乳腺癌幸存者皮质醇和C反应蛋白的行为、身体及心理预测因素：一项纵向研究
Behavioural, physical, and psychological predictors of cortisol and C-reactive protein in breast cancer survivors: A longitudinal study.
作者信息
Lambert M, Sabiston C M, Wrosch C, Brunet J
机构信息
School of Psychology, University of Ottawa, ON, Canada.
Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.
出版信息
Brain Behav Immun Health. 2020 Dec 1;10:100180. doi: 10.1016/j.bbih.2020.100180. eCollection 2021 Jan.
BACKGROUND
Breast cancer survivors (BCS) can exhibit a dysregulation of cortisol and elevated C-reactive protein (CRP) levels post-treatment, which increase the risk of diverse health outcomes. Certain behavioural, physical, and psychological variables may help to predict cortisol and CRP levels post-treatment. The aims of this study were to: (1) describe naturally occurring changes in absolute diurnal cortisol and CRP levels over a period of 1.5 years post-treatment among BCS, (2) assess if absolute diurnal cortisol and CRP levels change in tandem, and (3) assess behavioural, physical, and psychological variables as predictors of absolute diurnal cortisol levels and CRP levels.
METHODS
Capillary blood and saliva samples were collected from 201 BCS, on average, 3.5 months post-treatment (T1) and again 3, 6, 9, and 12 months later (T2-T5). At each time point, five saliva samples were collected on two nonconsecutive days: at awakening, 30 min after awakening, 2:00 p.m., 4:00 p.m., and at bedtime. At each time point, participants also completed self-report questionnaires and wore an accelerometer for seven consecutive days. Data were analyzed using multilevel modeling.
RESULTS
Absolute diurnal cortisol levels did not change significantly over time. CRP levels decreased across time points ( = -0.31, = .01), though the rate of decrease slowed over time ( = 0.05, = .03). Generally, greater sedentary time predicted higher overall absolute diurnal cortisol levels ( < 0.01, = .01); whereas higher physical activity ( = -0.004, < .01), lower body mass index ( = 0.10, < .01), and lower health- and cancer-related stress ( = 0.24, = .04) predicted lower overall CRP levels. Also, lower absolute diurnal cortisol levels were evident when participants engaged in more sedentary time, as compared to their own average sedentary time ( = -0.01, < .01).
CONCLUSIONS
Results offer insight into the nature of change in diurnal cortisol and CRP levels among BCS from treatment completion onwards and offer clinical implications. Helping BCS manage their weight, reduce stress, increase physical activity participation, and decrease sedentary time as soon as possible after treatment may help to reduce physiological dysregulations, thereby lowering the risk of adverse health outcomes in this population. Further research investigating specific intervention parameters such as type, context, frequency, and intensity are warranted for the development of the most optimal interventions.
背景
乳腺癌幸存者（BCS）在治疗后可能会出现皮质醇调节异常和C反应蛋白（CRP）水平升高的情况，这会增加出现各种健康问题的风险。某些行为、身体和心理变量可能有助于预测治疗后的皮质醇和CRP水平。本研究的目的是：（1）描述BCS在治疗后1.5年内绝对昼夜皮质醇和CRP水平的自然变化情况，（2）评估绝对昼夜皮质醇和CRP水平是否同步变化，以及（3）评估行为、身体和心理变量作为绝对昼夜皮质醇水平和CRP水平预测指标的情况。
方法
从201名BCS中采集毛细血管血和唾液样本，平均在治疗后3.5个月（T1），并在3、6、9和12个月后再次采集（T2 - T5）。在每个时间点，在两个非连续的日子里采集5份唾液样本：醒来时、醒来后30分钟、下午2点、下午4点和就寝时。在每个时间点，参与者还完成了自我报告问卷，并连续七天佩戴加速度计。使用多水平模型对数据进行分析。
结果
绝对昼夜皮质醇水平随时间没有显著变化。CRP水平在各时间点呈下降趋势（β = -0.31，p = 0.01），尽管下降速度随时间减缓（β = 0.05，p = 0.03）。一般来说，久坐时间越长，预测的总体绝对昼夜皮质醇水平越高（p < 0.01，β = 0.01）；而较高的身体活动水平（β = -0.004，p < 0.01）、较低的体重指数（β = 0.10，p < 0.01）以及较低的与健康和癌症相关的压力（β = 0.24，p = 0.04）预测总体CRP水平较低。此外，与参与者自己的平均久坐时间相比，当参与者久坐时间更多时，绝对昼夜皮质醇水平明显较低（β = -0.01，p < 0.01）。
结论
研究结果为BCS从治疗结束后昼夜皮质醇和CRP水平变化的本质提供了见解，并具有临床意义。帮助BCS在治疗后尽快控制体重、减轻压力、增加身体活动参与度并减少久坐时间，可能有助于减少生理调节异常，从而降低该人群不良健康后果的风险。对于开发最优化干预措施，有必要进一步研究特定的干预参数，如类型、环境、频率和强度。
Zotero 插件