Many studies have shown that patients with autoimmune disease present a hypoactive hypothalamic‐pituitary‐adrenal (HPA) axis, but the results are controversial. Our objective was to study differences in stress response axis activity between patients with autoimmune disease and healthy people. The study sample consisted of 97 women divided into four groups: 37 healthy women (HW), 21 with systemic lupus erythematosus (SLE), 21 with Sjögren's syndrome (SS), and 18 with systemic sclerosis (SSc). After being exposed to a stress task, participants' skin conductance and salivary cortisol levels were measured in order to assess their response to psychological stress. Diurnal cortisol concentrations were assessed by measuring salivary cortisol in samples collected five times over one day. In addition, self‐administered questionnaires were used to assess psychological variables. A time × group interaction effect was found (p = 0.003) in salivary cortisol secretion in response to stressful challenge. The healthy group presented normal activation, the SS and SLE groups showed no activation, and the SSc group presented a similar activation pattern to the HW group, except at the time of recovery. Total cortisol production (AUCg) was higher in the SSc group than in the HW group (p = 0.001). Differences were also observed in the cortisol AUCg collected over one day between healthy women and patients with SLE (p = 0.004) as well as with SSc (p = 0.001): women with SLE and SSc presented higher total hormone production than healthy women. Patients with autoimmune disease present a different HPA axis response, which may contribute to the harmful effects of stress in these diseases.

中文翻译：

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自身免疫性疾病患者和健康人的应激反应轴激活是否存在差异？

许多研究表明，自身免疫性疾病患者存在下丘脑-垂体-肾上腺（HPA）轴功能低下，但结果存在争议。我们的目的是研究自身免疫性疾病患者和健康人之间应激反应轴活动的差异。研究样本由 97 名女性组成，分为四组：37 名健康女性 (HW)、21 名系统性红斑狼疮 (SLE) 女性、21 名干燥综合征 (SS) 女性和 18 名系统性硬化症 (SSc) 女性。在承受压力任务后，测量了参与者的皮肤电导和唾液皮质醇水平，以评估他们对心理压力的反应。通过测量一天内五次收集的样本中的唾液皮质醇来评估每日皮质醇浓度。此外，还使用自填问卷来评估心理变量。发现时间×组交互作用（p= 0.003）唾液皮质醇分泌以应对压力挑战。健康组表现出正常的激活，SS和SLE组没有表现出激活，SSc组表现出与HW组相似的激活模式，除了在恢复时。SSc 组的总皮质醇产量 (AUCg) 高于 HW 组（p= 0.001）。健康女性和 SLE 患者一天内收集的皮质醇 AUCg 也存在差异（p= 0.004) 以及 SSc (p= 0.001)：患有 SLE 和 SSc 的女性比健康女性的总激素产生量更高。患有自身免疫性疾病的患者表现出不同的 HPA 轴反应，这可能会导致压力对这些疾病产生有害影响。