Wessa Michèle, Rohleder Nicolas, Kirschbaum Clemens, Flor Herta
Department of Clinical and Cognitive Neuroscience, Central Institute of Mental Health, University of Heidelberg, J 5, 68159 Mannheim, Germany.
Psychoneuroendocrinology. 2006 Feb;31(2):209-15. doi: 10.1016/j.psyneuen.2005.06.010. Epub 2005 Sep 9.
An altered function of the hypothalamic-pituitary-adrenal axis is assumed to be characteristic for Posttraumatic Stress Disorder (PTSD), although there is inconsistent empirical evidence. Only few studies examined the awakening cortisol response and a daytime profile in PTSD. Salivary cortisol levels were measured at seven intervals from awakening until 8 PM in trauma-exposed subjects with (N=29) and without PTSD (N=19) and in 15 non-exposed controls. While the three groups did not differ with respect to their first cortisol level immediately after awakening, the expected cortisol increase to awakening 15-60 min later was significantly lower in PTSD patients compared to non-PTSD subjects and healthy controls. This effect remained stable when trauma-exposed subjects with comorbid major depression were excluded from the analysis. A significant negative correlation between the overall cortisol secretion (AUC(G)) and overall PTSD symptomatology and hyper-arousal symptoms was found. The findings are discussed in light of the hypothesis of a counterregulation of hyper-arousal symptoms and chronic stress in PTSD.
尽管经验证据并不一致，但下丘脑 - 垂体 - 肾上腺轴功能改变被认为是创伤后应激障碍（PTSD）的特征。只有少数研究考察了PTSD患者觉醒时的皮质醇反应和日间变化情况。对有PTSD（N = 29）和无PTSD（N = 19）的创伤暴露受试者以及15名未暴露的对照组，从觉醒到晚上8点每隔一段时间测量唾液皮质醇水平。虽然三组在觉醒后即刻的首次皮质醇水平上没有差异，但与无PTSD受试者和健康对照组相比，PTSD患者在觉醒后15 - 60分钟预期的皮质醇升高显著更低。当将伴有共病重度抑郁的创伤暴露受试者排除在分析之外时，这一效应仍保持稳定。研究发现了总体皮质醇分泌（AUC(G)）与总体PTSD症状及过度唤醒症状之间存在显著负相关。根据PTSD中过度唤醒症状与慢性应激的反调节假说对这些发现进行了讨论。
