Zorn Jelle V, Schür Remmelt R, Boks Marco P, Kahn René S, Joëls Marian, Vinkers Christiaan H
Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
Psychoneuroendocrinology. 2017 Mar;77:25-36. doi: 10.1016/j.psyneuen.2016.11.036. Epub 2016 Dec 8.
The hypothalamus-pituitary-adrenal (HPA) axis and its end product cortisol are essential for an adequate response to stress. Considering the role of stress as a risk factor for psychiatric disorders, it is not surprising that cortisol stress reactivity has frequently been investigated in patients versus healthy individuals. However, the large heterogeneity in measures of the cortisol stress response has hampered a systematic evaluation of the evidence. We here report of a systematic literature review and meta-analysis on cortisol reactivity to psychosocial stress across psychiatric disorders. Original data from authors were obtained to construct standardized cortisol outcomes (the areas under the curve with respect to increase (AUCi) and ground (AUCg)) and to examine the influence of sex and symptomatic state on cortisol stress reactivity. Fourteen studies on major depressive disorder (MDD) (n=1129), 9 on anxiety disorders (n=732, including social anxiety disorder (SAD), posttraumatic stress disorder, panic disorder and mixed samples of anxiety disorders) and 4 on schizophrenia (n=180) were included that used the Trier Social Stress Test or an equivalent psychosocial stress task. Sex-dependent changes in stress reactivity were apparent in MDD and anxiety disorders. Specifically, women with current MDD or an anxiety disorder exhibited a blunted cortisol stress response, whereas men with current MDD or SAD showed an increased cortisol response to psychosocial stress. In individuals with remitted MDD, altered cortisol stress reactivity was less pronounced in women and absent in men. For schizophrenia, cortisol stress reactivity was blunted in both men and women, but the number of studies was limited and showed evidence for publication bias. These findings illustrate that sharing individual data to disentangle the effects of sex, symptom levels and other factors is essential for further understanding of the alterations in cortisol stress reactivity across psychiatric disorders.
下丘脑-垂体-肾上腺（HPA）轴及其终产物皮质醇对于充分应对压力至关重要。鉴于压力作为精神疾病风险因素的作用，皮质醇应激反应性在患者与健康个体中经常被研究也就不足为奇了。然而，皮质醇应激反应测量方法的巨大异质性阻碍了对证据的系统评估。我们在此报告一项关于精神疾病中皮质醇对心理社会压力反应性的系统文献综述和荟萃分析。获取作者的原始数据以构建标准化的皮质醇结果（相对于增加的曲线下面积（AUCi）和基线（AUCg）），并研究性别和症状状态对皮质醇应激反应性的影响。纳入了14项关于重度抑郁症（MDD）（n = 1129）、9项关于焦虑症（n = 732，包括社交焦虑症（SAD）、创伤后应激障碍、惊恐障碍和焦虑症混合样本）和4项关于精神分裂症（n = 180）的研究，这些研究使用了特里尔社会应激测试或等效的心理社会应激任务。在MDD和焦虑症中，应激反应性存在性别依赖性变化。具体而言，患有当前MDD或焦虑症的女性表现出皮质醇应激反应迟钝，而患有当前MDD或SAD的男性对心理社会压力的皮质醇反应增加。在缓解期MDD患者中，皮质醇应激反应性的改变在女性中不太明显，在男性中则不存在。对于精神分裂症，男性和女性的皮质醇应激反应性均迟钝，但研究数量有限且存在发表偏倚的证据。这些发现表明，共享个体数据以厘清性别、症状水平和其他因素的影响对于进一步理解精神疾病中皮质醇应激反应性的改变至关重要。
