Young Elizabeth A, Breslau Naomi
Department of Psychiatry and Mental Health Research Institute, University of Michigan, Ann Arbor, 48109-0720, USA.
Arch Gen Psychiatry. 2004 Apr;61(4):394-401. doi: 10.1001/archpsyc.61.4.394.
Prior research has connected posttraumatic stress disorder (PTSD) to increased levels of catecholamines. However, studies of cortisol levels have produced mixed results.
To examine urinary catecholamine and cortisol levels in individuals with PTSD in a community sample.
A representative cohort of young adult community residents, assessed periodically during a 10-year period for exposure to trauma and PTSD, was used to select a subset for urine collection studies conducted in a sleep laboratory across 2 consecutive nights and the intermediate day.
The sample of young adults was randomly selected from a large health maintenance organization and is representative of the geographic area except for the extremes of the socioeconomic status range.
A subsample was selected from the 10-year follow-up cohort (n = 913; 91.1% of the initial sample). Eligibility criteria were: (1) persons exposed to trauma during the preceding 5 years, (2) other individuals who met PTSD criteria, and (3) a random preselected subsample. Of 439 eligible individuals, 292 (66.5%) participated, including 69 with lifetime PTSD.
Measures of cortisol and catecholamine levels in urine.
The lifetime PTSD group demonstrated significantly higher catecholamine levels than the group exposed to trauma without PTSD and the nonexposed group. Individuals exposed to trauma without PTSD demonstrated significantly lower urine catecholamine levels than the nonexposed and the PTSD groups. Mean cortisol levels did not differ across groups. When analyzed by comorbidity with major depressive disorder (MDD), the PTSD-only group did not differ in cortisol levels from the groups with neither PTSD nor MDD. Women with MDD plus PTSD demonstrated significantly higher cortisol levels than women with neither disorder or with either disorder alone.
Trauma per se does not lead to sustained increases in cortisol or catecholamine levels. Posttraumatic stress disorder is associated with higher catecholamine levels. In contrast, persons with PTSD had neither an increase nor a decrease in mean urinary cortisol levels. Women with PTSD and comorbid MDD had higher cortisol levels.
先前的研究已将创伤后应激障碍（PTSD）与儿茶酚胺水平升高联系起来。然而，关于皮质醇水平的研究结果不一。
在社区样本中检测创伤后应激障碍患者的尿儿茶酚胺和皮质醇水平。
选取一组具有代表性的年轻成年社区居民队列，在10年期间定期评估其创伤暴露情况和创伤后应激障碍，从中选择一个子集，在睡眠实验室连续两个晚上及中间一天进行尿液收集研究。
该年轻成人样本是从一个大型健康维护组织中随机选取的，除了社会经济地位范围的极端情况外，代表了该地理区域。
从10年随访队列中选取一个子样本（n = 913；占初始样本的91.1%）。纳入标准为：（1）在过去5年内遭受创伤的人；（2）其他符合创伤后应激障碍标准的个体；（3）一个随机预先选定的子样本。在439名符合条件的个体中，292名（66.5%）参与了研究，其中69名有终生创伤后应激障碍。
尿液中皮质醇和儿茶酚胺水平的测量。
终生创伤后应激障碍组的儿茶酚胺水平显著高于未患创伤后应激障碍的创伤暴露组和未暴露组。未患创伤后应激障碍的创伤暴露个体的尿儿茶酚胺水平显著低于未暴露组和创伤后应激障碍组。各组的平均皮质醇水平无差异。当按与重度抑郁症（MDD）的共病情况分析时，仅患创伤后应激障碍组的皮质醇水平与既无创伤后应激障碍也无重度抑郁症组无差异。患有重度抑郁症合并创伤后应激障碍的女性的皮质醇水平显著高于既无这两种疾病或仅患其中一种疾病的女性。
创伤本身不会导致皮质醇或儿茶酚胺水平持续升高。创伤后应激障碍与较高的儿茶酚胺水平相关。相比之下，创伤后应激障碍患者的平均尿皮质醇水平既没有升高也没有降低。患有创伤后应激障碍合并重度抑郁症的女性的皮质醇水平较高。
