Pervanidou Panagiota, Kolaitis Gerasimos, Charitaki Stella, Margeli Alexandra, Ferentinos Spyros, Bakoula Chrysa, Lazaropoulou Christina, Papassotiriou Ioannis, Tsiantis John, Chrousos George P
First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Athens, Greece.
Psychoneuroendocrinology. 2007 Sep-Nov;32(8-10):991-9. doi: 10.1016/j.psyneuen.2007.07.001. Epub 2007 Sep 7.
This study examined prospectively the activity of the hypothalamic-pituitary-adrenal axis, the sympathetic nervous system and inflammatory factors in children shortly after a motor vehicle accident (MVA) in relation to later posttraumatic stress disorder (PTSD) development.
Fifty six children, aged 7-18, were studied after an MVA and 1 and 6 months later; 40 subjects served as controls. Morning serum cortisol and interleukin (IL)-6 and plasma catecholamine concentrations were measured within 24h after the event. Salivary cortisol was measured 5 times at defined time points during the same day. PTSD diagnoses 1 and 6 months later were based on K-SADS interview.
Morning serum IL-6 concentrations, measured within the first 24h after the accident, were higher in children that developed PTSD 6 months later than those who did not and those of the control group. Longitudinal IL-6 measurements revealed normalization of IL-6 in the PTSD group, while no differences between the three groups were detected 1 and 6 months later. Evening salivary cortisol and morning serum IL-6 after the accident were positively inter-related (r=0.54, p<0.001) and in separate regression analyses both predicted PTSD development 6 months later. In contrast, morning serum IL-6 did nor correlate with morning serum or salivary cortisol concentrations.
Immediate posttraumatic alterations in neuroendocrine or inflammatory factors-increased evening salivary cortisol and/or increased morning serum IL-6 concentrations-are involved in subsequent PTSD development in children and adolescents.
本研究前瞻性地调查了儿童在机动车事故（MVA）后不久下丘脑-垂体-肾上腺轴、交感神经系统和炎症因子的活性，以及它们与后期创伤后应激障碍（PTSD）发生发展的关系。
对56名7至18岁的儿童在机动车事故后、事故后1个月和6个月进行了研究；40名受试者作为对照。在事故发生后24小时内测量早晨血清皮质醇、白细胞介素（IL）-6和血浆儿茶酚胺浓度。在同一天的特定时间点测量5次唾液皮质醇。1个月和6个月后的创伤后应激障碍诊断基于儿童版情感障碍和精神分裂症问卷（K-SADS）访谈。
事故后最初24小时内测量的早晨血清IL-6浓度，在6个月后发生创伤后应激障碍的儿童中高于未发生创伤后应激障碍的儿童及对照组儿童。对IL-6的纵向测量显示，创伤后应激障碍组的IL-6恢复正常，而1个月和6个月后三组之间未检测到差异。事故后的晚间唾液皮质醇和早晨血清IL-6呈正相关（r = 0.54，p < 0.001），在单独的回归分析中，二者均预测了6个月后创伤后应激障碍的发生。相比之下，早晨血清IL-6与早晨血清或唾液皮质醇浓度无关。
创伤后立即出现的神经内分泌或炎症因子改变——晚间唾液皮质醇升高和/或早晨血清IL-6浓度升高——与儿童和青少年随后发生创伤后应激障碍有关。
