Vage Aaron, Gormley Gerard, Hamilton Paul K
Centre for Medical Education, Queen's University Belfast, Belfast, UK.
Department of Clinical Biochemistry, Belfast Health and Social Care Trust, Belfast, UK.
Ann Clin Biochem. 2025 May;62(3):165-173. doi: 10.1177/00045632241301618. Epub 2024 Nov 18.
BackgroundAs cortisol and metanephrine are involved in the stress response, it is often recommended that individuals are relaxed at the time of venepuncture, however, evidence behind these recommendations is lacking. We investigated the effects of acute psychological stress on serum cortisol and plasma metanephrine concentrations in healthy individuals exposed to varying levels of psychological stress and compared these results to self-reported measures of stress.MethodsTen medical students completed two medical in-person simulations (one low-complexity, one high-complexity) in a random order. At four times, participants completed the State-Trait Anxiety Inventory (STAI) and serum cortisol and plasma metanephrine/normetanephrine were tested.ResultsMedian (interquartile range) STAI prior to the low-complexity simulation was 44 (18) versus 33 (13) afterwards ( = 0.050). STAI prior to the high-complexity simulation was 33 (10) versus 48 (17) afterwards ( = 0.007). Cortisol prior to the low-complexity simulation was 272 nmol/L (115) versus 247 (115) afterwards ( = 0.333). Prior to the high-complexity simulation, cortisol was 246 (70) versus 261 (137) afterwards ( = 0.859). Metanephrine prior to the low-complexity simulation was 242 pmol/L (79) versus 247 (93) afterwards ( = 0.515). Metanephrine prior to the high-complexity simulation was 220 (81) versus 251 pmol/L (120) afterwards ( = 0.074). Normetanephrine prior to the low-complexity simulation was 593 pmol/L (247) versus 682 (281) afterwards ( = 0.047 for the difference). Normetanephrine prior to the high-complexity simulation was 696 (123) versus 705 pmol/L (224) afterwards ( = 0.169).ConclusionsThe trend in cortisol levels largely reflected changes in STAI. We outline some implications of these findings for current practice and future research.
背景
由于皮质醇和甲氧基肾上腺素参与应激反应，通常建议个体在静脉穿刺时保持放松，然而，这些建议背后缺乏证据。我们调查了急性心理应激对暴露于不同程度心理应激的健康个体血清皮质醇和血浆甲氧基肾上腺素浓度的影响，并将这些结果与自我报告的应激测量结果进行比较。
方法
十名医科学生以随机顺序完成了两次医学现场模拟（一次低复杂度，一次高复杂度）。在四个时间点，参与者完成状态-特质焦虑量表（STAI），并检测血清皮质醇和血浆甲氧基肾上腺素/去甲氧基肾上腺素。
结果
低复杂度模拟前STAI的中位数（四分位间距）为44（18），之后为33（13）（P = 0.050）。高复杂度模拟前STAI为33（10），之后为48（17）（P = 0.007）。低复杂度模拟前皮质醇为272 nmol/L（115），之后为247（115）（P = 0.333）。高复杂度模拟前，皮质醇为246（70），之后为261（137）（P = 0.859）。低复杂度模拟前甲氧基肾上腺素为242 pmol/L（79），之后为247（93）（P = 0.515）。高复杂度模拟前甲氧基肾上腺素为220（81），之后为251 pmol/L（120）（P = 0.074）。低复杂度模拟前去甲氧基肾上腺素为593 pmol/L（247），之后为682（281）（差异P = 0.047）。高复杂度模拟前去甲氧基肾上腺素为696（123），之后为705 pmol/L（224）（P = 0.169）。
结论
皮质醇水平的趋势在很大程度上反映了STAI的变化。我们概述了这些发现对当前实践和未来研究的一些启示。
