创伤后应激障碍、多梦症和代谢综合征

V.A. Serhiyenko, V. B. Sehin, V.I. Pankiv, A.A. Serhiyenko
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摘要

创伤后应激障碍(PTSD)和代谢综合征(MetS)经常同时存在,并具有共同的神经生物学和临床特征。特别是,荟萃分析结果表明,与普通人群相比,创伤后应激障碍患者的 MetS 患病率更高。创伤后应激障碍也是一种公认的 MetS 风险因素。这两种疾病的发病途径可以部分解释这种同步性。这些因素包括遗传因素、下丘脑-垂体-肾上腺轴功能失调、慢性低度炎症、氧化应激、胰岛素抵抗和免疫失调。因此,创伤后应激障碍的临床恶化和与 MetS 相关的不良心血管事件的发生也涉及类似的机制。多梦是创伤后应激障碍的临床特征之一。如今,人们认为创伤后昼夜节律紊乱是创伤后应激障碍的核心特征,而非次要特征,它介导了由于体内平衡失调而导致的神经生物学相关紊乱。同时,昼夜节律紊乱、时序破坏和抑郁障碍也是胰岛素抵抗、肥胖和代谢紊乱的发病机制之一。因此,治疗失眠是预防和治疗合并创伤后应激障碍和代谢综合征的关键任务之一。通过外源性干预,尤其是使用褪黑激素类药物来调节睡眠过程和昼夜节律,可能是预防和治疗创伤后应激障碍和代谢综合征患者睡眠障碍的关键部分。本综述旨在分析创伤后应激障碍与 MetS、创伤后应激障碍与多梦症、MetS 与睡眠障碍之间关系的具体细节。我们在 Scopus、Science Direct(来自 Elsevier)和 PubMed(包括 Medline)数据库中进行了搜索。使用的关键词是 "创伤后应激障碍"、"多梦"、"慢性毁损 "和 "代谢综合征"。为了确定在线搜索未找到的研究成果,需要对出版物的书目进行人工搜索。
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Post-traumatic stress disorder, dyssomnias, and metabolic syndrome
Post-traumatic stress disorder (PTSD) and metabolic syndrome (MetS) frequently coexist and share neurobiological and clinical features. In particular, the results of meta-analyses indicate a higher prevalence of MetS in patients with PTSD compared to the general population. PTSD is also a recognized risk factor for MetS. This synchronicity can be partially explained by pathogenetic pathways present in both conditions. These include genetic factors, dysfunction of the hypothalamic-pituitary-adrenal axis, chronic low-grade inflammation, oxidative stress, insulin resistance, and immune dysregulation. Thus, similar mechanisms are involved in the clinical worsening of PTSD and the development of adverse cardiovascular events associated with MetS. Dyssomnias are one of the characteristic clinical features of PTSD. Today, it is believed that posttraumatic circadian rhythm disorders are the core and not a secondary feature of PTSD, which mediate the neurobiological correlates of disorders due to homeostasis imbalance. At the same time, dyssomnias, chronodestruction, and depressive disorders are part of the pathogenesis of insulin resistance, obesity, and MetS. Thus, treatment of dyssomnias is one of the key tasks in the prevention and treatment of comorbid PTSD and MetS. Regulation of sleep processes and circadian rhythms through exogenous intervention, especially with melatonergic drugs, is likely to be a key part of preventing and treating dyssomnias in people who have both PTSD and MetS. The purpose of this review is to analyze the specifics of the relationships between PTSD and MetS, PTSD and dyssomnias, MetS and sleep disorders. We conducted the search in Scopus, Science Direct (from Elsevier), and PubMed, including Medline databases. The key words used were “post-traumatic stress disorder,” “dyssomnias,” “chronodestruction,” and “metabolic syndrome”. The identification of research findings that were not found during online searches involved manual searching of the bibliography of publications.
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