I-Core Research Center for Mass Trauma, Bob Shapell School of Social Work, Tel-Aviv University, P.O. Box 39040, Ramat Aviv, Tel-Aviv, 69978, Israel.
Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel.
J Clin Psychiatry. 2017 Nov/Dec;78(9):e1180-e1186. doi: 10.4088/JCP.16m11344.
This study sheds light on the importance of long-term follow-up of trauma survivors, posttraumatic stress disorder (PTSD) trajectories, and early detection of health risk factors in trauma survivors. The present study prospectively assessed the following over 23 years: (1) the association of psychological and physiologic stress during captivity with elevated C-reactive protein (CRP) levels and metabolic syndrome (MetS), which includes hypertension; elevated levels of insulin, triglycerides, and fasting glucose; decreased levels of high-density lipoprotein cholesterol; and obesity and (2) the implication of PTSD trajectories in elevated CRP levels and MetS.
Measurements were taken in 1991, 2003, 2008, and 2015. Participants were 116 Israeli combat veterans of the 1973 Yom Kippur War (of these, 101 were former prisoners of war [ex-POWs] and 15 were comparable controls). The medical assessments relevant for this study were body mass index, fasting blood glucose levels, and diabetes, blood pressure or a diagnosis of hypertension, high-density lipoprotein cholesterol and triglyceride levels, and medication intake. In addition, the PTSD Inventory was used to assess PTSD symptoms and trajectories over time according to DSM-IV-TR PTSD criteria.
Captivity-in particular, the captivity stressors of weight loss, physical suffering, psychological suffering, and humiliation-was implicated in both elevated CRP levels and MetS, significantly so with elevated CRP levels (P = .01, R² = 0.33). Captivity-induced PTSD, in particular chronic and delayed PTSD trajectories, was associated with elevated CRP levels and MetS, significantly so for MetS (P = .05).
Monitoring inflammation using markers like CRP level in trauma survivors can be beneficial, particularly if PTSD is chronic or delayed. Clinicians treating trauma survivors should raise awareness of the importance of such measures in light of long-term health vulnerabilities.
本研究强调了对创伤幸存者进行长期随访、创伤后应激障碍（PTSD）轨迹以及早期发现创伤幸存者健康风险因素的重要性。本研究前瞻性评估了以下内容超过 23 年：（1）被俘期间的心理和生理压力与 C 反应蛋白（CRP）水平升高和代谢综合征（MetS）之间的关系，包括高血压；胰岛素、甘油三酯和空腹血糖水平升高；高密度脂蛋白胆固醇水平降低；以及肥胖症，（2）PTSD 轨迹对 CRP 水平升高和 MetS 的影响。
于 1991 年、2003 年、2008 年和 2015 年进行了测量。参与者为 1973 年赎罪日战争的 116 名以色列战斗老兵（其中 101 人为前战俘[前战俘]，15 人为可比对照组）。本研究相关的医学评估包括体重指数、空腹血糖水平和糖尿病、血压或高血压诊断、高密度脂蛋白胆固醇和甘油三酯水平以及药物摄入。此外，还根据 DSM-IV-TR PTSD 标准使用 PTSD 清单评估 PTSD 症状和随时间的轨迹。
被俘-特别是体重减轻、身体痛苦、心理痛苦和屈辱等被俘压力源-与 CRP 水平升高和 MetS 有关，与 CRP 水平升高显著相关（P=0.01，R²=0.33）。被俘引起的 PTSD，特别是慢性和延迟性 PTSD 轨迹，与 CRP 水平升高和 MetS 有关，与 MetS 显著相关（P=0.05）。
在创伤幸存者中使用 CRP 水平等标志物监测炎症可能是有益的，特别是如果 PTSD 是慢性或延迟的。治疗创伤幸存者的临床医生应提高认识，重视这些措施对长期健康脆弱性的重要性。
