Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, and University of Bern, 3010, Bern, Switzerland.
Dig Dis Sci. 2010 Sep;55(9):2614-23. doi: 10.1007/s10620-009-1082-z. Epub 2009 Dec 24.
Research in rodents demonstrated that psychological stress increases circulating levels of alanine transaminase, aspartate transaminase, and alkaline phosphatase reflecting liver injury. Moreover, chronic posttraumatic stress disorder and transaminases predicted coronary heart disease.
To investigate the hypothesis that severity of posttraumatic stress disorder following myocardial infarction would prospectively relate to liver enzymes.
Study participants were 24 patients (mean 59+/-7 years, 79% men) with an interviewer-rated diagnosis of posttraumatic stress disorder caused by an index myocardial infarction 3+/-3 months before. After a mean follow-up of 26+/-6 months, patients had a clinical interview to reassess posttraumatic stress disorder severity, a medical history, and blood collected to determine liver enzymes.
Total posttraumatic stress disorder symptoms assessed at study entry prospectively predicted plasma levels of alanine transaminase (r=.47, p=.031) and alkaline phosphatase (r=.57, p=.004), but not of aspartate transaminase (p=.15), controlling for follow-up duration and antidepressant use. Total posttraumatic stress disorder symptoms assessed at follow-up were associated with alanine transaminase (r=.72, p=.004), aspartate transaminase (r=.60, p=.018), and alkaline phosphatase (r=.64, p=.001) in the 16 patients who had maintained diagnostic posttraumatic stress disorder, but not in all 24 patients.
The severity of posttraumatic stress disorder following myocardial infarction was associated with mild increase in liver enzyme levels, suggesting that chronic psychological stress relates to hepatic damage in humans. This might help to explain the previously observed increased cardiovascular risk in chronically traumatized individuals.
啮齿动物研究表明，心理压力会导致丙氨酸转氨酶、天冬氨酸转氨酶和碱性磷酸酶的循环水平升高，反映出肝损伤。此外，慢性创伤后应激障碍和转氨酶可预测冠心病。
研究心肌梗死后创伤后应激障碍的严重程度是否与肝酶呈前瞻性相关。
研究参与者为 24 名患者（平均年龄 59+/-7 岁，79%为男性），在心肌梗死发作前 3+/-3 个月通过访谈者评估诊断为创伤后应激障碍。在平均 26+/-6 个月的随访后，患者进行了临床访谈以重新评估创伤后应激障碍的严重程度、病史，并采集血液以确定肝酶。
研究开始时总创伤后应激障碍症状前瞻性预测了丙氨酸转氨酶（r=.47，p=.031）和碱性磷酸酶（r=.57，p=.004）的血浆水平，但对天冬氨酸转氨酶（p=.15）无影响，控制了随访时间和抗抑郁药的使用。在随访时评估的总创伤后应激障碍症状与在保持创伤后应激障碍诊断的 16 名患者中的丙氨酸转氨酶（r=.72，p=.004）、天冬氨酸转氨酶（r=.60，p=.018）和碱性磷酸酶（r=.64，p=.001）相关，但在所有 24 名患者中不相关。
心肌梗死后创伤后应激障碍的严重程度与肝酶水平的轻度升高相关，这表明慢性心理压力与人类的肝损伤有关。这可能有助于解释以前观察到的慢性创伤个体心血管风险增加的现象。
