Clinical Chemistry & Hematology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands.
School of Business & Economics, Maastricht University, Maastricht, The Netherlands.
Emerg Med J. 2021 Apr;38(4):297-302. doi: 10.1136/emermed-2019-209205. Epub 2021 Feb 11.
Acute or chronic stress can lead to physical and mental disorders. Measuring cortisol can objectify the degree of stress. Cortisol is traditionally measured in serum, but recently the relevant fraction of free cortisol can be reliably measured in saliva, using the very sensitive liquid chromatography tandem mass spectrometry (LC-MS/MS) method. The use of saliva is non-invasive and allows easy serial testing around stressful events. The main objective of this study is to investigate whether serial saliva cortisol determinations using the LC-MS/MS method can be used to assess the stress response that first responders may experience during moments of acute professional deployment in their daily work.
Healthy first responders (police officers, firefighters, rapid response team, ambulance personnel, first aid and emergency medical personnel) were recruited to participate in a Euregional high-reliability simulation training ('Be Aware'-scenario training, 19 April 2018). At three time points, simultaneous venous blood samples and saliva samples were obtained. These time points were 1 hour before, immediately after and 10 hours after the simulation training. The correlation between changes in saliva cortisol measured by LC-MS/MS and serum cortisol at all three time points was determined. Results were compared with spectators not directly participating in the simulation.
70 subjects participated in the simulation. There was a strong correlation between the changes in saliva and blood cortisol at the three time points. A significant increase in blood and saliva cortisol was shown 1 hour after the experienced stress moments. The levels had almost completely returned to baseline in all healthy volunteers 10 hours later. Cortisol in spectators was unaffected.
Serial saliva cortisol measurements using LC-MS/MS is a reliable and fast non-invasive functional stress assay, which can be easily collected in daily practice and used for investigation and monitoring of stress response in front line responders.
急性或慢性应激可导致身心障碍。测量皮质醇可以客观反映应激程度。皮质醇传统上在血清中测量，但最近可以使用非常灵敏的液相色谱串联质谱（LC-MS/MS）方法可靠地测量唾液中的游离皮质醇相关分数。唾液的使用是非侵入性的，并且可以在应激事件周围轻松进行连续测试。本研究的主要目的是探讨使用 LC-MS/MS 方法进行连续唾液皮质醇测定是否可用于评估急救人员在日常工作中急性专业部署期间可能经历的应激反应。
招募健康的急救人员（警察、消防员、快速反应小组、救护车人员、急救和急诊医疗人员）参加 Euregional 高可靠性模拟培训（“Be Aware”-情景培训，2018 年 4 月 19 日）。在三个时间点同时采集静脉血样和唾液样。这三个时间点分别为模拟训练前 1 小时、立即和 10 小时后。确定 LC-MS/MS 测量的唾液皮质醇变化与所有三个时间点的血清皮质醇之间的相关性。将结果与未直接参与模拟的观众进行比较。
70 名受试者参加了模拟。在三个时间点，唾液和血液皮质醇的变化之间存在很强的相关性。在经历应激时刻 1 小时后，血液和唾液皮质醇均显示出明显增加。所有健康志愿者 10 小时后，皮质醇水平几乎完全恢复到基线。观众的皮质醇不受影响。
使用 LC-MS/MS 进行连续唾液皮质醇测量是一种可靠且快速的非侵入性功能应激测定方法，可在日常实践中轻松收集，并用于调查和监测一线 responder 的应激反应。
