Nijm J, Kristenson M, Olsson A G, Jonasson L
Department of Medicine, Högland Hospital, Eksjö, and Department of Medicine and Care, Division of Cardiology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
J Intern Med. 2007 Sep;262(3):375-84. doi: 10.1111/j.1365-2796.2007.01817.x.
Inflammation is assumed to play a major role in the progress of atherosclerotic disease. We hypothesized that an altered hypothalamic-pituitary adrenal (HPA) axis activity was linked to a disinhibited inflammatory activity in patients with coronary artery disease (CAD).
Thirty CAD patients were assessed 12-14 weeks after a first-time acute coronary syndrome. Serum samples were assayed for C-reactive protein (CRP) and interleukin-6. Free cortisol was measured in a 24-h urine sample and in repeated saliva samples 30 min after awakening and at bedtime. The levels of inflammatory markers and cortisol were also determined before and after standardized physical and psychological stress tests.
The CAD patients had a higher 24-h cortisol secretion and a flattened diurnal slope, resulting from significantly higher cortisol levels at bedtime, compared to clinically healthy controls. The levels of evening cortisol were strongly related to inflammatory markers in serum. When exposed to acute physical and psychological stressors, the CAD patients showed a significantly blunted cortisol response compared to controls. In addition, a stress-induced increase in CRP was only observed in the patient group.
Patients with CAD exhibited a cortisol pattern that markedly differed from controls. The data indicate that a dysfunctional HPA axis response involves a failure to contain inflammatory activity in CAD patients, thus providing a possible link between stress and inflammation in disease.
炎症被认为在动脉粥样硬化疾病进展中起主要作用。我们假设，冠状动脉疾病（CAD）患者下丘脑 - 垂体 - 肾上腺（HPA）轴活性改变与炎症活动失控有关。
对30例首次发生急性冠状动脉综合征后12 - 14周的CAD患者进行评估。检测血清样本中的C反应蛋白（CRP）和白细胞介素 - 6。在24小时尿液样本以及醒来后30分钟和就寝时采集的多次唾液样本中测量游离皮质醇。在标准化身心应激测试前后也测定炎症标志物和皮质醇水平。
与临床健康对照相比，CAD患者24小时皮质醇分泌较高且昼夜斜率变平，这是由于就寝时皮质醇水平显著升高所致。夜间皮质醇水平与血清中的炎症标志物密切相关。与对照组相比，当暴露于急性身心应激源时，CAD患者的皮质醇反应明显减弱。此外，仅在患者组中观察到应激诱导的CRP增加。
CAD患者表现出与对照组明显不同的皮质醇模式。数据表明，功能失调的HPA轴反应涉及CAD患者无法抑制炎症活动，从而在疾病中提供了应激与炎症之间的可能联系。
