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情绪耗竭和过度工作承诺与健康学校教师接受低剂量 ACTH1-24(Synacthen)和地塞米松-CRH 测试时下丘脑-垂体-肾上腺(HPA)轴反应的差异相关。

Emotional exhaustion and overcommitment to work are differentially associated with hypothalamus-pituitary-adrenal (HPA) axis responses to a low-dose ACTH1-24 (Synacthen) and dexamethasone-CRH test in healthy school teachers.

机构信息

Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University Bremen, Bremen, Germany.

出版信息

Stress. 2013 Jan;16(1):54-64. doi: 10.3109/10253890.2012.683465. Epub 2012 May 16.

Abstract

Evidence for a detrimental impact of chronic work stress on health has accumulated in epidemiological research. Recent studies indicate altered hypothalamus-pituitary-adrenal (HPA) axis regulation as a possible biological pathway underlying the link between stress and disease. However, the direction of dysregulation remains unclear, with reported HPA hyper- or hyporeactivity. To disentangle potential effects on different functional levels in the HPA axis, we examined responses using two pharmacological stimulation tests in 53 healthy teachers (31 females, 22 males; mean age: 49.3 years; age range: 30-64 years): a low-dose adrenocorticotrophic hormone (ACTH(1-24), Synacthen) test was used to assess adrenal cortex sensitivity and the combined dexamethasone-corticotropin releasing hormone (DEX-CRH) test to examine pituitary and adrenal cortex reactivity. Blood and saliva samples were collected at - 1,+15,+30,+45,+60,+90,+120 min. Emotional exhaustion (EE), the core dimension of burnout, was measured with the Maslach Burnout Inventory. Overcommitment (OC) was assessed according to Siegrist's effort-reward-imbalance model. We found a significant association between EE and higher plasma cortisol profiles after Synacthen (p = 0.045). By contrast, OC was significantly associated with attenuated ACTH (p = 0.045), plasma cortisol (p = 0.005), and salivary cortisol (p = 0.023) concentrations following DEX-CRH. Results support the notion of altered HPA axis regulation in chronically work-stressed teachers, with differential patterns of hyper- and hyporeactivity depending on individual stress condition and the tested functional level of the HPA axis.

摘要

慢性工作压力对健康的不利影响在流行病学研究中已有大量证据。最近的研究表明,下丘脑-垂体-肾上腺(HPA)轴调节的改变可能是压力与疾病之间联系的潜在生物学途径。然而,调节的方向尚不清楚,报告的 HPA 反应过度或反应不足。为了厘清 HPA 轴不同功能水平上的潜在影响,我们使用两种药理学刺激测试检查了 53 名健康教师(31 名女性,22 名男性;平均年龄:49.3 岁;年龄范围:30-64 岁)的反应:使用低剂量促肾上腺皮质激素(ACTH(1-24),Synacthen)测试评估肾上腺皮质敏感性,联合地塞米松-促皮质素释放激素(DEX-CRH)测试检查垂体和肾上腺皮质反应性。在-1、+15、+30、+45、+60、+90、+120 分钟时采集血液和唾液样本。使用 Maslach 职业倦怠量表测量情感耗竭(EE),这是倦怠的核心维度。根据 Siegrist 的努力-回报失衡模型评估过度投入(OC)。我们发现 EE 与 Synacthen 后皮质醇水平升高之间存在显著关联(p = 0.045)。相反,OC 与 ACTH(p = 0.045)、皮质醇(p = 0.005)和唾液皮质醇(p = 0.023)浓度降低显著相关。研究结果支持慢性工作压力下 HPA 轴调节改变的观点,根据个体的应激状态和 HPA 轴的测试功能水平,存在不同的反应过度和反应不足模式。

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