【摘要】 目的 探讨不同亚型应激相关障碍患者遭受精神创伤事件类型及下丘脑-垂体-肾上腺轴功能的差异性。方法 对29例急性应激障碍(急性组)、26例创伤后应激障碍(创伤组)和24例适应障碍(适应组)患者采用创伤性生活事件量表和生活事件量表进行测评分析,并于治疗前后分别测定24 h尿17-羟皮质醇、24 h尿游离皮质酮、8.00 AM血浆皮质醇、0:00 AM血浆皮质醇浓度。结果 3组生活事件量表总值及负性事件值比较差异有显著性(P<0.05),遭受创伤事件类型构成比较差异有显著性(P<0.01),其中急性组以死亡威胁事件为主(48.3%),适应组以困境挫折事件为主(62.5%),创伤组以自然灾害类事件为主(50.0%)。治疗前3组24 h尿游离皮质酮、8:00 AM血浆皮质醇、0:00 AM血浆皮质醇水平比较差异有显著性(P<0.05或0.01),治疗后均显著低于治疗前(P<0.01)。遭受不同类型创伤事件患者治疗前24 h尿游离皮质酮、8:00 AM血浆皮质醇、0:00 AM血浆皮质醇水平比较差异有显著性(P<0.05或0.01),且以遭受死亡威胁事件患者较高;治疗后均显著降低(P<0.01),但24 h尿游离皮质酮和8:00 AM血浆皮质醇水平仍存在显著差异性(P<0.05或0.01)。结论 不同亚型应激相关障碍患者遭受精神创伤事件各有特点,不同类型创伤事件对HPA轴功能有相应的影响。更多还原

【Abstract】 Objective To explore psychological trauma events types and the difference of hypothalamic-pituitary-adrenal(HPA) axis function among patients with different subtypes of stress-related disorders(SRD).Methods Assessments were carried out with the Traumatic Life Event Questionnaire(TLEQ)and Life Event Scale(LES) in 29 patients with acute stress disorders(ASD group)> 26 post-traumatic stress disorder(PTSD group) and 24 adjustment disorder(AD group).before and after treatment 24 h urine 17-hydroxycorticosteroid levels,24 h urine free corticosterone,plasma corticosterone at 8:00 am and plasma corticosterone at 0:00 am detected.Results There were significant group differences in the TLEQ and LES scores(P<0.05) and in the constituent ratio of trauma events types(P<0.01),death/threat events were main in ASD group(48.3%),dilemmas/frustrations in AD(62.5%),and natural disasters in PTSD(50.0%).Three were significant group differences in 24 h urine free corticosterone levels,plasma corticosterone at 8:00 am and plasma corticosterone at 0:00 am before treatment(P<0.05 or 0.01),those of 3 groups were significantly lower after treatment compared with pretreatment(P<0.01).Three were significant group differences in 24 h urine free corticosterone levels,plasma corticosterone at 8:00 am and plasma corticosterone at 0:00 am among patients with different trauma events before treatment(P<0.05 or 0.01),those levels were the highest in ones with death/threat events,all lowered after treatment(F<0.01),but there were significant group differences in 24 h urine free corticosterone,plasma corticosterone at 8:00 am(P<0.05 or 0.01).Conclusion Different subtypes of SRD patients have different chara cteristics of psychological trauma events,different types of trauma events do relative influence on HPA axis function.更多还原