PROSPECTIVE NEUROBIOLOGICAL STUDY OF PTSD

这项竞争性延续提案的主要目标是：a) 首次获得下丘脑-垂体腺的连续测量结果- 老年人肾上腺(HPA)轴与交感神经系统(SNS)活动 大样本的心理创伤的人在直接 (B)创伤事件的后果和后续行动；要评估 HPA和SNS反应模式的时间进程与 发展创伤后应激障碍(PTSD)；c.检视 创伤后应激障碍患者下丘脑室旁核与下丘脑室旁核之间可能的相互作用S 发病机制。 300名患者将在短期内获得HPA和SNS措施 他们在一个主要城市教学的急诊室(ER)的演讲 以色列一家医院在经历了一次严重的心理创伤后， 并在接下来的四个月中每隔一段时间。百份之冠措施 将包括。)皮质醇、促肾上腺皮质激素和淋巴细胞 唾液、血液和/或糖皮质激素受体(GR)水平 尿液；b)唾液皮质醇峰谷差、峰下面积 曲线，以及在日循环中的下降速率；以及c.)百分比 0.5 mg剂量的合成药物对皮质醇和GR的抑制作用 类固醇地塞米松。SNS措施将包括：a.)心率和 血压；以及b.)去甲肾上腺素、肾上腺素和3-甲氧基-4- 唾液、血液和/或中测得的羟基苯甘醇(MHPG)水平 尿液。 Logistic回归将用于预测创伤后应激障碍与非创伤后应激障碍的状态 四个月。预测变量将逐步输入到 按时间顺序进行分析，例如：既往创伤病史；2.) 创伤性事件严重程度指数，三.)对指数的反应强度 创伤性事件；iv.)ER、HPA和SNS措施及其相互作用； 和V.)ER后HPA和SNS测量及其相互作用。在这 方法，评估HPA和SNS预测因子的效果和相互作用将 根据其他相关的先行变量的影响进行调整，以及 对于早期的HPA轴和SNS的影响和相互作用。

The major objectives of this competing continuation proposal are: a.)to obtain for the first time sequential measures of hypothalamic-pituitary- adrenal (HPA) axis and sympathetic nervous system (SNS) activity in a large sample of psychologically traumatized persons in the immediate aftermath of the traumatic event and in follow-up; b.) to evaluate the time course of HPA and SNS response patterns in relationship to the development of post-traumatic stress disorder (PTSD); and c.) to examine possible interactions between the SNS and HPA axis in PTSD s pathogenesis. HPA and SNS measures will be obtained in 300 patients shortly after their presentation to the emergency room (ER) of a major urban teaching hospital in Israel following an acute, psychologically traumatic event, and at specified intervals during the next four months. HPA measures will include a.) cortisol, adrenocorticotropin (ACTH), and lymphocyte glucocorticoid receptor (GR) levels measured in saliva, blood, and/or urine; b.) salivary cortisol peak-trough difference, area under the curve, and rate of decline over the diurnal cycle; and c.) percentage of cortisol and GR suppression induced by a 0.5 mg dose of the synthetic steroid dexamethasone. SNS measures will include: a.) heart rate and blood pressure; and b.) norepinephrine, epinephrine, and 3-methoxy-4- hydroxy-phenylglycol (MHPG) levels measured in saliva, blood, and/or urine. Logistic regression will be used to predict PTSD vs. non-PTSD status at four months. Predictor variables will be entered stepwise into the analysis on a chronological basis, e.g., i.) past trauma history; ii.) index traumatic event severity, iii.) response intensity to the index traumatic event; iv.) ER HPA and SNS measures and their interactions; and v.) post-ER HPA and SNS measures and their interactions. In this way, evaluation of HPA and SNS predictor effects and interactions will be adjusted for the effects of other relevant, antecedent variables, and for earlier HPA axis and SNS effects and interactions.