van Zuiden Mirjam, Geuze Elbert, Maas Mirjam, Vermetten Eric, Heijnen Cobi J, Kavelaars Annemieke
Laboratory of Psychoneuroimmunology, University Medical Center Utrecht, Utrecht, The Netherlands.
Brain Behav Immun. 2009 Nov;23(8):1132-9. doi: 10.1016/j.bbi.2009.07.004. Epub 2009 Jul 25.
Severe fatigue and co-morbid depressive symptoms are frequently reported by recently deployed military personnel. Stress can induce lasting changes in the negative feedback regulation of the hypothalamic-pituitary-adrenal axis (HPA-axis) and the regulation of the immune system by cortisol. Since these actions of cortisol are modulated via glucocorticoid receptors (GR), we investigated the effect of deployment and of deployment-related fatigue on glucocorticoid binding to peripheral blood mononuclear cells (PBMCs) in a prospective design. Psychological assessments and blood sample collection took place before and one and six months after deployment. Participants were selected from a larger group and assigned to three groups based on their level of fatigue and depressive symptoms six months after deployment. We compared fatigued participants without depressive symptoms (n=21), fatigued participants with depressive symptoms (n=14) and non-fatigued participants without depressive symptoms (n=21). Fatigued participants with depressive symptoms at six months after deployment had higher glucocorticoid binding to PMBCs than the other two groups at all three time points. Notably, this difference was already present before deployment. There was no effect of deployment on glucocorticoid binding to PBMCs. The observed differences in glucocorticoid binding were not related to pre-existing group differences in psychological symptoms. No group differences were observed in the composition of the PBMC population and plasma cortisol levels. These results indicate that high glucocorticoid binding to PBMCs might represent a vulnerability factor for the development of severe fatigue with depressive symptoms after a sustained period of stress, such as deployment.
近期部署的军事人员经常报告有严重疲劳和共病抑郁症状。压力可导致下丘脑 - 垂体 - 肾上腺轴（HPA轴）负反馈调节以及皮质醇对免疫系统调节的持久变化。由于皮质醇的这些作用是通过糖皮质激素受体（GR）介导的，我们采用前瞻性设计研究了部署及与部署相关的疲劳对糖皮质激素与外周血单核细胞（PBMC）结合的影响。在部署前、部署后1个月和6个月进行心理评估和血样采集。参与者从一个较大的群体中选取，并根据部署后6个月的疲劳和抑郁症状水平分为三组。我们比较了无抑郁症状的疲劳参与者（n = 21）、有抑郁症状的疲劳参与者（n = 14）和无抑郁症状的非疲劳参与者（n = 21）。部署后6个月有抑郁症状的疲劳参与者在所有三个时间点的糖皮质激素与PMBC的结合均高于其他两组。值得注意的是，这种差异在部署前就已存在。部署对糖皮质激素与PBMC的结合没有影响。观察到的糖皮质激素结合差异与心理症状方面预先存在的组间差异无关。在PBMC群体组成和血浆皮质醇水平方面未观察到组间差异。这些结果表明，糖皮质激素与PBMC的高结合可能是在持续压力（如部署）后出现伴有抑郁症状的严重疲劳的一个易患因素。
