创伤后应激障碍患者临床症状、心理健康与血浆皮质醇水平的相关性研究

目的 研究创伤后应激障碍(post-traumatic stress disorder,PTSD)患者的临床症状、心身健康状况与血浆皮质醇水平的关系.方法 以遭遇创伤事件的个体为研究对象,采用美国<精神疾病诊断与统计手册>第四版(DSM-Ⅳ)为诊断标准.将研究对象分为PTSD组(35例)和非PTSD组(28例),分别进行PTSD症状调查,并测查症状自评量表(SCL-90)和艾森克人格问卷(EPQ).采用放射免疫法检测血浆皮质醇浓度.结果 35例PTSD患者中,PTSD症状最常见的依次是兴趣爱好范围变窄(94.29%)、激惹或易发怒(94.29%)、难以入睡或睡眠不深(91.43%).除了不由自主地重现创伤事件、反复出现错觉、幻觉及选择性遗忘外,其余症状PTSD组与非PTSD组差异均有统计学意义,P＜0.05.PTSD组、非PTSD组血浆皮质醇浓度[(281.57±123.93)ng/ml,(243.39±125.60)ng/ml]均低于正常对照组[(344.21±86.76)ng/ml],分别为P=0.037,P=0.009.血浆皮质醇浓度与SCL-90中人际关系敏感(r=0.446,P=0.008)、抑郁(r=0.428,P=0.019)和EPQ中神经质(r=0.380,P=0.026)因子分正相关.结论 遭遇创伤事件后会出现程度不等的PTSD症状;PTSD患者血浆皮质醇浓度较正常对照降低;且血浆皮质醇浓度水平与人际关系敏感、抑郁、神经质成正相关.

Study of the correlation of clinical symptoms,mental health and plasma cortisol level of post-traumatic stress disorder

Objectives To study the correlation of clinical symptoms,mental health and plasma cortisol levels of post-traumatic stress disorder(PTSD).Methods According to diagnostic and statistic manual of mental disorders,4th ed(DSM-Ⅳ)criteria,all subjects were divided into PTSD group and non-PTSD group.PTSD symptoms were investigated and subjects were assessed with Symptom Checklist-90(SCL-90)and Eysenck Personality Questionnaire(EPQ).Radio-immunity technique was used to test plasma cortisol concentration.Results The most common of PTSD symptoms were markedly diminished interest or participation in significant activities (94.29%),irritability or outbursts of anger(94.29%)and difficulty falling or staying asleep(91.43%)respectively.There were different in PTSD symptoms,but recurrent and intrusive distressing recollections of the events,recurrent illusions and hallucinations and selective forgetting,between PTSD group and non-PTSD group(P＜0.05).Plasma cortisol concentrations in patients with PTSD((281.57±123.93)ng/ml)and those without PTSD ((243.39±125.60)ng/ml)were all lower than that in normal controls((344.21±86.76)ng/ml,P=0.037,P=0.009).In Pearson correlation model,plasma cortisol was significantly positive correlated with interpersonal sensitivity(r=0.446,P=0.008),depression(r=0.428,P=0.019)of SCL-90 and neuroticism(r=0.380,P=0.026)of EPQ.Conclusions People with traumatic events have some PTSD symptoms.Plasma cortisol concentrations in patients with PTSD axe lower than those in normal controls.And plasma cortisol are significantly positive correlated with interpersonal sensitivity,depression and neurotieism.