Baker Dewleen G, Ekhator Nosa N, Kasckow John W, Dashevsky Boris, Horn Paul S, Bednarik Ludmila, Geracioti Thomas D
Psychiatry Service, San Diego VA Healthcare System, CA, USA.
Am J Psychiatry. 2005 May;162(5):992-4. doi: 10.1176/appi.ajp.162.5.992.
Results of basal peripheral cortisol measures in posttraumatic stress disorder (PTSD) have been variable. The authors' goal was to measure CSF cortisol concentrations, which more accurately reflect brain glucocorticoid exposure, in subjects with or without PTSD.
CSF was withdrawn from a subarachnoid catheter and plasma from a venous catheter, both indwelling, over a 6-hour interval to determine hourly plasma ACTH and cortisol concentrations and hourly CSF cortisol levels in eight well-characterized combat veterans with PTSD and eight matched healthy volunteers.
Mean CSF cortisol concentrations were significantly higher in the subjects with PTSD (3.18 ng/ml, SD=0.33) than in the normal volunteers (2.33 ng/ml, SD=0.50), largely due to higher CSF cortisol concentration nadirs. No group differences were observed in either plasma ACTH or peripheral (plasma or urinary free) cortisol. CSF corticotropin-releasing hormone and CSF cortisol concentrations were positively and significantly correlated.
Despite normal peripheral cortisol indexes in the veterans with PTSD, their CNS exposure to cortisol was greater than that of normal comparison subjects.
创伤后应激障碍（PTSD）患者基础外周皮质醇测量结果存在差异。作者的目标是测量患有或未患有PTSD的受试者的脑脊液皮质醇浓度，其能更准确地反映大脑糖皮质激素暴露情况。
通过蛛网膜下腔导管抽取脑脊液，通过留置的静脉导管抽取血浆，在6小时内测定8名特征明确的患有PTSD的退伍军人及8名匹配的健康志愿者的每小时血浆促肾上腺皮质激素（ACTH）和皮质醇浓度以及每小时脑脊液皮质醇水平。
患有PTSD的受试者的脑脊液皮质醇平均浓度（3.18 ng/ml，标准差=0.33）显著高于正常志愿者（2.33 ng/ml，标准差=0.50），这主要是由于脑脊液皮质醇浓度最低点较高。血浆ACTH或外周（血浆或尿游离）皮质醇均未观察到组间差异。脑脊液促肾上腺皮质激素释放激素与脑脊液皮质醇浓度呈显著正相关。
尽管患有PTSD的退伍军人外周皮质醇指标正常，但其中枢神经系统的皮质醇暴露量高于正常对照受试者。
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