Stress hormones and post-traumatic stress disorder in civilian trauma victims: a longitudinal study. Part I: HPA axis responses.
Stress hormones and post-traumatic stress disorder in civilian trauma victims: a longitudinal study. Part I: HPA axis responses.
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DOI：
10.1017/s1461145707008127
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发表时间：
2008-05
期刊：
影响因子：
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通讯作者：
A. Shalev;E. Videlock;T. Peleg;R. Segman;R. Pitman;R. Yehuda
中科院分区：
文献类型：
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作者：
A. Shalev;E. Videlock;T. Peleg;R. Segman;R. Pitman;R. Yehuda
该研究的目的是评估创伤后障碍（PTSD）与下丘脑-垂体-肾上腺（HPA）轴对触发创伤的反应之间的关系。一篇配套论文评估了肾上腺素能反应和两者之间的相互作用。我们测量了血浆和唾液皮质醇，每小时尿皮质醇排泄量，促肾上腺皮质激素（ACTH）的血浆水平，和白细胞糖皮质激素受体（GR）密度的155名非受伤的创伤事件幸存者（91名男性和64名女性; 125道路交通事故，19恐怖袭击，11人）。在幸存者入住综合医院急诊室（ER）期间以及早晨、10 d、1个月和5个月后进行测量。每次随访时都会评估创伤前后分裂、创伤后应激障碍和抑郁症的症状。临床医生管理的PTSD量表（CAPS）在5个月时诊断为PTSD。5个月时有PTSD（n=31）和无PTSD（n=124）的幸存者在所有时间的激素水平相似。两组血浆皮质醇水平均随时间下降。女性受试者的ACTH水平低于男性。女性的PTSD与较高水平的ACTH有关。在创伤幸存者中，PTSD之前没有可检测到的外周HPA轴激素异常。
The aim of the study was to evaluate the association between post-traumatic disorder (PTSD) and hypothalamic-pituitary-adrenal (HPA) axis responses to the triggering trauma. A companion paper evaluates the adrenergic response and interactions between the two. We measured plasma and saliva cortisol, hourly urinary excretion of cortisol, plasma levels of adrenocorticotropin (ACTH), and the leukocyte glucocorticoid receptor (GR) density of 155 non-injured survivors of traumatic events (91 males and 64 females; 125 road traffic accidents, 19 terrorist attacks, 11 others). Measurements were taken during survivors' admissions to an emergency room (ER) of a general hospital, and in the mornings, 10 d, 1 month, and 5 months later. Symptoms of peri-traumatic dissociation, PTSD, and depression were assessed on each follow-up session. The clinician-administered PTSD scale (CAPS) conferred a diagnosis of PTSD at 5 months. Survivors with (n=31) and without (n=124) PTSD at 5 months had similar levels of hormones at all times. Plasma cortisol levels decreased with time in both groups. Female subjects had lower ACTH levels than males. PTSD in females was associated with higher levels of ACTH. In unselected cohorts of trauma survivors, PTSD is not preceded by a detectable abnormality of peripheral HPA axis hormones.