{"title":"慢性应激相关疾病中毛发皮质醇、脱氢表雄酮与感知应激的关系：一项系统综述和荟萃分析。","authors":"Ravish Huchegowda, Ranganath R Kulkarni, Somashekhar Bijjal, Prasad Nagamangala Nagesh, Mariyamma Philip, Vijaykumar Harbishettar","doi":"10.1177/02537176251370986","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hair concentrations of cortisol and dehydroepiandrosterone (DHEA) are increasingly recognized as non-invasive, retrospective biomarkers of hypothalamic-pituitary-adrenal axis function. The ratio of these hormones may reflect the balance between catabolic and anabolic activity, potentially serving as a composite marker of chronic stress. Despite its theoretical relevance, the clinical utility of the hair cortisol: DHEA ratio remains unclear. This PROSPERO-registered systematic review, done according to PRISMA guidelines, aimed to evaluate the association between the hair cortisol: DHEA ratio and perceived stress in adults with chronic stress exposure.</p><p><strong>Methods: </strong>A comprehensive search of five electronic databases and grey literature was conducted up to March 5, 2025. Studies were eligible if they included adults (≥18 years) with at least 4 weeks of documented chronic stress exposure and reported both hair cortisol and DHEA concentrations alongside validated perceived stress measures. Meta-analyses were performed for correlation coefficients and group comparisons. Risk of bias was assessed using a modified Downs and Black checklist.</p><p><strong>Results: </strong>Eight studies (five cross-sectional, three cohort; <i>n</i> = 60-210) met inclusion criteria. A meta-analysis of two studies using validated stress scales showed no significant association between the hair cortisol/DHEA ratio and perceived stress (<i>ρ</i> = 0.09; 95% CI: -0.07 to 0.26; <i>I</i>² = 0%). However, a separate analysis of three studies comparing high- versus low-stress groups revealed a moderate, statistically significant pooled effect (Hedges' <i>g</i> = 0.69; 95% CI: 0.14-1.24; <i>p</i> = .01) with substantial heterogeneity (<i>I</i>² = 77.17%). Risk of bias ranged from moderate to low, but the overall certainty of evidence was rated very low due to small sample sizes and inconsistent findings.</p><p><strong>Conclusion: </strong>The hair cortisol: DHEA ratio has biological plausibility as a marker of chronic stress, but current evidence is insufficient to support its clinical application. Further standardized, longitudinal studies are needed to establish its diagnostic and prognostic value.</p><p><strong>Prospero registration: </strong>CRD420251003364.</p>","PeriodicalId":13476,"journal":{"name":"Indian Journal of Psychological Medicine","volume":" ","pages":"02537176251370986"},"PeriodicalIF":2.0000,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446278/pdf/","citationCount":"0","resultStr":"{\"title\":\"Association Between Hair Cortisol, Dehydroepiandrosterone and Perceived Stress in Chronic Stress-related Conditions: A Systematic Review and Meta-analysis.\",\"authors\":\"Ravish Huchegowda, Ranganath R Kulkarni, Somashekhar Bijjal, Prasad Nagamangala Nagesh, Mariyamma Philip, Vijaykumar Harbishettar\",\"doi\":\"10.1177/02537176251370986\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Hair concentrations of cortisol and dehydroepiandrosterone (DHEA) are increasingly recognized as non-invasive, retrospective biomarkers of hypothalamic-pituitary-adrenal axis function. The ratio of these hormones may reflect the balance between catabolic and anabolic activity, potentially serving as a composite marker of chronic stress. Despite its theoretical relevance, the clinical utility of the hair cortisol: DHEA ratio remains unclear. This PROSPERO-registered systematic review, done according to PRISMA guidelines, aimed to evaluate the association between the hair cortisol: DHEA ratio and perceived stress in adults with chronic stress exposure.</p><p><strong>Methods: </strong>A comprehensive search of five electronic databases and grey literature was conducted up to March 5, 2025. Studies were eligible if they included adults (≥18 years) with at least 4 weeks of documented chronic stress exposure and reported both hair cortisol and DHEA concentrations alongside validated perceived stress measures. Meta-analyses were performed for correlation coefficients and group comparisons. Risk of bias was assessed using a modified Downs and Black checklist.</p><p><strong>Results: </strong>Eight studies (five cross-sectional, three cohort; <i>n</i> = 60-210) met inclusion criteria. A meta-analysis of two studies using validated stress scales showed no significant association between the hair cortisol/DHEA ratio and perceived stress (<i>ρ</i> = 0.09; 95% CI: -0.07 to 0.26; <i>I</i>² = 0%). However, a separate analysis of three studies comparing high- versus low-stress groups revealed a moderate, statistically significant pooled effect (Hedges' <i>g</i> = 0.69; 95% CI: 0.14-1.24; <i>p</i> = .01) with substantial heterogeneity (<i>I</i>² = 77.17%). Risk of bias ranged from moderate to low, but the overall certainty of evidence was rated very low due to small sample sizes and inconsistent findings.</p><p><strong>Conclusion: </strong>The hair cortisol: DHEA ratio has biological plausibility as a marker of chronic stress, but current evidence is insufficient to support its clinical application. 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引用次数: 0
摘要
研究背景：毛发中皮质醇和脱氢表雄酮（DHEA）的浓度越来越被认为是下丘脑-垂体-肾上腺轴功能的非侵入性、回顾性生物标志物。这些激素的比例可能反映了分解代谢和合成代谢活性之间的平衡，可能作为慢性应激的综合标志物。尽管其理论相关性，毛发皮质醇：脱氢表雄酮比例的临床应用仍不清楚。根据PRISMA指南进行的这项普洛斯彼罗注册的系统评价，旨在评估慢性应激暴露的成人头发皮质醇：脱氢表雄酮比率与感知应激之间的关系。方法：综合检索截至2025年3月5日的5个电子数据库和灰色文献。如果纳入至少有4周慢性应激暴露记录的成年人（≥18岁），并报告毛发皮质醇和脱氢表雄酮浓度以及有效的感知应激测量，则研究符合条件。对相关系数和组间比较进行meta分析。使用改进的Downs和Black检查表评估偏倚风险。结果：8项研究（5项横断面研究，3项队列研究，n = 60-210）符合纳入标准。使用有效压力量表的两项研究的荟萃分析显示，毛发皮质醇/脱氢表雄酮比率与感知压力之间无显著关联（ρ = 0.09; 95% CI: -0.07至0.26;I²= 0%）。然而，对三个比较高压力组和低压力组的研究进行的单独分析显示，有一个中等的、统计学上显著的合并效应（Hedges' g = 0.69; 95% CI: 0.14-1.24; p = 0.01），具有显著的异质性（I²= 77.17%）。偏倚风险从中等到低不等，但由于样本量小且结果不一致，证据的总体确定性被评为非常低。结论：毛发皮质醇：脱氢表雄酮比值作为慢性应激标志物具有生物学合理性，但目前证据不足以支持其临床应用。需要进一步标准化的纵向研究来确定其诊断和预后价值。普洛斯彼罗注册：CRD420251003364。
Association Between Hair Cortisol, Dehydroepiandrosterone and Perceived Stress in Chronic Stress-related Conditions: A Systematic Review and Meta-analysis.
Background: Hair concentrations of cortisol and dehydroepiandrosterone (DHEA) are increasingly recognized as non-invasive, retrospective biomarkers of hypothalamic-pituitary-adrenal axis function. The ratio of these hormones may reflect the balance between catabolic and anabolic activity, potentially serving as a composite marker of chronic stress. Despite its theoretical relevance, the clinical utility of the hair cortisol: DHEA ratio remains unclear. This PROSPERO-registered systematic review, done according to PRISMA guidelines, aimed to evaluate the association between the hair cortisol: DHEA ratio and perceived stress in adults with chronic stress exposure.
Methods: A comprehensive search of five electronic databases and grey literature was conducted up to March 5, 2025. Studies were eligible if they included adults (≥18 years) with at least 4 weeks of documented chronic stress exposure and reported both hair cortisol and DHEA concentrations alongside validated perceived stress measures. Meta-analyses were performed for correlation coefficients and group comparisons. Risk of bias was assessed using a modified Downs and Black checklist.
Results: Eight studies (five cross-sectional, three cohort; n = 60-210) met inclusion criteria. A meta-analysis of two studies using validated stress scales showed no significant association between the hair cortisol/DHEA ratio and perceived stress (ρ = 0.09; 95% CI: -0.07 to 0.26; I² = 0%). However, a separate analysis of three studies comparing high- versus low-stress groups revealed a moderate, statistically significant pooled effect (Hedges' g = 0.69; 95% CI: 0.14-1.24; p = .01) with substantial heterogeneity (I² = 77.17%). Risk of bias ranged from moderate to low, but the overall certainty of evidence was rated very low due to small sample sizes and inconsistent findings.
Conclusion: The hair cortisol: DHEA ratio has biological plausibility as a marker of chronic stress, but current evidence is insufficient to support its clinical application. Further standardized, longitudinal studies are needed to establish its diagnostic and prognostic value.
期刊介绍：
The Indian Journal of Psychological Medicine (ISSN 0253-7176) was started in 1978 as the official publication of the Indian Psychiatric Society South Zonal Branch. The journal allows free access (Open Access) and is published Bimonthly. The Journal includes but is not limited to review articles, original research, opinions, and letters. The Editor and publisher accept no legal responsibility for any opinions, omissions or errors by the authors, nor do they approve of any product advertised within the journal.
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