Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
Neurosci Biobehav Rev. 2019 May;100:35-57. doi: 10.1016/j.neubiorev.2019.02.005. Epub 2019 Feb 19.
Posttraumatic stress disorder (PTSD) is often associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis. Previous findings are inconsistent, possibly due to trauma exposure of controls or different hormone measurement methods. We investigated cortisol, dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S) in adults with clinical PTSD under basal or challenged conditions (Prospero registration no. CRD42016041690). A search of PubMed, Scopus, Medline, PsycINFO, Pilots/ProQuest, and Web of Science resulted in 108 included studies (N = 6484). Morning and 24 h cortisol were significantly lower in PTSD than in controls (g = -0.21; 95% CI: -0.42-(-0.01); g = -0.31; CI: -0.60-(-0.03)). Significant cortisol increases occurred after awakening in PTSD (g = 0.40; CI: 0.13-0.67) and in non-exposed controls (g = 0.96; CI: 0.59-1.33). Evening DHEA was significantly higher in PTSD than in non-exposed controls (g = 0.58; CI: 0.17-0.99). All groups showed large cortisol suppression effects after dexamethasone administration. Overall, the potential moderators investigated did not reveal a consistent pattern of HPA alterations.
创伤后应激障碍（PTSD）常与下丘脑-垂体-肾上腺（HPA）轴的改变有关。既往研究结果不一致，可能与对照者的创伤暴露或不同的激素测量方法有关。我们在基础或应激条件下研究了临床 PTSD 成年人的皮质醇、脱氢表雄酮（DHEA）及其硫酸盐（DHEA-S）（Prospero 注册号：CRD42016041690）。在 PubMed、Scopus、Medline、PsycINFO、Pilots/ProQuest 和 Web of Science 上进行检索，共纳入了 108 项研究（N=6484）。与对照组相比，PTSD 患者的清晨和 24 小时皮质醇显著降低（g=-0.21；95%CI：-0.42-(-0.01)；g=-0.31；CI：-0.60-(-0.03)）。在 PTSD 和非暴露对照组中，觉醒后皮质醇均显著增加（g=0.40；CI：0.13-0.67；g=0.96；CI：0.59-1.33）。PTSD 患者的夜间 DHEA 水平显著高于非暴露对照组（g=0.58；CI：0.17-0.99）。所有组在给予地塞米松后均显示出较大的皮质醇抑制作用。总的来说，所研究的潜在调节因素并未显示出 HPA 改变的一致模式。
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