Relationship of cardiovascular reactivity, stressful life events, and multiple sclerosis disease activity
Relationship of cardiovascular reactivity, stressful life events, and multiple sclerosis disease activity
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DOI：
10.1016/s0889-1591(03)00047-3
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发表时间：
2003-06-01
影响因子：
15.1
通讯作者：
Baum, A
中科院分区：
文献类型：
--
作者：
Ackerman, KD;Stover, A;Baum, A
以前的研究表明，在多发性硬化症患者的压力，生活事件可能会改变MS的发病和发展，但是，结果一直不一致，因为不频繁的监测和报告的偏见。我们对50名女性MS患者进行了为期一年的随访，以确定与MS加重相关的生活事件特征，并检查心血管活动的影响。受试者完成每周生活事件检查表。使用生活事件和困难时间表确定每个事件的短期和长期威胁。还每周监测神经系统症状。MS加重由对心理社会事件设盲的神经科医生确认。在研究开始时测定心血管对急性心理应激的反应性，每月监测静息心率和血压。42%的生活事件与随后6周内的病情加重有关。Logistic回归分析证实，在生活事件发生后的危险期，病情加重的可能性更大，并且与威胁水平和压力源类型相对独立。对急性应激具有较高心血管反应性和较高基线心率的参与者表现出更多的急性加重次数和患病周数。使用多元回归，我们发现残疾程度，药物使用，心血管反应性，基线心率和生活事件密度解释了大约30%的患病周数比例的方差。这些结果与压力是MS疾病活动的潜在触发因素的假设一致，并表明自主神经张力和压力反应性可能在压力相关加重的发展中发挥作用。(C)2003 Elsevier Science（美国）。All rights reserved.
Previous studies of stress in multiple sclerosis patients have suggested that life events may alter the onset and development of MS. However, results have been inconsistent because of infrequent monitoring and reporting bias. We followed fifty female MS patients for I year to determine characteristics of life events associated with MS exacerbations, and examine the influence of cardiovascular activity. Subjects completed weekly life-event checklists. The short- and long-term threat of each event was determined using the Life Events and Difficulties Schedule. Neurologic symptoms were also monitored weekly. MS exacerbations were confirmed by a neurologist blinded to psychosocial events. Cardiovascular reactivity to an acute psychological stressor was determined at study onset, and resting heart rate and blood pressure were monitored monthly. Forty-two percent of life events were associated with exacerbations in the subsequent 6 weeks. Logistic regression confirmed that exacerbations were more likely during at-risk periods following life events and were relatively independent of the threat level and type of stressor. Participants with higher cardiovascular reactivity to acute stress and higher baseline heart rate demonstrated a greater number of exacerbations and proportion of weeks ill. Using multiple regression, we found that disability level, medication usage, cardiovascular reactivity, baseline heart rate, and life event density explained approximately 30% of the variance in the proportion of weeks ill. These results are consistent with the hypothesis that stress is a potential trigger of MS disease activity and suggest that autonomic tone and stress reactivity may play a role in the development of stress-related exacerbations. (C) 2003 Elsevier Science (USA). All rights reserved.