Center of Excellence for Stress and Mental Health, Veteran's Administration, San Diego, California2Department of Psychiatry, University of California, San Diego, La Jolla, California.
Center of Excellence for Stress and Mental Health, Veteran's Administration, San Diego, California2Department of Psychiatry, University of California, San Diego, La Jolla, California3Department of Psychiatry, Veterans Administration San Diego Healthcare S.
JAMA Psychiatry. 2015 Oct;72(10):979-86. doi: 10.1001/jamapsychiatry.2015.0922.
Disrupted autonomic nervous system functioning as measured by heart rate variability (HRV) has been associated with posttraumatic stress disorder (PTSD). It is not clear, however, whether reduced HRV before trauma exposure contributes to the risk for development of PTSD.
To examine whether HRV before combat deployment is associated with increased risk of a PTSD diagnosis after deployment when accounting for deployment-related combat exposure.
DESIGN, SETTING, AND PARTICIPANTS: Between July 14, 2008, and May 24, 2012, active-duty Marines were assessed 1 to 2 months before a combat deployment and again 4 to 6 months after their return. The first phase of the Marine Resiliency Study (MRS-I) included 1415 male Marines, 59 of whom developed PTSD after deployment. Participants in the second phase of the Marine Resiliency Study (MRS-II) included 745 male Marines, 25 of whom developed PTSD after deployment. Analysis was conducted from November 25, 2013, to April 16, 2015.
Predeployment HRV was measured via finger photoplethysmography during a 5-minute period of rest. Frequency-domain measures of HRV were generated. Diagnosis of PTSD was determined using the Clinician-Administered PTSD Scale.
After accounting for deployment-related combat exposure, lower HRV before deployment as measured by an increased low-frequency (LF) to high-frequency (HF) ratio of HRV was associated with risk of PTSD diagnosis after deployment (combined MRS-I and MRS-II cohort meta-analysis odds ratio, 1.47; 95% CI, 1.10-1.98; P = .01). The prevalence of postdeployment PTSD was higher in participants with high predeployment LF:HF ratios (15.8% [6 of 38 participants]) compared with participants who did not have high LF:HF ratios (3.7% [78 of 2122 participants]).
This prospective longitudinal study provides initial and modest evidence that an altered state of autonomic nervous system functioning contributes to PTSD vulnerability, taking into account other key risk factors. If these findings are replicated, interventions that change autonomic nervous system function may open novel opportunities for prevention and treatment of PTSD.
心率变异性（HRV）测量的自主神经系统功能紊乱与创伤后应激障碍（PTSD）有关。然而，尚不清楚创伤前 HRV 降低是否会增加 PTSD 的发病风险。
当考虑到与部署相关的战斗暴露时，研究部署前 HRV 是否与部署后 PTSD 诊断的风险增加有关。
设计、地点和参与者：2008 年 7 月 14 日至 2012 年 5 月 24 日期间，现役海军陆战队员在战斗部署前 1 至 2 个月和返回后 4 至 6 个月进行评估。海军陆战队复原力研究（MRS-I）的第一阶段包括 1415 名男性海军陆战队员，其中 59 人在部署后患上了 PTSD。海军陆战队复原力研究（MRS-II）的第二阶段参与者包括 745 名男性海军陆战队员，其中 25 人在部署后患上了 PTSD。分析于 2013 年 11 月 25 日至 2015 年 4 月 16 日进行。
使用手指光体积描记法在 5 分钟的休息期间测量部署前的 HRV。生成 HRV 的频域测量值。使用临床医生管理的 PTSD 量表确定 PTSD 的诊断。
在考虑与部署相关的战斗暴露后，与部署后 PTSD 诊断相关的 HRV 降低，通过增加 HRV 的低频（LF）与高频（HF）比值来衡量（MRS-I 和 MRS-II 综合队列荟萃分析的优势比，1.47；95%置信区间，1.10-1.98；P=0.01）。与没有高 LF:HF 比值的参与者相比，具有高部署前 LF:HF 比值的参与者（15.8%[38 名参与者中的 6 名]）在 PTSD 后出现 PTSD 的患病率更高（3.7%[2122 名参与者中的 78 名]）。
这项前瞻性纵向研究初步且适度地表明，自主神经系统功能的改变状态导致 PTSD 易感性，同时考虑到其他关键风险因素。如果这些发现得到复制，改变自主神经系统功能的干预措施可能为 PTSD 的预防和治疗开辟新的机会。
