Análise comparativa de marcadores biológicos entre homens saudáveis e com diagnóstico clínico de Transtorno de Estresse Pós-Traumático (TEPT)

Abstract

Posttraumatic Stress Disorder (PTSD) is a psychiatric condition characterized by the appearance of typical symptoms after exposure to a traumatic event, which can occur either directly or indirectly. The clinical presentation is of reliving the trauma, avoidance maneuvers of these intrusive memories, negative changes in cognition and mood, and symptoms of physical and psychic hyperreactivity. The chronic stress situation present in PTSD involves changes in the physiological mechanisms related to the hypothalamic-pituitary-adrenal (HPA) axis and to the autonomic nervous and immune systems. The literature shows no homogeneity regarding the findings indicative of the changes, demonstrating that the secretion profile of the hormone cortisol is high, reduced or unmodified, in studies involving participants with PTSD compared to a control group. A similar situation occurs with dehydroepiandrosteronesulfate hormone (DHEA-S) as well as with the immune response associated with PTSD, evaluated by C-reactive protein (CRP). The present study was carried out with two groups of men, matched for age, 17 of them with clinical diagnosis of PTSD and 17 of the control group (without PTSD). The serum profiles of cortisol, DHEA-S, cortisol / DHEA-S ratio and CRP in the two groups were analyzed using nonparametric Wilcoxon-Mann-Whitney, Kruskall-Wallis and Spearman´s correlation coefficient. The statistical analysis considered the value of p <0.05. There was no statistically significant difference in any of these indicators between the two groups. Within the experimental group, when PTSD grades were stratified, DHEA-S levels were statistically lower in men with severe PTSD grade, when compared to the sum of the levels of participants with mild and moderate degrees. The Spearman´s correlation coefficient showed a negative association between cortisol levels and DHEA-S in the control group and, in the experimental group, a positive correlation between cortisol and CRP. These results suggest that the studied variables, alone, do not seem to be good markers for PTSD diagnosis, but when correlated, may reinforce this diagnosis. In addition, significantly lower levels of DHEA-S in severe PTSD suggest a decrease in the neuroprotective effect of this hormone and, consequently, the worsening of PTSD. The increase in the sample size could better characterize this alteration and if the reduction of DHEA-S could represent a marker for the diagnosis of PTSD severity.