Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.
Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, Canada.
BMC Psychiatry. 2018 Oct 5;18(1):324. doi: 10.1186/s12888-018-1910-9.
Studies investigating salivary cortisol level as susceptibility marker for post-traumatic stress disorder (PTSD) produced inconsistent results. The aim of this study was to compare salivary cortisol concentration levels in PTSD patients with those in controls by synthesizing published data.
We did a systematic review, meta-analysis and meta-regression of studies comparing concentrations of salivary cortisol between patients with PTSD and controls. The electronic databases of PubMed, Embase, Web of Science and Psyc-ARTICLES were searched for relevant articles. A random-effects model with restricted maximum-likelihood estimator is used to synthesize the effect size (assessed by standardized mean difference).
A total of 784 articles were identified of which 22 were included in the final analysis. A trend of lower salivary cortisol levels was found in PTSD patients when compared with the controls (SMD = - 0.28, 95% CI-0.53;-0.04, p = 0.022). Subgroup analysis showed that the salivary cortisol levels were lower in patients with PTSD than in controls in studies conducted after 2007 or in studies using saliva samples collected in the morning.
The evidence from this meta-analysis supports that salivary samples collected in the morning consistently showed a lower salivary cortisol level in patients with PTSD than in controls, although whether salivary cortisol could be used as a diagnostic tool requires further research.
研究发现，唾液皮质醇水平可作为创伤后应激障碍（PTSD）的易感性标志物，但结果并不一致。本研究旨在通过综合已发表的数据，比较 PTSD 患者和对照组的唾液皮质醇浓度。
我们对比较 PTSD 患者和对照组唾液皮质醇浓度的研究进行了系统评价、荟萃分析和荟萃回归。检索了 PubMed、Embase、Web of Science 和 Psyc-ARTICLES 电子数据库中的相关文章。使用受限极大似然估计的随机效应模型来综合效应大小（用标准化均数差评估）。
共确定了 784 篇文章，其中 22 篇被纳入最终分析。与对照组相比，PTSD 患者的唾液皮质醇水平呈下降趋势（SMD=-0.28，95%CI-0.53;-0.04，p=0.022）。亚组分析显示，与对照组相比，2007 年后进行的研究或使用清晨采集的唾液样本进行的研究中，PTSD 患者的唾液皮质醇水平较低。
这项荟萃分析的证据支持，尽管唾液皮质醇是否可作为诊断工具尚需进一步研究，但清晨采集的唾液样本显示，PTSD 患者的唾液皮质醇水平始终低于对照组。
