Videlock Elizabeth J, Adeyemo Mopelola, Licudine Arlene, Hirano Miyoshi, Ohning Gordon, Mayer Minou, Mayer Emeran A, Chang Lin
Center for Neurobiology of Stress, David Geffen School of Medicine, University of California, Los Angeles, California 90095-7378, USA.
Gastroenterology. 2009 Dec;137(6):1954-62. doi: 10.1053/j.gastro.2009.08.058. Epub 2009 Sep 6.
BACKGROUND & AIMS: A history of early adverse life events (EALs) is associated with a poorer outcome and higher levels of distress in adult patients with functional gastrointestinal disorders. An EAL is thought to predispose individuals to develop a range of chronic illnesses by inducing persistent changes in the central stress response systems, including the hypothalamic-pituitary-adrenal (HPA) axis. We sought to determine if EALs affect the HPA axis response to a visceral stressor in irritable bowel syndrome (IBS) patients and healthy controls, and to determine if this is affected by sex or related to symptoms or quality of life.
Forty-four IBS patients (25 women, 19 men) and 39 healthy controls (21 women, 18 men) were assessed for gastrointestinal and psychological symptoms and EALs by validated questionnaires and interview. All subjects underwent a visceral stressor (sigmoidoscopy). Salivary cortisol was collected at baseline and serially for 1 hour poststressor.
Twenty-one IBS patients and 18 controls had EALs. In subjects with and without IBS, an EAL was associated with higher mean (+/-SD) cortisol levels (0.32 +/- 0.2 vs 0.20 +/- 0.1 microg/dL; P = .003) and higher area under the curve (28.1 +/- 17 vs 18.6 +/- 13 microg x min/dL; P = .005) after the stressor compared with subjects without EALs. In IBS, a faster resolution of cortisol to basal values corresponded to lower symptom severity (r = -0.36, P < .05) and better disease-specific quality of life (r = 0.33, P < .05).
HPA axis hyperresponsiveness to a visceral stressor is related more to a history of EALs than to the presence of IBS. However, HPA axis reactivity has a moderating effect on IBS symptoms.
早年不良生活事件（EALs）史与成年功能性胃肠病患者较差的预后及更高的痛苦水平相关。EALs被认为通过诱导包括下丘脑 - 垂体 - 肾上腺（HPA）轴在内的中枢应激反应系统发生持续变化，使个体易患一系列慢性疾病。我们试图确定EALs是否影响肠易激综合征（IBS）患者和健康对照者的HPA轴对内脏应激源的反应，并确定这是否受性别影响或与症状或生活质量相关。
通过经过验证的问卷和访谈，对44例IBS患者（25例女性，19例男性）和39例健康对照者（21例女性，18例男性）进行胃肠道和心理症状以及EALs评估。所有受试者均接受内脏应激源（乙状结肠镜检查）。在基线时以及应激源后连续1小时收集唾液皮质醇。
21例IBS患者和18例对照者有EALs。在有和没有IBS的受试者中，与没有EALs的受试者相比，EALs与应激源后更高的平均（±标准差）皮质醇水平（0.32±0.2 vs 0.20±0.1μg/dL；P = 0.003）和更高的曲线下面积（28.1±17 vs 18.6±13μg·min/dL；P = 0.005）相关。在IBS中，皮质醇更快恢复到基础值对应于更低的症状严重程度（r = -0.36，P < 0.05）和更好的疾病特异性生活质量（r = 0.33，P < 0.05）。
HPA轴对内脏应激源的高反应性更多地与EALs史相关，而非与IBS的存在相关。然而，HPA轴反应性对IBS症状有调节作用。
