Department of Psychiatry and Mental Health, Groote Schuur Hospital, University of Cape Town Cape Town, South Africa; Division of Dermatology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Division of Dermatology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Psychoneuroendocrinology. 2018 Jan;87:204-214. doi: 10.1016/j.psyneuen.2017.10.022. Epub 2017 Nov 2.
Several factors are known contribute to hair cortisol concentration (HCC) in adults. However, there is less research on determinants of HCC in children and adolescents. HCC is a valuable tool for medical research pertaining to the hypothalamic-pituitary-adrenal (HPA) axis. This review aims to assess the extent to which established determinants of HCC in adults have been consistently reported in children (birth - 18 years) and to identify determinants of HCC specific to this age group.
Eligible studies were identified, selected and appraised as per PRISMA-P guidelines and as detailed in our systematic review protocol, registered on PROSPERO (registration number CRD42017056220). In view of contrasting methods and measures, a meta-analysis could not be done but a qualitative synthesis was performed.
Thirty-six studies were included in the analysis. Higher HCC is associated with male sex and anthropometry, particularly increased body mass index and waist circumference. There is preliminary evidence to suggest that socio-economic status is inversely related to child HCC, particularly with reference to caregiver education and income. Of note, most of the studies analysing socio-economic variables were performed in relatively equal societies. Hair wash frequency and use of hair products and treatments do not affect HCC when proximal segments of hair are used. There is conflicting evidence regarding the relationship between HCC and age in children and adolescents. Further investigation is required to better delineate if and how the following are associated with HCC in children: hair colour, hair type, exposure to trauma and stressors, psychiatric illness, atopic illness, steroid use (including topical and inhaled steroids) and perinatal variables.
Sex and anthropometry are potential confounders and should be considered for adjustment in hair cortisol research. Hair wash frequency and use of hair products and treatments are not important confounders when proximal hair segments are used. A better understanding of HCC in children in relation to exposure to trauma and stressors is required before it can be used as a biomarker, particularly in terms of vulnerable developmental stages, definition and measurement of stress, and temporal relationship to stressors. Age, SES and other correlates also warrant further investigation.
已知有几个因素会影响成人的头发皮质醇浓度（HCC）。然而，关于儿童和青少年 HCC 的决定因素的研究较少。HCC 是研究下丘脑-垂体-肾上腺（HPA）轴相关医学问题的一个很有价值的工具。本综述旨在评估在儿童（出生至 18 岁）中，成人 HCC 的既定决定因素得到一致报告的程度，并确定该年龄组特有的 HCC 决定因素。
根据 PRISMA-P 指南和我们的系统综述方案进行了合格研究的识别、选择和评估，该方案已在 PROSPERO（注册号 CRD42017056220）上注册。鉴于方法和措施存在差异，因此无法进行荟萃分析，但进行了定性综合分析。
共纳入 36 项研究进行分析。较高的 HCC 与男性性别和人体测量学指标有关，特别是体重指数和腰围增加。有初步证据表明，社会经济地位与儿童 HCC 呈负相关，尤其是与看护人教育和收入有关。值得注意的是，分析社会经济变量的大多数研究都是在相对平等的社会中进行的。当使用近端头发段时，洗发频率和使用头发产品和处理方法不会影响 HCC。关于儿童 HCC 与年龄之间的关系存在矛盾的证据。需要进一步研究，以更好地确定头发颜色、头发类型、创伤和压力源暴露、精神疾病、特应性疾病、类固醇使用（包括局部和吸入性类固醇）和围产期变量是否以及如何与儿童 HCC 相关。
性别和人体测量学指标可能是混杂因素，在头发皮质醇研究中应考虑进行调整。当使用近端头发段时，洗发频率和使用头发产品和处理方法不是重要的混杂因素。在将 HCC 用作生物标志物之前，需要更好地了解儿童与创伤和压力源暴露的关系，特别是在易受伤害的发育阶段、应激的定义和测量以及与应激源的时间关系方面。年龄、社会经济地位和其他相关因素也需要进一步研究。
