Heim C, Ehlert U, Hanker J P, Hellhammer D H
Center for Psychobiological and Psychosomatic Research, University of Trier, Germany.
Psychosom Med. 1998 May-Jun;60(3):309-18. doi: 10.1097/00006842-199805000-00017.
Although numerous organic conditions may cause chronic pelvic pain (CPP), diagnostic laparoscopy reveals a normal pelvis in many patients with CPP. However, psychological studies yield a high frequency of psychopathology and increased prevalences of chronic stress and traumatic life events, ie, sexual and physical abuse, in women with CPP, suggesting a relationship between posttraumatic stress disorder (PTSD) and CPP. As chronic stress and PTSD have been associated with specific alterations of the hypothalamic-pituitary-adrenal (HPA) axis, we explored stress history, psychopathology and HPA axis alterations in women with CPP.
We recruited 16 patients with CPP and 14 painfree, infertile controls from a general hospital where diagnostic laparoscopy was performed. Psychological assessment included standardized interviews on clinical symptoms, abuse experiences and major life events as well as psychometric testing for PTSD-like symptoms and depression. Endocrinological evaluation involved determinations of diurnal salivary cortisol levels and hormonal responses to a corticotropin-releasing factor (CRF) stimulation test (100 microg human CRF) and a low-dose dexamethasone suppression test (0.5 mg).
We observed increased prevalences of abuse experiences and PTSD in women with CPP as well as a higher total number of major life events, whereas the mean extent of depression was within the normal range. With respect to endocrine measures, women with CPP demonstrated normal to low diurnal salivary cortisol levels, normal plasma-adrenocorticotropin (ACTH), but reduced salivary cortisol levels in the CRF stimulation test, and an enhanced suppression of salivary cortisol by dexamethasone.
Women with CPP demonstrate HPA axis alterations, that partly parallel and partly contrast neuroendocrine correlates of PTSD, but show marked similarity to findings in patients with other stress-related bodily disorders. These findings suggest that a lack of protective properties of cortisol may be of relevance for the development of bodily disorders in chronically stressed or traumatized individuals.
尽管多种器质性疾病可能导致慢性盆腔疼痛（CPP），但诊断性腹腔镜检查发现许多CPP患者的盆腔正常。然而，心理学研究表明，CPP女性中精神病理学的发生率较高，慢性应激和创伤性生活事件（如性虐待和身体虐待）的患病率增加，这表明创伤后应激障碍（PTSD）与CPP之间存在关联。由于慢性应激和PTSD与下丘脑-垂体-肾上腺（HPA）轴的特定改变有关，我们探讨了CPP女性的应激史、精神病理学和HPA轴改变。
我们从一家进行诊断性腹腔镜检查的综合医院招募了16例CPP患者和14例无疼痛的不孕对照者。心理评估包括对临床症状、虐待经历和重大生活事件的标准化访谈，以及对PTSD样症状和抑郁的心理测量测试。内分泌评估包括测定昼夜唾液皮质醇水平以及对促肾上腺皮质激素释放因子（CRF）刺激试验（100微克人CRF）和低剂量地塞米松抑制试验（0.5毫克）的激素反应。
我们观察到CPP女性中虐待经历和PTSD的患病率增加，以及重大生活事件的总数更多，而抑郁的平均程度在正常范围内。在内分泌指标方面，CPP女性的昼夜唾液皮质醇水平正常至偏低，血浆促肾上腺皮质激素（ACTH）正常，但在CRF刺激试验中唾液皮质醇水平降低，并且地塞米松对唾液皮质醇的抑制作用增强。
CPP女性表现出HPA轴改变，部分与PTSD的神经内分泌相关性平行，部分与之相反，但与其他应激相关身体疾病患者的发现有明显相似之处。这些发现表明，皮质醇缺乏保护特性可能与慢性应激或受创伤个体身体疾病的发生有关。
