Yehuda R, Lowy M T, Southwick S M, Shaffer D, Giller E L
Psychiatry Department, University of Connecticut Health Center, Farmington 06032.
Am J Psychiatry. 1991 Apr;148(4):499-504. doi: 10.1176/ajp.148.4.499.
The authors' objective was to investigate the possibility that glucocorticoid receptor changes may be involved in the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in posttraumatic stress disorder (PTSD).
They measured the number of lymphocyte cytosolic glucocorticoid receptors and plasma cortisol concentrations in 15 consecutively admitted male combat Vietnam veterans with PTSD and in a normal comparison group of 11 subjects.
Both the patients and the normal comparison subjects showed a morning-to-afternoon decline in glucocorticoid receptor concentrations, paralleling the normal diurnal decline in cortisol levels. The number of glucocorticoid receptors was 63% greater in the morning and 26% greater in the afternoon in the patients with PTSD than in the normal subjects. No group differences in cortisol levels were observed, nor were glucocorticoid receptor number and cortisol levels correlated. The number of morning glucocorticoid receptors was positively correlated with symptoms of PTSD and anxiety.
These results provide further evidence for a dysregulation of the HPA axis in PTSD. The finding that patients with PTSD had a substantially greater number of lymphocyte glucocorticoid receptors than normal comparison subjects is consistent with the authors' previous observations of low 24-hour urinary cortisol excretion in subjects with PTSD. Furthermore, the receptor changes observed are opposite of those reported in major depressive disorder. The present data, along with other findings of HPA abnormalities in PTSD, support the possibility of a greater negative feedback sensitivity at one or more levels of the HPA axis.
作者的目的是研究糖皮质激素受体变化可能参与创伤后应激障碍（PTSD）下丘脑 - 垂体 - 肾上腺（HPA）轴失调的可能性。
他们测量了15名连续入院的患有PTSD的越战男性退伍军人以及11名正常对照受试者的淋巴细胞胞质糖皮质激素受体数量和血浆皮质醇浓度。
患者和正常对照受试者的糖皮质激素受体浓度均呈现从早晨到下午的下降，与皮质醇水平正常的昼夜下降情况平行。PTSD患者早晨的糖皮质激素受体数量比正常受试者多63%，下午多26%。未观察到两组在皮质醇水平上的差异，糖皮质激素受体数量与皮质醇水平也无相关性。早晨糖皮质激素受体数量与PTSD和焦虑症状呈正相关。
这些结果为PTSD中HPA轴失调提供了进一步证据。PTSD患者淋巴细胞糖皮质激素受体数量比正常对照受试者显著更多这一发现，与作者之前对PTSD患者24小时尿皮质醇排泄量低的观察结果一致。此外，观察到的受体变化与重度抑郁症中报道的变化相反。目前的数据，连同PTSD中HPA异常的其他发现，支持了HPA轴一个或多个水平上存在更大负反馈敏感性的可能性。
