Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, 1639 Pierce Drive, WMB 3300, Atlanta, GA, 30322, USA.
Research Service Line, Atlanta VA Medical Center, Decatur, GA, USA.
Clin Auton Res. 2020 Oct;30(5):409-421. doi: 10.1007/s10286-020-00729-7. Epub 2020 Oct 6.
Over 7 million U.S. adults and about 20% of the military population have post-traumatic stress disorder (PTSD), a debilitating condition that is independently linked to a significantly greater risk of developing cardiovascular disease (CVD). Women have twice the probability of developing PTSD after experiencing a traumatic event compared to men. Existing literatures have reported higher inflammation and autonomic dysfunction including impaired baroreflex sensitivity, increased sympathetic reactivity and decreased parasympathetic activity in PTSD. However, most of these findings stem from studies conducted predominantly in males.
We attempt in this narrative review to summarize the mixed literature available on sex differences in autonomic dysfunction and inflammation in PTSD, at rest and in response to stress in PTSD.
This review reveals that there is a paucity of research exploring autonomic function in females with PTSD. Recent studies have included female participants without probing for sex differences. A small number of studies have been conducted exclusively in women. Available data suggest that sympathetic nervous system output tends to be heightened, while parasympathetic activity and arterial baroreflex sensitivity appear more blunted in females with PTSD. Although few studies have investigated sex differences in inflammation in PTSD, data within females suggest chronic increases in inflammation with PTSD. This autonomic dysregulation and inflammation have also been described in males with PTSD.
In sum, given the inherent biological differences in CVD clinical presentation and characteristics between men and women, human and animal studies aiming at elucidating sex differences in the pathophysiology of PTSD are needed.
超过 700 万美国成年人和约 20%的军人患有创伤后应激障碍（PTSD），这是一种使人衰弱的疾病，与心血管疾病（CVD）的风险显著增加独立相关。女性在经历创伤性事件后患上 PTSD 的可能性是男性的两倍。现有文献报道 PTSD 患者炎症和自主神经功能障碍更高，包括压力反射敏感性受损、交感神经反应性增加和副交感神经活动减少。然而，这些发现大多来自主要在男性中进行的研究。
我们在这篇叙述性综述中试图总结 PTSD 中自主神经功能障碍和炎症在静息和应激状态下的性别差异的混合文献。
这篇综述揭示了在 PTSD 女性中探索自主功能的研究很少。最近的研究纳入了女性参与者，但没有探究性别差异。少数研究仅在女性中进行。现有数据表明，PTSD 女性的交感神经输出往往升高，而副交感活动和动脉压力反射敏感性似乎更迟钝。尽管很少有研究调查 PTSD 中炎症的性别差异，但女性的数据表明，PTSD 会导致慢性炎症增加。这种自主神经失调和炎症也在 PTSD 男性中有所描述。
总之，鉴于 CVD 临床表现和特征在男性和女性之间存在固有生物学差异，需要进行旨在阐明 PTSD 病理生理学中性别差异的人体和动物研究。
