Huchegowda Ravish, Kulkarni Ranganath R, Bijjal Somashekhar, Nagesh Prasad Nagamangala, Philip Mariyamma, Harbishettar Vijaykumar
Dept. of Neurochemistry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India.
Dept. of Psychiatry, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka, India.
Indian J Psychol Med. 2025 Sep 18:02537176251370986. doi: 10.1177/02537176251370986.
Hair concentrations of cortisol and dehydroepiandrosterone (DHEA) are increasingly recognized as non-invasive, retrospective biomarkers of hypothalamic-pituitary-adrenal axis function. The ratio of these hormones may reflect the balance between catabolic and anabolic activity, potentially serving as a composite marker of chronic stress. Despite its theoretical relevance, the clinical utility of the hair cortisol: DHEA ratio remains unclear. This PROSPERO-registered systematic review, done according to PRISMA guidelines, aimed to evaluate the association between the hair cortisol: DHEA ratio and perceived stress in adults with chronic stress exposure.
A comprehensive search of five electronic databases and grey literature was conducted up to March 5, 2025. Studies were eligible if they included adults (≥18 years) with at least 4 weeks of documented chronic stress exposure and reported both hair cortisol and DHEA concentrations alongside validated perceived stress measures. Meta-analyses were performed for correlation coefficients and group comparisons. Risk of bias was assessed using a modified Downs and Black checklist.
Eight studies (five cross-sectional, three cohort; = 60-210) met inclusion criteria. A meta-analysis of two studies using validated stress scales showed no significant association between the hair cortisol/DHEA ratio and perceived stress ( = 0.09; 95% CI: -0.07 to 0.26; ² = 0%). However, a separate analysis of three studies comparing high- versus low-stress groups revealed a moderate, statistically significant pooled effect (Hedges' = 0.69; 95% CI: 0.14-1.24; = .01) with substantial heterogeneity (² = 77.17%). Risk of bias ranged from moderate to low, but the overall certainty of evidence was rated very low due to small sample sizes and inconsistent findings.
The hair cortisol: DHEA ratio has biological plausibility as a marker of chronic stress, but current evidence is insufficient to support its clinical application. Further standardized, longitudinal studies are needed to establish its diagnostic and prognostic value.
CRD420251003364.
头发中皮质醇和脱氢表雄酮（DHEA）的浓度越来越被认为是下丘脑 - 垂体 - 肾上腺轴功能的非侵入性回顾性生物标志物。这些激素的比例可能反映分解代谢和合成代谢活动之间的平衡，有可能作为慢性应激的综合标志物。尽管其具有理论相关性，但头发皮质醇：DHEA比例的临床效用仍不明确。这项在PROSPERO注册的系统评价，根据PRISMA指南进行，旨在评估头发皮质醇：DHEA比例与慢性应激暴露的成年人感知应激之间的关联。
截至2025年3月5日，对五个电子数据库和灰色文献进行了全面检索。如果研究纳入了年龄≥18岁且有至少4周记录的慢性应激暴露的成年人，并报告了头发皮质醇和DHEA浓度以及经过验证的感知应激测量值，则这些研究符合纳入标准。对相关系数和组间比较进行了荟萃分析。使用修改后的唐斯和布莱克清单评估偏倚风险。
八项研究（五项横断面研究，三项队列研究；n = 60 - 210）符合纳入标准。对两项使用经过验证的应激量表的研究进行的荟萃分析表明，头发皮质醇/ DHEA比例与感知应激之间无显著关联（r = 0.09；95% CI：-0.07至0.26；I² = 0%）。然而，对三项比较高应激组和低应激组的研究进行的单独分析显示，合并效应适中且具有统计学意义（Hedges' g = 0.69；95% CI：0.14 - 1.24；P = 0.01），存在较大异质性（I² = 77.17%）。偏倚风险从中度到低度不等，但由于样本量小和结果不一致，证据的总体确定性被评为非常低。
头发皮质醇：DHEA比例作为慢性应激标志物具有生物学合理性，但目前的证据不足以支持其临床应用。需要进一步进行标准化的纵向研究来确定其诊断和预后价值。
PROSPERO注册编号：CRD420251003364。
