Pacella Maria L, Hruska Bryce, Steudte-Schmiedgen Susann, George Richard L, Delahanty Douglas L
Kent State University, Department of Psychological Sciences, Kent, OH, USA.
Kent State University, Department of Psychological Sciences, Kent, OH, USA.
Soc Sci Med. 2017 Feb;175:228-234. doi: 10.1016/j.socscimed.2016.12.046. Epub 2017 Jan 19.
Although cortisol alterations have been associated with posttraumatic stress disorder (PTSD) and PTSD symptoms (PTSS), the direction of association is mixed. Cortisol which is measured in blood, saliva, or urine is subject to transient factors that may confound results. Recent advances in cortisol sampling techniques provide novel opportunities to address these inconsistencies. Hair cortisol sampling is a non-invasive method for the retrospective assessment of long-term integrated cortisol, yet its utility at predicting PTSS has not been assessed in acute injury victims.
The aim of this prospective study was to examine whether higher levels of hair cortisol concentrations (HCC) were associated with increases in PTSS following traumatic physical injury.
From January 2012 to May 2013, injury victims admitted to a level-1 Midwestern trauma center were recruited during their routine trauma clinic appointment within 30-days post-injury. Thirty participants had sufficient hair length to obtain 3-cm hair samples for cortisol assay. These participants completed PTSS assessments in relation to their recent injury at both the baseline and follow-up assessments (within 30- and 60-days post-injury, respectively).
Hierarchical regression analyses - which controlled for baseline PTSS, age, and sex - revealed that higher HCC predicted significant increases in overall PTSS at follow-up. Higher HCC also predicted increases in the avoidance/numbing subscale symptoms of PTSS. Dividing the avoidance symptoms and numbing symptoms into two separate clusters (consistent with the 4-factor DSM-5 model of PTSD) revealed that HCC was only marginally associated with numbing, but not with avoidance symptoms.
Hair sampling is a feasible method for assessing integrated cortisol levels soon after traumatic physical injury. This study suggests that elevated HCC may serve as a biomarker of risk for the development of posttraumatic symptomatology, and identifies specific symptoms that may be targeted for intervention in those with high HCC in the aftermath of injury.
尽管皮质醇变化与创伤后应激障碍（PTSD）及PTSD症状（PTSS）相关，但其关联方向并不一致。在血液、唾液或尿液中测量的皮质醇会受到可能混淆结果的瞬时因素影响。皮质醇采样技术的最新进展为解决这些不一致性提供了新机会。毛发皮质醇采样是一种用于回顾性评估长期综合皮质醇的非侵入性方法，但尚未在急性损伤受害者中评估其预测PTSS的效用。
这项前瞻性研究的目的是检查较高水平的毛发皮质醇浓度（HCC）是否与创伤性身体损伤后PTSS的增加相关。
2012年1月至2013年5月，在创伤后30天内，于一家中西部一级创伤中心就诊的受伤受害者在其常规创伤门诊预约时被招募。30名参与者有足够的头发长度以获取3厘米的头发样本用于皮质醇测定。这些参与者在基线和随访评估（分别在受伤后30天和60天内）完成了与近期损伤相关的PTSS评估。
分层回归分析（控制了基线PTSS、年龄和性别）显示，较高的HCC预测随访时总体PTSS会显著增加。较高的HCC还预测PTSS的回避/麻木子量表症状会增加。将回避症状和麻木症状分为两个单独的类别（与PTSD的4因素DSM-5模型一致）显示，HCC仅与麻木有微弱关联，与回避症状无关。
毛发采样是创伤性身体损伤后不久评估综合皮质醇水平的可行方法。本研究表明，升高的HCC可能作为创伤后症状发展风险的生物标志物，并确定了受伤后HCC较高者可能针对干预的特定症状。
