HPA轴功能紊乱在童年期不良经历暴露模式和青少年非自杀性自伤行为关联中的作用

童年期不良经历(ACEs)与青少年非自杀性自伤行为(NSSI)密切相关，但ACEs暴露模式如何影响NSSI以及其中的生物学机制尚待阐明。本研究在全国4个地区9600名初一至高三学生中开展调查，利用潜类别分析评价ACEs暴露模式，探讨其与NSSI的关联。选择其中2个地区1600名初一和高一学生开展为期2.5年的随访，结合潜类别和潜转变分析评价ACEs动态暴露模式，分析其对新发NSSI的预测效应，探讨静息态HPA轴（下丘脑-垂体-肾上腺轴）功能在ACEs暴露模式与青少年NSSI关联中的作用。而后引入析因设计，根据随访期NSSI新发情况及ACEs暴露模式选择配对样本，从应激态HPA轴功能和皮质醇受体抵抗揭示ACEs暴露模式影响NSSI发生的HPA轴机制。以此验证“HPA轴功能紊乱是ACEs高暴露模式致青少年NSSI增加的重要生物学基础”的假说，也为ACEs健康危害效应的干预提供理论支撑。

Adverse childhood experiences (ACEs) are closely related with nonsuicidal self-injury behaviors (NSSI) among adolescents, but the effect of ACEs patterns on NSSI is unknown and their possible biological mechanism are needed to clarify. A cross-sectional study will be administered among 9,600 students from grade 1 to grade 3 in junior and senior middle schools in 4 representative areas in China. Latent class analysis will be used to evaluate the patterns of ACEs, and the relationship between patterns of ACEs and past nonsuicidal self-injury behaviors will be analyzed. Then a total of 1,600 students from grade 1 in junior and senior middle schools in 2 areas will be followed up for 2.5 years, at which the participants were re-interviewed every 6 months. And thus the dynamic patterns of ACEs can be evaluated using latent class analysis and latent transition analysis based on the baseline and follow-up data. The predictive value of ACEs patterns on NSSI will be analyzed in the follow-up study. The role of resting HPA axis function in the relationship between ACEs patterns and NSSI can be assessed. Factorial design will be used after the follow-up study, the samples can be selected by the dimensions of ACEs patterns and the presence of NSSI during follow-up. Then the social stressor induced HPA axis function and cortisol resistance can be measured to reveal the mechanism of HPA axis function in the relationship between ACEs patterns and NSSI further. Thus the hypothesis that dysfunction of HPA axis function represent one pathway by which higher ACEs patterns influence NSSI in adolescents will be clarified. Results will offer a theoretical foundation for future intervention aiming at preventing or controlling adverse health effects of ACEs.