Biological predictors of insulin resistance associated with posttraumatic stress disorder in young military veterans
Biological predictors of insulin resistance associated with posttraumatic stress disorder in young military veterans
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DOI：
10.1016/j.psyneuen.2017.04.016
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发表时间：
2017-08-01
影响因子：
3.7
通讯作者：
Marmar, Charles R.
中科院分区：
文献类型：
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作者：
Blessing, Esther M.;Reus, Victor;Marmar, Charles R.
创伤后应激障碍(PTSD)与2型糖尿病和心血管疾病(心脏代谢性疾病)的风险增加有关，需要对有针对性的预防策略进行研究。在这项对160名年轻(平均年龄32.7岁)男性退伍军人进行的病例对照研究中，我们旨在评估PTSD状态是否预示着其他健康个体心脏代谢风险标记物的增加，并进一步探索PTSD与这些心脏代谢风险标记物增加之间的生物学途径。为了达到这些目的，我们比较了80例PTSD患者和80例非PTSD对照组的心脏代谢风险指标，即胰岛素抵抗、代谢综合征(METS)和糖尿病前期。然后，我们确定与创伤后应激障碍相关的HOMA-IR增加是否与先前假设的将创伤后应激障碍与心脏代谢风险联系起来的特定生物变量相关，包括全身炎症(C-反应蛋白、白介素6和肿瘤坏死因子a增加)、交感神经过度活动(静息心率增加)和神经内分泌失调(血浆皮质醇或血清脑源性神经营养因子(BDNF)增加)。我们发现创伤后应激障碍的诊断与显著较高的HOMA-IR相关(例4.3。+/-4.3vs2.4+/-2.0p<；0.001)，甲硫氨酸水平较高(21.3%vs2.5%；p<；0.001)，但不是糖尿病前期(20.0%vs18.8%；p>；0.05)。这些患者的促炎细胞因子(P<；0.01)、心率(P<；0.001)和脑源性神经营养因子(P<；0.001)的增加共同预测HOIVIA-IR增加(调整后的R-2=0.68，P<；0.001)。结果显示，在没有心脏代谢性疾病的年轻男性退伍军人中，PTSD的诊断与IR增加有关，这是先前假设将PTSD与心脏代谢风险增加联系在一起的生物学改变所预测的。这一发现支持了对创伤后应激障碍患者心脏代谢性疾病的早期、有针对性预防的进一步研究。
Posttraumatic stress disorder (PTSD) is associated with increased risk for Type 2 diabetes and cardiovascular disease (cardiometabolic disease), warranting research into targeted prevention strategies. In the present case control study of 160 young (mean age 32.7 years) male military veterans, we aimed to assess whether PTSD status predicted increased markers of cardiometabolic risk in otherwise healthy individuals, and further, to explore biological pathways between PTSD and these increased markers of cardiometabolic risk. Toward these aims, we compared measures of cardiometabolic risk, namely insulin resistance alo (HOMA-IR), metabolic syndrome (MetS) and prediabetes, between 80 PTSD cases and 80 controls without PTSD. We then determined whether PTSD-associated increases in HOMA-IR were correlated with select biological variables from pathways previously hypothesized to link PTSD with cardiometabolic risk, including systemic inflammation (increased C-reactive protein, interleukin-6, and tumor necrosis factor a), sympathetic over-activity (increased resting heart rate), and neuroendocrine dysregulation (increased plasma cortisol or serum brain-derived neurotrophic factor (BDNF)). We found PTSD diagnosis was associated with substantially higher HOMA-IR (cases 4.3. +/- 4.3 vs controls 2.4 +/- 2.0; p < 0.001), and a higher frequency of MetS (cases 21.3% vs controls 2.5%; p < 0.001), but not prediabetes (cases 20.0% vs controls 18.8%; p > 0.05). Cases also had increased pro-inflammatory cytokines (p < 0.01), heart rate (p < 0.001), and BDNF (p < 0.001), which together predicted increased HOIVIA-IR (adjusted R-2 = 0.68, p < 0.001). Results show PTSD diagnosis in young male military veterans without cardiometabolic disease is associated with increased IR, predicted by biological alterations previously hypothesized to link PTSD to increased cardiometabolic risk. Findings support further research into early, targeted prevention of cardiometabolic disease in individuals with PTSD.