Abstract: Background　Cortisol，as the end product of hypothalamus-pituitary-adrenal（HPA）axis，is an important biological indicator of HPA axis function. It has been found that abnormal cortisol secretion exists in  posttraumatic stress disorder （PTSD） and that cortisol can improve PTSD symptoms. At present，PTSD clinical symptoms multi-scale evaluation，cortisol and scale correlation analysis，to provide a biological basis for the evaluation of PTSD symptoms. Objective　To investigate the difference of serum cortisol between patients with PTSD and normal population，and the correlation between cortisol and clinical symptoms in patients with PTSD.Methods　Twenty-four patients with PTSD admitted to the First Affiliated Hospital of the Medical College，Shihezi University from December 2016 to December 2017 were selected as PTSD group.Twenty-four healthy persons with similar age，gender and menstrual history were selected as control group.General questionnaires were used to record general information of all subjects.The PTSD group was investigated by using Hamilton Depression Scale （HAMD），the Hamilton Anxiety Scale （HAMA），and the Posttraumatic Stress Disorder Check-list-civilian Version （PCL-C）．Serum cortisol levels were detected in PTSD group and control group.Women in PTSD group and control group were divided into the luteal phase group，the follicular phase group，and the menopause group according to the menstrual cycle in which the blood was collected.Results　The serum cortisol level in PTSD group was 165 （131，181） μg/L，lower than 212 （202，258）μg/L  in control group （Z=-5.574，P<0.001）．The serum cortisol level of male patients in PTSD group was 175 （106，193） μg/L，lower than 214 （208，235） μg/L in control group （Z=-2.878，P=0.004）．The serum cortisol level of patients at luteal phase in PTSD group was 138 （72，165） μg/L，lower than 261 （200，333） μg/L of patients at luteal phase in control group （Z=-3.130，P=0.002）．The serum cortisol level of patients at follicular phase of PTSD group was 176 （151，206） μg/L，lower than 261 （200，333） μg/L of patients at follicular phase of control group （Z=-2.193，P=0.028）．The serum cortisol level of patients at menopause in PTSD group was 138（83，186） μg/L，lower than 209（202，229） μg/L of patients at menopause in control group （Z=-2.878，P=0.004）．Cortisol was negatively correlated with HAMD total score，PCL-C total score，and scores of cognitive impairment，day and night change，block，sleep disorder，despair，general symptoms，somatic anxiety，re-experience symptoms，avoidance/numbness symptoms and hyper-arousal symptoms（P<0.05）．Conclusion　Serum cortisol level in patients with PTSD decreased compared with that of normal population.Therefore，it can provide more evidence for assessing symptoms of patients with PTSD.

Key words: Stress disorders, post-traumatic；Cortisol；Signs and symptoms；Scale

摘要： 背景　皮质醇作为下丘脑-垂体-肾上腺（HPA）轴的终末产物，是反映HPA轴功能的重要生物指标。研究发现，创伤后应激障碍（PTSD）存在皮质醇分泌异常，同时还发现给予皮质醇后可改善PTSD症状。目前PTSD临床症状多用量表评估，将皮质醇水平与量表得分做相关性分析，可以为PTSD症状的评估提供生物学依据。目的　探讨PTSD患者与健康人群的血清皮质醇水平差异以及皮质醇与PTSD患者临床症状的相关性。方法　选取2016年12月—2017年12月石河子大学医学院第一附属医院收治的PTSD患者24例，作为PTSD组；同时选取性别、年龄、月经周期相当的于本院体检的健康人群24例，作为对照组。PTSD组与对照组入院时采用一般资料调查表记录一般资料，PTSD组采用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、创伤后应激障碍量表平民版（PCL-C）进行调查；PTSD组与对照组检测血清皮质醇水平。根据采血时间所处的月经周期将PTSD组和对照组的女性分为黄体期、卵泡期、绝经期。结果　PTSD组患者血清皮质醇水平为165（131，181）μg/L，低于对照组的212（202，258）μg/L（Z=-5.574，P<0.001）；PTSD组男性患者血清皮质醇水平为175（106，193）μg/L，低于对照组男性的214（208，235）μg/L（Z=-2.878，P=0.004）；PTSD组黄体期患者血清皮质醇水平为138（72，165）μg/L，低于对照组黄体期者的261（200，333）μg/L（Z=-3.130，P=0.002）；PTSD组卵泡期患者血清皮质醇水平为176（151，206）μg/L，低于对照组卵泡期者的261（200，333）μg/L（Z=-2.193，P=0.028）；PTSD组绝经期患者血清皮质醇水平为138（83，186）μg/L，低于对照组绝经期者的209（202，229）μg/L（Z=-2.878，P=0.004）。PTSD患者血清皮质醇水平与HAMD总分、认识障碍、日夜变化、阻滞、睡眠障碍、绝望感、全身症状、躯体性焦虑、PCL-C总分、再体验、麻木和回避、警觉性增高维度得分均呈负相关（P<0.05）。结论　PTSD患者血清皮质醇水平低于健康人群，皮质醇水平可为临床评估PTSD患者的症状程度提供更多方向。

关键词: 应激障碍, 创伤后；皮质醇；体征和症状；量表