唾液皮质醇水平以及物理（疼痛压力阈值检查）和化学（过夜 0.25 毫克地塞米松抑制试验）应激后的血清皮质醇水平来评估 HPA 轴功能。使用适当的回归分析对 HPA 功能与疼痛和评估的各种社会心理量表之间的关系进行建模，并根据年龄和性别进行调整。在所有 131 名患有慢性广泛疼痛的人（参与率 74%）中，对 267 名“处于危险中”的人（58%）和 56 名对照者（70%）进行了研究。慢性广泛疼痛组和“高危组”的唾液皮质醇评分处于最低三分之一的可能性分别高出 3.1（95% CI（1.3，7.3））和 1.8（0.8，4.0）倍。然而，所测量的社会心理因素均与唾液皮质醇评分无关。此外，慢性广泛疼痛（1.9（0.8，4.7））和“有风险”（1.6（0.7，3.6））组的人也更有可能具有最高的血清皮质醇评分。应激后血清皮质醇水平升高与心理困扰水平升高相关（p = 0.05，95% CI (0.02, 0.08)）。在调整心理困扰水平后，慢性广泛疼痛与应激后皮质醇评分之间的关联仍然存在，尽管略有减弱。这是第一项人群研究，证明患有慢性广泛疼痛的人和心理上有慢性广泛疼痛风险的人表现出 HPA 轴功能异常，这在前一组中更为明显。尽管功能改变的某些方面与测量的心理社会因素有关，但我们得出结论，患有慢性广泛疼痛的人发生 HPA 异常并不能完全用伴随的心理压力来解释。
In clinic studies, altered hypothalamic-pituitary-adrenal (HPA) axis function has been associated with fibromyalgia, a syndrome characterised by chronic widespread body pain. These results may be explained by the associated high rates of psychological distress and somatisation. We address the hypothesis that the latter, rather than the pain, might explain the HPA results. A population study ascertained pain and psychological status in subjects aged 25 to 65 years. Random samples were selected from the following three groups: satisfying criteria for chronic widespread pain; free of chronic widespread pain but with strong evidence of somatisation ('at risk'); and a reference group. HPA axis function was assessed from measuring early morning and evening salivary cortisol levels, and serum cortisol after physical (pain pressure threshold exam) and chemical (overnight 0.25 mg dexamethasone suppression test) stressors. The relationship between HPA function with pain and the various psychosocial scales assessed was modelled using appropriate regression analyses, adjusted for age and gender. In all 131 persons with chronic widespread pain (participation rate 74%), 267 'at risk' (58%) and 56 controls (70%) were studied. Those in the chronic widespread pain and 'at risk' groups were, respectively, 3.1 (95% CI (1.3, 7.3)) and 1.8 (0.8, 4.0) times more likely to have a saliva cortisol score in the lowest third. None of the psychosocial factors measured were, however, associated with saliva cortisol scores. Further, those in the chronic widespread pain (1.9 (0.8, 4.7)) and 'at risk' (1.6 (0.7, 3.6)) groups were also more likely to have the highest serum cortisol scores. High post-stress serum cortisol was related to high levels of psychological distress (p = 0.05, 95% CI (0.02, 0.08)). After adjusting for levels of psychological distress, the association between chronic widespread pain and post-stress cortisol scores remained, albeit slightly attenuated. This is the first population study to demonstrate that those with established, and those psychologically at risk of, chronic widespread pain demonstrate abnormalities of HPA axis function, which are more marked in the former group. Although some aspects of the altered function are related to the psychosocial factors measured, we conclude that the occurrence of HPA abnormality in persons with chronic widespread pain is not fully explained by the accompanying psychological stress.
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影响因子：
--
作者：
CROFFORD, LJ;PILLEMER, SR;WILDER, RL
通讯作者：
WILDER, RL
影响因子：
5.5
作者：
Hunt, IM;Silman, AJ;Macfarlane, GJ
通讯作者：
Macfarlane, GJ
影响因子：
5.5
作者：
McBeth, J;Macfarlane, GJ;Silman, AJ
通讯作者：
Silman, AJ
影响因子：
3
作者：
Okifuji, A;Turk, DC
通讯作者：
Turk, DC
DOI：
10.3109/00048677609159482
发表时间：
1976-01-01
影响因子：
4.6
作者：
TENNANT, C;ANDREWS, G
通讯作者：
ANDREWS, G