创伤后应激障碍患者皮质醇水平与临床症状的相关性研究
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摘要
背景皮质醇作为下丘脑-垂体-肾上腺(HPA)轴的终末产物,是反映HPA轴功能的重要生物指标。研究发现,创伤后应激障碍(PTSD)存在皮质醇分泌异常,同时还发现给予皮质醇后可改善PTSD症状。目前PTSD临床症状多用量表评估,将皮质醇水平与量表得分做相关性分析,可以为PTSD症状的评估提供生物学依据。目的探讨PTSD患者与健康人群的血清皮质醇水平差异以及皮质醇与PTSD患者临床症状的相关性。方法选取2016年12月—2017年12月石河子大学医学院第一附属医院收治的PTSD患者24例,作为PTSD组;同时选取性别、年龄、月经周期相当的于本院体检的健康人群24例,作为对照组。PTSD组与对照组入院时采用一般资料调查表记录一般资料,PTSD组采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、创伤后应激障碍量表平民版(PCL-C)进行调查;PTSD组与对照组检测血清皮质醇水平。根据采血时间所处的月经周期将PTSD组和对照组的女性分为黄体期、卵泡期、绝经期。结果 PTSD组患者血清皮质醇水平为165(131,181)μg/L,低于对照组的212(202,258)μg/L(Z=-5.574,P<0.001);PTSD组男性患者血清皮质醇水平为175(106,193)μg/L,低于对照组男性的214(208,235)μg/L(Z=-2.878,P=0.004);PTSD组黄体期患者血清皮质醇水平为138(72,165)μg/L,低于对照组黄体期者的261(200,333)μg/L(Z=-3.130,P=0.002);PTSD组卵泡期患者血清皮质醇水平为176(151,206)μg/L,低于对照组卵泡期者的261(200,333)μg/L(Z=-2.193,P=0.028);PTSD组绝经期患者血清皮质醇水平为138(83,186)μg/L,低于对照组绝经期者的209(202,229)μg/L(Z=-2.878,P=0.004)。PTSD患者血清皮质醇水平与HAMD总分、认识障碍、日夜变化、阻滞、睡眠障碍、绝望感、全身症状、躯体性焦虑、PCL-C总分、再体验、麻木和回避、警觉性增高维度得分均呈负相关(P<0.05)。结论 PTSD患者血清皮质醇水平低于健康人群,皮质醇水平可为临床评估PTSD患者的症状程度提供更多方向。
Background Cortisol,as the end product of hypothalamus-pituitary-adrenal(HPA)axis,is an important biological indicator of HPA axis function. It has been found that abnormal cortisol secretion exists in posttraumatic stress disorder(PTSD) and that cortisol can improve PTSD symptoms. At present,PTSD clinical symptoms multi-scale evaluation,cortisol and scale correlation analysis,to provide a biological basis for the evaluation of PTSD symptoms. Objective To investigate the difference of serum cortisol between patients with PTSD and normal population,and the correlation between cortisol and clinical symptoms in patients with PTSD.Methods Twenty-four patients with PTSD admitted to the First Affiliated Hospital of the Medical College,Shihezi University from December 2016 to December 2017 were selected as PTSD group.Twentyfour healthy persons with similar age,gender and menstrual history were selected as control group.General questionnaires were used to record general information of all subjects.The PTSD group was investigated by using Hamilton Depression Scale(HAMD),the Hamilton Anxiety Scale(HAMA),and the Posttraumatic Stress Disorder Check-list-civilian Version(PCL-C).Serum cortisol levels were detected in PTSD group and control group.Women in PTSD group and control group were divided into the luteal phase group,the follicular phase group,and the menopause group according to the menstrual cycle in which the blood was collected.Results The serum cortisol level in PTSD group was 165(131,181) μg/L,lower than 212(202,258)μg/L in control group(Z=-5.574,P<0.001).The serum cortisol level of male patients in PTSD group was 175(106,193)μg/L,lower than 214(208,235) μg/L in control group(Z=-2.878,P=0.004).The serum cortisol level of patients at luteal phase in PTSD group was 138(72,165) μg/L,lower than 261(200,333) μg/L of patients at luteal phase in control group(Z=-3.130,P=0.002).The serum cortisol level of patients at follicular phase of PTSD group was 176(151,206) μg/L,lower than 261(200,333) μg/L of patients at follicular phase of control group(Z=-2.193,P=0.028).The serum cortisol level of patients at menopause in PTSD group was 138(83,186) μg/L,lower than 209(202,229)μg/L of patients at menopause in control group(Z=-2.878,P=0.004).Cortisol was negatively correlated with HAMD total score,PCL-C total score,and scores of cognitive impairment,day and night change,block,sleep disorder,despair,general symptoms,somatic anxiety,re-experience symptoms,avoidance/numbness symptoms and hyper-arousal symptoms(P<0.05).Conclusion Serum cortisol level in patients with PTSD decreased compared with that of normal population.Therefore,it can provide more evidence for assessing symptoms of patients with PTSD.
Background Cortisol,as the end product of hypothalamus-pituitary-adrenal(HPA)axis,is an important biological indicator of HPA axis function. It has been found that abnormal cortisol secretion exists in posttraumatic stress disorder(PTSD) and that cortisol can improve PTSD symptoms. At present,PTSD clinical symptoms multi-scale evaluation,cortisol and scale correlation analysis,to provide a biological basis for the evaluation of PTSD symptoms. Objective To investigate the difference of serum cortisol between patients with PTSD and normal population,and the correlation between cortisol and clinical symptoms in patients with PTSD.Methods Twenty-four patients with PTSD admitted to the First Affiliated Hospital of the Medical College,Shihezi University from December 2016 to December 2017 were selected as PTSD group.Twentyfour healthy persons with similar age,gender and menstrual history were selected as control group.General questionnaires were used to record general information of all subjects.The PTSD group was investigated by using Hamilton Depression Scale(HAMD),the Hamilton Anxiety Scale(HAMA),and the Posttraumatic Stress Disorder Check-list-civilian Version(PCL-C).Serum cortisol levels were detected in PTSD group and control group.Women in PTSD group and control group were divided into the luteal phase group,the follicular phase group,and the menopause group according to the menstrual cycle in which the blood was collected.Results The serum cortisol level in PTSD group was 165(131,181) μg/L,lower than 212(202,258)μg/L in control group(Z=-5.574,P<0.001).The serum cortisol level of male patients in PTSD group was 175(106,193)μg/L,lower than 214(208,235) μg/L in control group(Z=-2.878,P=0.004).The serum cortisol level of patients at luteal phase in PTSD group was 138(72,165) μg/L,lower than 261(200,333) μg/L of patients at luteal phase in control group(Z=-3.130,P=0.002).The serum cortisol level of patients at follicular phase of PTSD group was 176(151,206) μg/L,lower than 261(200,333) μg/L of patients at follicular phase of control group(Z=-2.193,P=0.028).The serum cortisol level of patients at menopause in PTSD group was 138(83,186) μg/L,lower than 209(202,229)μg/L of patients at menopause in control group(Z=-2.878,P=0.004).Cortisol was negatively correlated with HAMD total score,PCL-C total score,and scores of cognitive impairment,day and night change,block,sleep disorder,despair,general symptoms,somatic anxiety,re-experience symptoms,avoidance/numbness symptoms and hyper-arousal symptoms(P<0.05).Conclusion Serum cortisol level in patients with PTSD decreased compared with that of normal population.Therefore,it can provide more evidence for assessing symptoms of patients with PTSD.
引文
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[4]王倩,高隽,杨蕴萍.艾滋病感染者中创伤后应激障碍的发病率及症状结构[J].中国临床心理学杂志,2015,23(3):482-486.DOI:10.16128/j.cnki.1005-3611.2015.03.022.WANG Q,GAO J,YANG Y P.The prevalence of post-traumatic stress disorder(PTSD)and the classification of PTSD symptoms among Chinese HIV-positive people[J].Chinese Journal ofClinicalPsychology,2015,23(3):482-486.DOI:10.16128/j.cnki.1005-3611.2015.03.022.
[5]叶虹,侯振海,施建国,等.道路交通事故致创伤后应激障碍的研究[J].中国康复理论与实践,2009,15(3):265-266.DOI:10.3969/j.issn.1006-9771.2009.03.026.YE H,HOU Z H,SHI J G,et al.Posttraumatic stress disorders after road traffic accident:a clinical investigation[J].Chinese Journal of Rehabilitation Theory and Practice,2009,15(3):265-266.DOI:10.3969/j.issn.1006-9771.2009.03.026.
[6]贺顺龙,刘小红,谢培增,等.海上灾害创伤后应激障碍的临床特点[J].广东医学,2012,33(6):786-788.DOI:10.3969/j.issn.1001-9448.2012.06.025.HE S L,LIU X H,XIE P Z,et al.Clinical characteristics of post traumatic stress disorder in marine disasters[J].Guangdong Medical Journal,2012,33(6):786-788.DOI:10.3969/j.issn.1001-9448.2012.06.025.
[7]孙丽艳,李笑富,白鹰,等.汶川地震后6个月安县受灾群众创伤后应激障碍(PTSD)的发生率及相关因素的分析[J].医学理论与实践,2011,24(20):2412-2415,2425.DOI:10.3969/j.issn.1001-7585.2011.20.005.SUN L Y,LI X F,BAI Y,et al.Prevalence and correlated factors of PTSD in refugees created by disaster 6 months after Wenchuan earthquake[J].The Journal of Medical Theory and Practice,2011,24(20):2412-2415,2425.DOI:10.3969/j.issn.1001-7585.2011.20.005.
[8]JORDAN N N,HOGE C W,TOBLER S K,et al.Mental health impact of 9/11 Pentagon attack:validation of a rapid assessment tool[J].Am J Prev Med,2004,26(4):284-293.DOI:10.1016/j.amepre.2004.01.005.
[9]MORRIS M C,RAO U.Psychobiology of PTSD in the acute aftermath of trauma:integrating research on coping,HPA function and sympathetic nervous system activity[J].Asian J Psychiatry,2013,6(1):3-21.DOI:10.1016/j.ajp.2012.07.012.
[10]YEHUDA R.Post traumatic stress disorder[J].N Engl J Med,2002,346(2):108-114.DOI:10.1056/NEJMra012941.
[11]HAWK L W,DOUGALL A L,URSANO R J,et al.Urinary catecholamines and cortisol in recent-onset posttraumatic stress disorder after motor vehicle accidents[J].Psychosom Med,2000,62(3):423-434.
[12]SCHMIDT U,KALTWASSER S F,WOTJAK C T.Biomarkers in posttraumatic stress disorder:overview and implications for future research[J].Dis Markers,2013,35(1):43-54.DOI:10.1155/2013/835876.
[13]DSM-ⅣWorking Group.Diagnosticand statistical manual of mental disorders[M].4th ed.American Psychiatric Association:1994.
[14]郭念锋.国家职业资格培训教程:心理咨询师(1级)[M].北京:民族出版社,2011.GUO N F.National vocational qualification training course:psychological counsellor(level 1)[M].Beijing:The Ethnic Publishing House,2011.
[15]GEORGE M.Diagnostic and statistical manual of mental disorders,fourth edition(DSM-Ⅳ)[M].American Psychiatric Association,2013:4189.
[16]刘光雄,杨来启,许向东,等.车祸事件后创伤后应激障碍的研究[J].中国心理卫生杂志,2002,16(1):18-20.DOI:10.3321/j.issn:1000-6729.2002.01.007.LIU G X,YANG L Q,XU X D,et al.PTSD after traffic accident[J].Chinese Mental Health Journal,2002,16(1):18-20.DOI:10.3321/j.issn:1000-6729.2002.01.007.
[17]PITMAN R K,RASMUSSON A M,KOENEN K C,et al.Biological studies of post-traumatic stress disorder[J].Nat Rev Neurosci,2012,13(11):769-787.DOI:10.1038/nrn3339.
[18]张权,陈崝,王玮文,等.创伤后应激障碍患者的HPA轴功能变化的时间序列特征[J].心理科学进展,2016,24(4):536-546.DOI:10.3724/SP.J.1042.2016.00536.ZHANGQ,CHENZ,WANGWW,etal.Temporal characteristicsofchangeinHPAactivityamongPTSD patients[J].Advances in Psychological Science,2016,24(4):536-546.DOI:10.3724/SP.J.1042.2016.00536.
[19]DASKALAKIS N P,LEHRNER A,YEHUDA R.Endocrine aspects of post-traumatic stress disorder and implications for diagnosis and treatment[J].Endocrinol Metab Clin North Am,2013,42(3):503-513.DOI:10.1016/j.ecl.2013.05.004.
[20]段妮,张心华,于建华.创伤后应激障碍患者临床症状、心理健康与血浆皮质醇水平的相关性研究[J].中华行为医学与脑科学杂志,2010,19(3):212-214.DOI:10.3760/cma.j.issn.1674-6554.2010.03.007.DUAN N,ZHANG X H,YU J H.Study of the correlation of clinical symptoms,mental health and plasma cortisol level of post-traumatic stress disorder[J].Chinese Journal of Behavioral Medicine and Brain Science,2010,19(3):212-214.DOI:10.3760/cma.j.issn.1674-6554.2010.03.007.
[21]周涵辉,高镇松,钟滂江.创伤后应激障碍患者的焦虑抑郁与血浆皮质醇水平观察[J].精神医学杂志,2009,22(3):201-202.DOI:10.3969/j.issn.1009-7201.2009.03.014.ZHOU H H,GAO Z S,ZHONG P J.An observation on changes of anxiety-depression symptoms and level of serium cortisone in patients with post-traumatic stress disorder[J].Journal of Psychiatry,2009,22(3):201-202.DOI:10.3969/j.issn.1009-7201.2009.03.014.
[22]WIRTH M M,SCHERER S M,HOKS R M,et al.The effect of cortisol on emotional responses depends on order of cortisol and placebo administration in a within-subject design[J].Psychoneuroendocrinology,2011,36(7):945-954.DOI:10.1016/j.psyneuen.2010.11.010.
[23]DELAHANTY D L,RAIMONDE A J,SPOONSTER E.Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident victims[J].Biol Psychiatry,2000,48(9):940-947.
[24]WANG L,CAO C,WANG W,et al.Linking hair cortisol levels to phenotypic heterogeneity of posttraumatic stress symptoms in highly traumatized Chinese women[J].Biol Psychiatry,2015,77(4):e21-22.DOI:10.1016/j.biopsych.2014.05.026.
[2]American Psychinatric Association.Posttraumic stress disorder.Diagnostc and statistical manual of mental disorder,fourth edition,text revision(DSM-Ⅳ-TR)[M].Washing,DC:American Psychiatric Association,2000:463-468.
[3]李洪波.矿难后矿工创伤后应激障碍的研究[D].长春:吉林大学,2011.LIHB.Posttraumaticstressdisorderinminersaftermine disaster[D].Changchun:Jilin University,2011.
[4]王倩,高隽,杨蕴萍.艾滋病感染者中创伤后应激障碍的发病率及症状结构[J].中国临床心理学杂志,2015,23(3):482-486.DOI:10.16128/j.cnki.1005-3611.2015.03.022.WANG Q,GAO J,YANG Y P.The prevalence of post-traumatic stress disorder(PTSD)and the classification of PTSD symptoms among Chinese HIV-positive people[J].Chinese Journal ofClinicalPsychology,2015,23(3):482-486.DOI:10.16128/j.cnki.1005-3611.2015.03.022.
[5]叶虹,侯振海,施建国,等.道路交通事故致创伤后应激障碍的研究[J].中国康复理论与实践,2009,15(3):265-266.DOI:10.3969/j.issn.1006-9771.2009.03.026.YE H,HOU Z H,SHI J G,et al.Posttraumatic stress disorders after road traffic accident:a clinical investigation[J].Chinese Journal of Rehabilitation Theory and Practice,2009,15(3):265-266.DOI:10.3969/j.issn.1006-9771.2009.03.026.
[6]贺顺龙,刘小红,谢培增,等.海上灾害创伤后应激障碍的临床特点[J].广东医学,2012,33(6):786-788.DOI:10.3969/j.issn.1001-9448.2012.06.025.HE S L,LIU X H,XIE P Z,et al.Clinical characteristics of post traumatic stress disorder in marine disasters[J].Guangdong Medical Journal,2012,33(6):786-788.DOI:10.3969/j.issn.1001-9448.2012.06.025.
[7]孙丽艳,李笑富,白鹰,等.汶川地震后6个月安县受灾群众创伤后应激障碍(PTSD)的发生率及相关因素的分析[J].医学理论与实践,2011,24(20):2412-2415,2425.DOI:10.3969/j.issn.1001-7585.2011.20.005.SUN L Y,LI X F,BAI Y,et al.Prevalence and correlated factors of PTSD in refugees created by disaster 6 months after Wenchuan earthquake[J].The Journal of Medical Theory and Practice,2011,24(20):2412-2415,2425.DOI:10.3969/j.issn.1001-7585.2011.20.005.
[8]JORDAN N N,HOGE C W,TOBLER S K,et al.Mental health impact of 9/11 Pentagon attack:validation of a rapid assessment tool[J].Am J Prev Med,2004,26(4):284-293.DOI:10.1016/j.amepre.2004.01.005.
[9]MORRIS M C,RAO U.Psychobiology of PTSD in the acute aftermath of trauma:integrating research on coping,HPA function and sympathetic nervous system activity[J].Asian J Psychiatry,2013,6(1):3-21.DOI:10.1016/j.ajp.2012.07.012.
[10]YEHUDA R.Post traumatic stress disorder[J].N Engl J Med,2002,346(2):108-114.DOI:10.1056/NEJMra012941.
[11]HAWK L W,DOUGALL A L,URSANO R J,et al.Urinary catecholamines and cortisol in recent-onset posttraumatic stress disorder after motor vehicle accidents[J].Psychosom Med,2000,62(3):423-434.
[12]SCHMIDT U,KALTWASSER S F,WOTJAK C T.Biomarkers in posttraumatic stress disorder:overview and implications for future research[J].Dis Markers,2013,35(1):43-54.DOI:10.1155/2013/835876.
[13]DSM-ⅣWorking Group.Diagnosticand statistical manual of mental disorders[M].4th ed.American Psychiatric Association:1994.
[14]郭念锋.国家职业资格培训教程:心理咨询师(1级)[M].北京:民族出版社,2011.GUO N F.National vocational qualification training course:psychological counsellor(level 1)[M].Beijing:The Ethnic Publishing House,2011.
[15]GEORGE M.Diagnostic and statistical manual of mental disorders,fourth edition(DSM-Ⅳ)[M].American Psychiatric Association,2013:4189.
[16]刘光雄,杨来启,许向东,等.车祸事件后创伤后应激障碍的研究[J].中国心理卫生杂志,2002,16(1):18-20.DOI:10.3321/j.issn:1000-6729.2002.01.007.LIU G X,YANG L Q,XU X D,et al.PTSD after traffic accident[J].Chinese Mental Health Journal,2002,16(1):18-20.DOI:10.3321/j.issn:1000-6729.2002.01.007.
[17]PITMAN R K,RASMUSSON A M,KOENEN K C,et al.Biological studies of post-traumatic stress disorder[J].Nat Rev Neurosci,2012,13(11):769-787.DOI:10.1038/nrn3339.
[18]张权,陈崝,王玮文,等.创伤后应激障碍患者的HPA轴功能变化的时间序列特征[J].心理科学进展,2016,24(4):536-546.DOI:10.3724/SP.J.1042.2016.00536.ZHANGQ,CHENZ,WANGWW,etal.Temporal characteristicsofchangeinHPAactivityamongPTSD patients[J].Advances in Psychological Science,2016,24(4):536-546.DOI:10.3724/SP.J.1042.2016.00536.
[19]DASKALAKIS N P,LEHRNER A,YEHUDA R.Endocrine aspects of post-traumatic stress disorder and implications for diagnosis and treatment[J].Endocrinol Metab Clin North Am,2013,42(3):503-513.DOI:10.1016/j.ecl.2013.05.004.
[20]段妮,张心华,于建华.创伤后应激障碍患者临床症状、心理健康与血浆皮质醇水平的相关性研究[J].中华行为医学与脑科学杂志,2010,19(3):212-214.DOI:10.3760/cma.j.issn.1674-6554.2010.03.007.DUAN N,ZHANG X H,YU J H.Study of the correlation of clinical symptoms,mental health and plasma cortisol level of post-traumatic stress disorder[J].Chinese Journal of Behavioral Medicine and Brain Science,2010,19(3):212-214.DOI:10.3760/cma.j.issn.1674-6554.2010.03.007.
[21]周涵辉,高镇松,钟滂江.创伤后应激障碍患者的焦虑抑郁与血浆皮质醇水平观察[J].精神医学杂志,2009,22(3):201-202.DOI:10.3969/j.issn.1009-7201.2009.03.014.ZHOU H H,GAO Z S,ZHONG P J.An observation on changes of anxiety-depression symptoms and level of serium cortisone in patients with post-traumatic stress disorder[J].Journal of Psychiatry,2009,22(3):201-202.DOI:10.3969/j.issn.1009-7201.2009.03.014.
[22]WIRTH M M,SCHERER S M,HOKS R M,et al.The effect of cortisol on emotional responses depends on order of cortisol and placebo administration in a within-subject design[J].Psychoneuroendocrinology,2011,36(7):945-954.DOI:10.1016/j.psyneuen.2010.11.010.
[23]DELAHANTY D L,RAIMONDE A J,SPOONSTER E.Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident victims[J].Biol Psychiatry,2000,48(9):940-947.
[24]WANG L,CAO C,WANG W,et al.Linking hair cortisol levels to phenotypic heterogeneity of posttraumatic stress symptoms in highly traumatized Chinese women[J].Biol Psychiatry,2015,77(4):e21-22.DOI:10.1016/j.biopsych.2014.05.026.