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炎症与创伤后应激障碍。

Inflammation and post-traumatic stress disorder.

机构信息

Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.

出版信息

Psychiatry Clin Neurosci. 2019 Apr;73(4):143-153. doi: 10.1111/pcn.12820. Epub 2019 Feb 21.

Abstract

While post-traumatic stress disorder (PTSD) is currently diagnosed based solely on classic psychological and behavioral symptoms, a growing body of evidence has highlighted a link between this disorder and alterations in the immune and inflammatory systems. Epidemiological studies have demonstrated that PTSD is associated with significantly increased rates of physical comorbidities in which immune dysregulation is involved, such as metabolic syndrome, atherosclerotic cardiovascular disease, and autoimmune diseases. In line with this, a number of blood biomarker studies have reported that compared to healthy controls, individuals with PTSD exhibit significantly elevated levels of proinflammatory markers, such as interleukin-1β, interleukin-6, tumor necrosis factor-α, and C-reactive protein. Moreover, various lines of animal and human research have suggested that inflammation is not only associated with PTSD but also can play an important role in its pathogenesis and pathophysiology. In this review, we first summarize evidence suggestive of increased inflammation in PTSD. We then examine findings that suggest possible mechanisms of inflammation in this disorder in terms of two different but interrelated perspectives: putative causes of increased proinflammatory activities and potential consequences that inflammation generates. Given that there is currently a dearth of treatment options for PTSD, possibilities of new therapeutic approaches using pharmacological and non-pharmacological treatments/interventions that have anti-inflammatory effects are also discussed. Despite the increasing attention given to the inflammatory pathology of PTSD, there remains much to be elucidated, including more detailed mechanisms of inflammation, potential usefulness of inflammatory biomarkers as diagnostic and prognostic markers, and efficacy of novel treatment strategies targeting inflammation.

摘要

虽然创伤后应激障碍(PTSD)目前仅基于经典的心理和行为症状进行诊断,但越来越多的证据强调了这种疾病与免疫和炎症系统的改变之间存在联系。流行病学研究表明,PTSD 与涉及免疫失调的身体合并症的发生率显著增加有关,例如代谢综合征、动脉粥样硬化性心血管疾病和自身免疫性疾病。与此一致,许多血液生物标志物研究报告称,与健康对照组相比,患有 PTSD 的个体表现出明显升高的促炎标志物水平,例如白细胞介素-1β、白细胞介素-6、肿瘤坏死因子-α 和 C 反应蛋白。此外,各种动物和人类研究表明,炎症不仅与 PTSD 有关,而且可能在其发病机制和病理生理学中发挥重要作用。在这篇综述中,我们首先总结了 PTSD 中炎症增加的证据。然后,我们检查了从两个不同但相互关联的角度来看,炎症在这种疾病中的潜在机制的发现:促炎活性增加的假设原因和炎症产生的潜在后果。鉴于目前 PTSD 的治疗选择有限,因此还讨论了使用具有抗炎作用的药理学和非药理学治疗/干预措施的新治疗方法的可能性。尽管人们越来越关注 PTSD 的炎症病理,但仍有许多问题需要阐明,包括炎症的更详细机制、炎症生物标志物作为诊断和预后标志物的潜在用途,以及针对炎症的新型治疗策略的疗效。

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