Earthquake-induced potentiation of acute risk factors in hypertensive elderly patients: Possible triggering of cardiovascular events after a major earthquake
Earthquake-induced potentiation of acute risk factors in hypertensive elderly patients: Possible triggering of cardiovascular events after a major earthquake
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DOI：
10.1016/s0735-1097(97)00002-8
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发表时间：
1997-04-01
影响因子：
24
通讯作者：
Shimada, K
中科院分区：
文献类型：
--
作者：
Kario, K;Matsuo, T;Shimada, K
目标。我们试图调查阪神淡路地震（里氏 7.2 级）后急性危险因素的增强程度。背景。大地震发生后心血管事件的发生频率有所增加，但其致病因素尚未得到充分调查。方法。我们研究了震中附近（淡路北段地区）的 42 名高血压控制良好的老年门诊患者在震后 7 至 14 天大余震持续期间的心血管危险因素的变化，根据 DSM-III-R，他们都经历了最高的压力等级 6（灾难性压力）。为了研究止血特性和内皮细胞状态，我们测量了血压 (BP)、血细胞比容和血脂特性以及纤维蛋白原、纤维蛋白转换标记物 (D-二聚体)、纤溶因子（纤溶酶-α(2) 纤溶酶抑制剂复合物 [PIC]、组织型纤溶酶原激活剂 [t-PA] 抗原和 t-PA 抑制剂 [PAI] 活性）和内皮细胞衍生标记物 (von血友病因子 [vWF]）。结果。地震后收缩压和舒张压等变量增加，地震前后，收缩压中位值（25%至75%）分别为152（范围142至164）和170毫米汞柱（范围161至178）（p<0.0001），舒张压为83（范围79）至 88）和 91 mm Hg（范围 84 至 96），分别（p < 0.0001）。 在血液粘度决定因素中，血细胞比容分别为 38.1%（范围 40.7% 至 35.9%）和 39.7%（范围 42.9% 至 38.3%）（p < 0.001），纤维蛋白原 316（范围272 至 360）和 335 mg/dl（范围 307 至 391）（p < 0.05），Von Willebrand 因子分别为 128%（范围 74% 至 148%）和 148%（范围 100% 至 178%）（p < 0.01）； D-二聚体分别为 410（范围 285 至 633）和 560 ng/ml（范围 391 至 888）（p < 0.0001）； PIC 分别为 0.74（范围 0.58 至 0.91）和 0.75 μg/ml（范围 0.58 至 1.1）（p < 0.05）。相比之下，地震后脂质分布没有变化。根据房屋受损程度和家庭成员受伤程度将患者分为高应激组和中应激组时，仅前者的纤维蛋白原、vWF、PIC和t-PA抗原水平升高，而BP、血细胞比容和D-二聚体水平在两组中均仅升高。这些急性危险因素的异常，除vWF外，只是短暂的，在震后4~6个月降至震前水平。结论。地震引起的应激似乎会导致血压、血液粘度决定因素和纤维蛋白周转短暂增加，并延长内皮细胞刺激时间。这些急性危险因素的增强可能导致患有高血压的老年受试者在大地震后发生心血管事件。
Objectives. We sought to investigate the potentiation of acute risk factors after the Hanshin-Awaji earthquake (7.2 on the Richter scale).Background. The frequency of cardiovascular events increases just after a major earthquake, but the causative factors have not been fully investigated.Methods. We studied the changes in cardiovascular risk factors in 42 elderly outpatients with well-controlled hypertension living near the epicenter (Awaji-Hokudan districts) 7 to 14 days after the earthquake when the major felt-aftershocks persisted, They all experienced the highest stress grading of 6 (catastrophic stress) according to the DSM-III-R. To study the hemostatic profile and endothelial cell state, we measured the blood pressure (BP), hematocrit and lipid profiles as well as fibrinogen, a marker of fibrin turnover (D-dimer), fibrinolytic factors (plasmin-alpha(2) plasmin inhibitor complex [PIC], tissue-type plasminogen activator [t-PA] antigen and t-PA inhibitor [PAI] activity) and an endothelial cell-derived marker (von Willebrand factor [vWF]).Results. Systolic and diastolic blood pressures and other variables increased after the earthquake, Before and after the earthquake, the median (25th to 75th percentiles) systolic BP was 152 (range 142 to 164) and 170 mm Hg (range 161 to 178), respectively (p < 0.0001), and the diastolic BP was 83 (range 79 to 88) and 91 mm Hg (range 84 to 96), respectively (p < 0.0001), Of blood viscosity determinants, hematocrit was 38.1% (range 40.7% to 35.9%) and 39.7% (range 42.9% to 38.3%), respectively (p < 0.001), and fibrinogen 316 (range 272 to 360) and 335 mg/dl (range 307 to 391), respectively (p < 0.05), Von Willebrand factor was 128% (range 74% to 148%) and 148% (range 100% to 178%), respectively (p < 0.01); D-dimer was 410 (range 285 to 633) and 560 ng/ml (range 391 to 888), respectively (p < 0.0001); and PIC was 0.74 (range 0.58 to 0.91) and 0.75 mu g/ml (range 0.58 to 1.1), respectively (p < 0.05), In contrast, lipid profiles did not change after the quake. When the patients were classified into the high stress and moderate stress groups according to the degrees of damage to their house and injury to family members, the levels of fibrinogen, vWF, PIC and t-PA antigen were increased only in the former group, whereas BP, hematocrit and D-dimer levels mere increased in both groups, These abnormalities of acute risk factors, except for vWF, mere transient and decreased to prequake levels by 4 to 6 months after the quake.Conclusions. Earthquake-induced stress seems to induce transient increases in BP, blood viscosity determinants and fibrin turnover and to prolong endothelial cell stimulation, The potentiation of these acute risk factors might contribute to the occurrence of cardiovascular events just after a major earthquake in elderly subjects with hypertension.