Altered stress system reactivity after pediatric injury: Relation with post-traumatic stress symptoms.
Altered stress system reactivity after pediatric injury: Relation with post-traumatic stress symptoms.
复制标题
儿科受伤后应激系统反应性的改变：与创伤后应激症状的关系。
DOI：
10.1016/j.psyneuen.2017.06.003
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发表时间：
2017
影响因子：
3.7
通讯作者：
Swank,PaulR
中科院分区：
文献类型：
--
作者：
Ewing-Cobbs,Linda;Prasad,MaryR;CoxJr,CharlesS;Granger,DouglasA;Duque,Gerardo;Swank,PaulR
伤害是儿童死亡和残疾的主要原因。受伤儿童的应激反应系统和创伤后应激症状（PTSS）发生变化的风险很高，这可能会损害长期的身心健康。在一项前瞻性、观察性队列研究中，我们检查了儿童损伤后下丘脑-垂体-肾上腺轴（HPA;唾液皮质醇）和自主神经系统（ANS;唾液α淀粉酶，sAA）应激反应的个体差异和相关性。参与者年龄8-15岁，因车祸后创伤性脑损伤（TBI; n = 55; M年龄= 13.9岁; 40名男性）或颅外损伤（EI; n = 29; M年龄12.3岁，20名男性）住院。伤后6个月，在特里尔社会压力测试前后收集唾液，随后测定皮质醇和sAA。相对于健康的非受伤对照组（n = 33; M年龄= 12.5岁，16名男性），受伤的儿童（年龄8-12岁），但不是青少年（年龄13-15岁），有较高的皮质醇水平;无论年龄大小，受伤的参与者表现出抑制皮质醇反应社会评价的威胁。与EI参与者相比，TBI儿童皮质醇升高，青少年sAA升高。PTSS方面，sAA的个体差异与TBI组的回避呈负相关，与EI组的情感麻木呈正相关。重要的是，心理和神经生物学后遗症与损伤严重程度弱相关。鉴于儿童损伤的高患病率，这些后遗症影响许多儿童，并代表了一个重大的公共卫生问题。因此，创伤后后遗症的监测应包括损伤严重程度的全方位。监测对环境损伤敏感的生物系统的活性、反应性和调节可能会促进我们对创伤性儿科损伤后后遗症和适应的个体差异的理解。
Injury is the leading cause of death and disability in childhood. Injured children are at high risk for developing alterations in stress response systems and post-traumatic stress symptoms (PTSS) that may compromise long-term physical and psychological health. In a prospective, observational cohort study, we examined individual differences in, and correlates of, stress-reactivity of the hypothalamic-pituitary-adrenal axis (HPA; salivary cortisol) and autonomic nervous system (ANS; salivary alpha amylase, sAA) following pediatric injury. Participants were 8–15 years of age and hospitalized for traumatic brain injury (TBI; n = 55; M age = 13.9 yrs; 40 males) or extracranial injury (EI; n = 29; M age 12.3 yrs, 20 males) following vehicular accidents. Six months post-injury, saliva was collected before and after the Trier Social Stress Test and later assayed for cortisol and sAA. Relative to a healthy non-injured comparison group (n = 33; M age = 12.5 yrs, 16 males), injured children (ages 8–12 years), but not adolescents (ages 13–15 yrs), had higher cortisol levels; regardless of age, injured participants showed dampened cortisol reactivity to social evaluative threat. Compared to participants with EI, children with TBI had elevated cortisol and adolescents had elevated sAA. With respect to PTSS, individual differences in sAA were negatively correlated with avoidance in the TBI group and positively correlated with emotional numbing within the EI group. Importantly, psychological and neurobiological sequelae were weakly related to injury severity. Given the high prevalence of pediatric injury, these sequelae affect many children and represent a significant public health concern. Consequently, surveillance of post-traumatic sequelae should include the full spectrum of injury severity. Monitoring the activity, reactivity, and regulation of biological systems sensitive to environmental insults may advance our understanding of individual differences in sequelae and adaptation following traumatic pediatric injury.