Translational Research in GastroIntestinal Disorders (TARGID), Department of chronic diseases, metabolism, and ageing, Faculty of Medicine, KU Leuven, Belgium; Leuven Brain Institute, KU Leuven, Leuven, Belgium.
Translational Research in GastroIntestinal Disorders (TARGID), Department of chronic diseases, metabolism, and ageing, Faculty of Medicine, KU Leuven, Belgium.
Psychoneuroendocrinology. 2021 Jun;128:105220. doi: 10.1016/j.psyneuen.2021.105220. Epub 2021 Apr 3.
Venepuncture is recognized as a potent stressor and, by activating the hypothalamic-pituitary-adrenal (HPA) axis, can interfere with measuring subsequent HPA axis indices such as cortisol. A resting period of 110 min is recommended between venepuncture and the commencement of psychosocial stress induction or cortisol measurement to allow cortisol levels to return to baseline first. In experiment 1 (n = 65), in which stress induction occurred 120 min after venepuncture, we observed three cortisol stress response patterns: conventional response ("responders", 77%), conventional non-response ("non-responders", 6.15%), and aberrant non-response characterized by high baseline (pre-stress) cortisol levels ("high-baseliners", 16.9%). Based on subjective clinical observation, the aberrant non-response was exclusively present in those who experienced vasovagal reactions during venepuncture, ranging from nervousness, lightheadedness, nausea, feeling of being extremely hot or cold, confusion, slight inability to speak, weakness and visual disturbances, to loss of consciousness (syncope). In experiment 2 (n = 79), we showed that allowing 210 min between venepuncture and stress induction permits the return of cortisol levels back to baseline even in participants who experience vasovagal reactions, thereby allowing for the exhibition of a conventional cortisol stress response. In sum, while 110 min may be sufficient to circumvent the usual effects of venepuncture on cortisol levels, 210 min are needed to effectively adjust for the effects of venepuncture-induced vasovagal reactions and the subsequent sustained rise in cortisol. Allowing sufficient time between venepuncture and stress induction or cortisol measurement should also prevent misclassification of participants who show aberrant responses as non-responders or anticipatory responders.
静脉穿刺被认为是一种强烈的应激源，通过激活下丘脑-垂体-肾上腺 (HPA) 轴，会干扰随后测量 HPA 轴指标（如皮质醇）。建议在静脉穿刺和开始进行心理社会应激诱导或皮质醇测量之间留出 110 分钟的休息时间，以使皮质醇水平首先恢复到基线。在实验 1（n=65）中，静脉穿刺后 120 分钟发生应激诱导，我们观察到三种皮质醇应激反应模式：常规反应（“反应者”，77%）、常规无反应（“无反应者”，6.15%）和以高基线（应激前）皮质醇水平为特征的异常无反应（“高基线者”，16.9%）。基于主观临床观察，异常无反应仅存在于那些在静脉穿刺期间经历血管迷走反应的人，这些反应包括紧张、头晕、恶心、极度冷热感、困惑、轻微言语障碍、虚弱和视觉障碍，甚至意识丧失（晕厥）。在实验 2（n=79）中，我们表明，在静脉穿刺和应激诱导之间留出 210 分钟的时间，即使在经历血管迷走反应的参与者中，也可以使皮质醇水平恢复到基线，从而允许表现出常规的皮质醇应激反应。总之，虽然 110 分钟可能足以避免静脉穿刺对皮质醇水平的通常影响，但需要 210 分钟才能有效地调整静脉穿刺引起的血管迷走反应和随后皮质醇的持续升高的影响。在静脉穿刺和应激诱导或皮质醇测量之间留出足够的时间，还应防止将表现出异常反应的参与者错误分类为无反应者或预期反应者。
