Pervanidou Panagiota, Kolaitis Gerasimos, Charitaki Stella, Lazaropoulou Christina, Papassotiriou Ioannis, Hindmarsh Peter, Bakoula Chrysa, Tsiantis John, Chrousos George P
First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Athens, Greece.
Biol Psychiatry. 2007 Nov 15;62(10):1095-102. doi: 10.1016/j.biopsych.2007.02.008. Epub 2007 Jul 12.
The hypothalamic-pituitary-adrenal axis and the catecholaminergic system are involved in the pathophysiology of post-traumatic stress disorder (PTSD). This was a prospective and longitudinal study of neuroendocrine physiology in children with PTSD following a motor vehicle accident (MVA).
Sixty children aged 7-18 were studied immediately after an MVA and 1 and 6 months later. Fasting morning plasma catecholamine and serum cortisol concentrations were measured. Salivary cortisol concentrations were measured serially five times daily to examine circadian variation in all three assessments. Values were compared between those who did (PTSD) or did not develop PTSD (non-PTSD) after the trauma and a control group at months 1 and 6.
Twenty-three of the children had PTSD at the 1-month and 9 children at the 6-month evaluations. 1) Plasma noradrenaline concentrations were higher in the PTSD group than in the other two groups at both months 1 and 6 (p = .001 and p = .001, respectively). Additionally, the PTSD patients presented with significantly higher salivary cortisol concentrations at 18.00 (p = .03) and 21.00 (p = .04) at month 1.2) Eight children suffering from PTSD at both months 1 and 6 had significantly elevated plasma noradrenaline concentrations at month 6 compared with those at month 1 and at baseline and to the other two groups (within subjects: p < .001; between subjects: p = .005). The initially elevated evening salivary cortisol concentrations in this group normalized at month 6.
This progressive divergence of noradrenaline and cortisol concentrations over time might underlie the natural history and pathophysiology of PTSD.
下丘脑 - 垂体 - 肾上腺轴和儿茶酚胺能系统参与创伤后应激障碍（PTSD）的病理生理过程。这是一项对机动车事故（MVA）后患有PTSD的儿童进行神经内分泌生理学的前瞻性纵向研究。
对60名7至18岁的儿童在MVA后立即进行研究，并在1个月和6个月后再次研究。测量空腹早晨血浆儿茶酚胺和血清皮质醇浓度。每天连续测量5次唾液皮质醇浓度，以检查在所有三次评估中的昼夜变化。在创伤后1个月和6个月时，比较发生PTSD（PTSD组）或未发生PTSD（非PTSD组）的儿童与对照组的值。
在1个月评估时有23名儿童患有PTSD，在6个月评估时有9名儿童患有PTSD。1）在1个月和6个月时，PTSD组的血浆去甲肾上腺素浓度均高于其他两组（分别为p = 0.001和p = 0.001）。此外，在第1个月时，PTSD患者在18:00（p = 0.03）和21:00（p = 0.04）时的唾液皮质醇浓度显著更高。2）在1个月和6个月时均患有PTSD的8名儿童，其在第6个月时的血浆去甲肾上腺素浓度与第1个月和基线时相比以及与其他两组相比显著升高（受试者内：p < 0.001；受试者间：p = 0.005）。该组最初升高的夜间唾液皮质醇浓度在第6个月时恢复正常。
随着时间的推移，去甲肾上腺素和皮质醇浓度的这种逐渐差异可能是PTSD自然病程和病理生理学的基础。
