大地震创伤后应激障碍患者的心理与神经内分泌变化
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摘要
目的 :研究唐山大地震所致慢性创伤后应激障碍患者基础血清皮质醇浓度和地塞米松抑制试验。方法 :唐山大地震所致创伤后应激障碍 3 5例 (研究组 )和 3 3例正常人 (对照组 )接受了基础血清皮质醇水平的测定和地塞米松抑制试验。结果 :两组基础血清皮质醇水平比较差异无统计学显著性 ,各组男女之间基础血清皮质醇水平分别比较差异亦无统计学显著性。两组服用相同剂量的地塞米松后 ,研究组血清皮质醇水平低于对照组和对血清皮质醇的抑制作用高于对照组 ,差异均有统计学显著性。各组男女之间的基础血清皮质醇水平、服用地塞米松后血清皮质醇水平和对地塞米松的抑制率比较差异无统计学显著性。结论 :唐山大地震所致慢性PTSD患者对糖皮质激素的敏感性增高而导致PHA轴负反馈抑制增强 ,无性别差异
Objective:To explore change of HPA axis in patients with PTSD (post traumatic stress disorder) after Tangshan Earthquake Method:35 patients with PTSD and 33 normal controls were collected Serum cortisol levels were measured and DST (dexamethasone suppression test) was done in both groups Result:There was no significant difference of serum cortisol level between the two groups In each group, there was no significant difference of cortisol level between male and female In DST, PTSD group showed significant suppression effect with lower cortisol level than that of control But male and female of both groups had no significant difference in DST Conclusion: Patients with PTSD are sensitive to DST, and this sensitivity has no sex difference
Objective:To explore change of HPA axis in patients with PTSD (post traumatic stress disorder) after Tangshan Earthquake Method:35 patients with PTSD and 33 normal controls were collected Serum cortisol levels were measured and DST (dexamethasone suppression test) was done in both groups Result:There was no significant difference of serum cortisol level between the two groups In each group, there was no significant difference of cortisol level between male and female In DST, PTSD group showed significant suppression effect with lower cortisol level than that of control But male and female of both groups had no significant difference in DST Conclusion: Patients with PTSD are sensitive to DST, and this sensitivity has no sex difference
引文
1 BoscarinoJA PTSD ,exposuretocombat,andlowerplasmacorti solamongVietnamveterans:findingsandclinicalimplications,JConsultClinPsychology,1996,64:191-201
2 GoenjianAK ,YehudaR ,PynoosRS ,etalBasalcortisolanddexamethasonesuppressionofcortisolamongadolescentsafterthe1988earthquakeinArmeniaAmJPsychiatry,1995,153:929-934
3 BournePB ,RoseRM ,MasonJW 17-OHCSlevelsincombat:specialforces’A’teamunderthreatofattack,ArchGenPsychi atry,1968,19:135-40
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5 YehudaR ,SouthwickSM ,KrystalJM ,etalEnhancedsuppres sionofcortisolfollowingdexamethasoneincombatveteranswithposttraumaticstressdisorderandmajordepressivedisorderAMJPsychiatry,1993,150:83-86
6 HalbreichU ,OlympiaJ ,CarsonS ,etalHypothalamic-pituitary-adrenalactivityinendogenouslydepressedpost-traumaticstressdisorderpatientsPsychoneuroendocrinology,1989,14:365-370
7 DinanTG ,BarryS ,YathamLN ,etal,Apilotstudyofaneuro endocrinetestbatteryinposttraumaticstressdisorder,BiolPsychia try(1990)28:665-72
8 KosternTR ,WahbyV ,GillerE ,etalThedexamethasonesup pressiontestandthyrotropin-releasinghormonestimulationtestinPTSD ,BiolPsychiatry,1990,28:657
9 KudlerH ,DavidsonJ ,MeadorK ,etalTheDSTandpost-trau maticstressdisorder,AmJPsychiatry,1987,144:1068-71
10 张本,王学义,孙贺祥等唐山大地震心理创伤后应激障碍的抽样调查研究中华精神科杂志,1999,32(2):106～108
11 OliveraAA ,FeroD Affectivedisorders,DST ,andtreatmentinPTSDpatients:clinicalobservations,JTraumastress,1990,3:407-14
12 GormleyGJ ,LowyMT ,RederAT ,etalGlucocorticoidrecep torsindepression:relationshiptothedexamethasonesuppressiontest,AmJPsychiatry,1985,142:1278-84
13 BankiCM ,BissetteG ,AratoM ,etalCSFCorticotrophin-re leasingfactor-likeimmunnore-activeincombatveteranswithposttraumaticstressdisorder,AmJPsychiatry,1999,156:985-988
2 GoenjianAK ,YehudaR ,PynoosRS ,etalBasalcortisolanddexamethasonesuppressionofcortisolamongadolescentsafterthe1988earthquakeinArmeniaAmJPsychiatry,1995,153:929-934
3 BournePB ,RoseRM ,MasonJW 17-OHCSlevelsincombat:specialforces’A’teamunderthreatofattack,ArchGenPsychi atry,1968,19:135-40
4 McFarlaneAC ,AtchisonM ,YehudaR TheacutestressresponsefollowingmotorvehicleaccidentsanditsrelationtoPTSD In:Ye hudaR ,McFarlaneAC ,eds,psychobiologyofPosttraumaticStressDisorderAnnalsoftheNewYorkAcademyofSciencesNewYork,1997,821:437-441
5 YehudaR ,SouthwickSM ,KrystalJM ,etalEnhancedsuppres sionofcortisolfollowingdexamethasoneincombatveteranswithposttraumaticstressdisorderandmajordepressivedisorderAMJPsychiatry,1993,150:83-86
6 HalbreichU ,OlympiaJ ,CarsonS ,etalHypothalamic-pituitary-adrenalactivityinendogenouslydepressedpost-traumaticstressdisorderpatientsPsychoneuroendocrinology,1989,14:365-370
7 DinanTG ,BarryS ,YathamLN ,etal,Apilotstudyofaneuro endocrinetestbatteryinposttraumaticstressdisorder,BiolPsychia try(1990)28:665-72
8 KosternTR ,WahbyV ,GillerE ,etalThedexamethasonesup pressiontestandthyrotropin-releasinghormonestimulationtestinPTSD ,BiolPsychiatry,1990,28:657
9 KudlerH ,DavidsonJ ,MeadorK ,etalTheDSTandpost-trau maticstressdisorder,AmJPsychiatry,1987,144:1068-71
10 张本,王学义,孙贺祥等唐山大地震心理创伤后应激障碍的抽样调查研究中华精神科杂志,1999,32(2):106～108
11 OliveraAA ,FeroD Affectivedisorders,DST ,andtreatmentinPTSDpatients:clinicalobservations,JTraumastress,1990,3:407-14
12 GormleyGJ ,LowyMT ,RederAT ,etalGlucocorticoidrecep torsindepression:relationshiptothedexamethasonesuppressiontest,AmJPsychiatry,1985,142:1278-84
13 BankiCM ,BissetteG ,AratoM ,etalCSFCorticotrophin-re leasingfactor-likeimmunnore-activeincombatveteranswithposttraumaticstressdisorder,AmJPsychiatry,1999,156:985-988
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