精神分裂症患者对心理社会应激源的外周皮质醇及炎症反应
Peripheral Cortisol and Inflammatory Response to a Psychosocial Stressor in People with Schizophrenia.
作者信息
Glassman Matthew, Wehring Heidi J, Pocivavsek Ana, Sullivan Kelli M, Rowland Laura M, McMahon Robert P, Chiappelli Joshua, Liu Fang, Kelly Deanna L
机构信息
Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA.
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
出版信息
J Neuropsychiatry (Foster City). 2018;2(2). doi: 10.21767/2471-8548.10008. Epub 2018 May 23.
OBJECTIVES
There is growing evidence of both hypothalamic-pituitary-adrenal (HPA) axis and immune system dysfunction in schizophrenia. Additionally, accumulating evidence has linked dysfunction in the kynurenine pathway to schizophrenia as well as to stress and inflammation. The current pilot tested changes in immune, cortisol and kynurenine and kynurenic acid responses to a psychosocial stressor in people with schizophrenia and healthy controls.
METHODS
Ten people with schizophrenia/schizoaffective disorder and 10 healthy controls were included. Participants completed the Trier Social Stress Test (TSST) and cortisol, cytokines (IL-6 & TNF-α), kynurenine and kynurenic acid were measured in the plasma at baseline 15, 30, 60 and 90 minutes following the TSST.
RESULTS
Compared to baseline, at 30 minutes post TSST, mean cortisol levels had increased by 7.6 ng/ml (11%) in healthy controls but decreased by 16.3 ng/ml (25%) in schizophrenia (F=4.34, df=3,38.2, p=0.010). While people with schizophrenia had a lower TNF-α level at baseline (χ =10.14, p=0.001), no decreases or increases occurred after the TSST in either group. Both groups had a similar increase in IL-6 at 15 minutes post TSST (F=4.17, df=3, 16.3, p=0.023) demonstrating an immune response to the stress in both groups. A trend towards increased kynurenine from baseline was found immediately after the TSST followed by a decrease at 60 minutes in healthy controls but no change was found in people with schizophrenia (F=2.46, df=3, 49.1, p=0.074).
CONCLUSION
People with schizophrenia showed a decrease in cortisol from baseline following the TSST as compared to an elevation from baseline seen in healthy controls, supporting HPA axis dysfunction in schizophrenia. An immediate inflammatory response with IL-6 was seen in both groups following the TSST. Larger studies should examine psychosocial stress response in schizophrenia and the relationship of immune function and kynurenine pathway.
目的
越来越多的证据表明，精神分裂症患者存在下丘脑 - 垂体 - 肾上腺（HPA）轴和免疫系统功能障碍。此外，越来越多的证据将犬尿氨酸途径的功能障碍与精神分裂症以及压力和炎症联系起来。当前的试点研究测试了精神分裂症患者和健康对照者对心理社会应激源的免疫、皮质醇、犬尿氨酸和犬尿酸反应的变化。
方法
纳入10名精神分裂症/分裂情感性障碍患者和10名健康对照者。参与者完成了特里尔社会应激测试（TSST），并在TSST后的基线、15、30、60和90分钟测量血浆中的皮质醇、细胞因子（IL - 6和TNF - α）、犬尿氨酸和犬尿酸。
结果
与基线相比，在TSST后30分钟，健康对照者的平均皮质醇水平升高了7.6 ng/ml（11%），而精神分裂症患者的皮质醇水平下降了16.3 ng/ml（25%）（F = 4.34，自由度 = 3,38.2，p = 0.010）。虽然精神分裂症患者在基线时TNF - α水平较低（χ = 10.14，p = 0.001），但两组在TSST后均未出现下降或升高。两组在TSST后15分钟时IL - 6均有类似的升高（F = 4.17，自由度 = 3, 16.3，p = 0.023），表明两组对压力均有免疫反应。TSST后立即发现健康对照者的犬尿氨酸较基线有升高趋势，随后在60分钟时下降，但精神分裂症患者未发现变化（F = 2.46，自由度 = 3, 49.1，p = 0.074）。
结论
与健康对照者基线时升高相比，精神分裂症患者在TSST后皮质醇从基线下降，支持精神分裂症患者的HPA轴功能障碍。两组在TSST后均出现了IL - 6介导的即时炎症反应。更大规模的研究应检查精神分裂症患者的心理社会应激反应以及免疫功能与犬尿氨酸途径的关系。
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