创伤后应激障碍患者的HPA轴功能变化的时间序列特征

已知创伤后应激障碍(posttraumatic stress disorder, PTSD)患者表现出HPA轴(hypothalamic-pituitary- adrenocortical axis)功能异常, 而皮质醇是反映PTSD患者HPA轴功能的重要生物标记。近期的研究结果提示, PTSD患者的皮质醇水平变化可能有明显的时间序列特征, 即应激事件发生后先升高, 后下降至正常水平之下。这一特征受到生物标记的时间特性, 患者病程, 应激源类型和强度, 伴生疾病等因素的干扰和掩蔽。未来研究应进一步采用长期追踪设计, 控制干扰因素的影响, 结合急性应激和慢性应激生物标记来综合验证PTSD患者皮质醇水平变化的时间序列特征|并利用该特征预测PTSD的发生、发展, 以便及时进行干预|考虑皮质醇的代谢、拮抗等机制, 结合多种生物标记综合评估、诊断PTSD患者的HPA轴功能活性。

Temporal characteristics of change in HPA activity among PTSD patients

Posttraumatic stress disorder (PTSD) is associated with abnormal functioning of the hypothalamic- pituitary-adrenocortical (HPA) axis, as shown by alterations of cortisol levels. However, results on the link of cortisol level with PTSD are inconsistent. Recent studies imply that PTSD patients show temporal characteristics of the change in cortisol level with the elevation at early stage and thereafter the decrease relative to the normal basal cortisol level after traumatic exposure. The temporal characteristics might be disturbed or masked by some factors, such as characteristics of biomarker, course of PTSD, type and intensity of stressor and comorbid disease. The present review suggested that future research needs to further profile temporal characteristics of change in cortisol level among PTSD patients by controlling the influencing factors and utilizing long-term follow-up design in combination with acute-stress and chronic- stress biomarkers and investigate whether it can be used to predict and intervene PTSD through cortisol treatment. Considering that cortisol level is regulated by metabolism and antagonism procedures, the use of multi-biomarkers will facilitate the reliable evaluation of the HPA axis activity among PTSD patients.