JNNP：慢性压力或导致中风风险升高

近日，刊登在国际著名杂志Journal of Neurology Neurosurgery and Psychiatry上的一篇研究报告指出，由主要生活压力和A型人格特质引发的慢性压力和高风险的中风直接相关。慢性压力，已经表明的对于应激物所产生的身体或精神上的压力，如果持续长达6个月以上，便会增加患者患心脏疾病的风险，但是对于产生中风的风险便不得而知。

研究小组对150个，平均年龄为54岁的成年人进行研究，这些人群已经被证实具有一个中风单位，同时研究小组也对300个随机选择的健康人群进行了研究。慢性压力的水平可以使用四项验证标准进行综合性的定量评定。观察主要的生活事件以及症状，比如焦虑、压抑常规幸福感以及A型人格类型的行为（ERCTA标准）。A型行为包括敌对意识、侵犯意识、急躁以及急性子脾气。如果ERCTA标准得分为24或者以上都可以认为是A型人格。

参与者随后进行了中风生物风险因子的评估，包括糖尿病，高血压、高胆固醇以及心脏节律异常或者日间嗜睡等。随后研究者询问参与者的生活方式，包括他们的咖啡因、酒精以及能量饮料的摄入，以及参与者是否吸烟等等。结果显示，许多因素都和中风风险相关。

相比健康对照组中风风险，早期经历重大事件的参与者发生中风的风险是前者的4倍，而ERCTA的高分值超过了中风风险的2倍，也揭示了参与者与长期的吸烟历史以及高能量饮料的摄入相关。

调查发现，心脏节律紊乱的参与者中风风险是日间嗜睡参与者的三倍以上。研究者表示，当把所有因子放在一起进行评估后发现，中风风险和高压力生活以及A型人格特质明显相关。

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编译自：Chronic Stress Linked to High Risk of Stroke

doi:10.1136/jnnp-2012-302420
PMC:
PMID:

Is psycho-physical stress a risk factor for stroke? A case-control study

Jose Antonio Egido1, Olga Castillo1, Beatriz Roig1, Isabel Sanz1, Maria Rosa Herrero1, Maria Teresa Garay1, Ana María Garcia1, Manuel Fuentes2, Cristina Fernandez2

Background Chronic stress is associated with cardiovascular diseases, but the link with stroke has not been well established. Stress is influenced by life-style habits, personality type and anxiety levels. We sought to evaluate psycho-physical stress as a risk factor for stroke, while assessing gender influences.

Methods Case-control study. Cases: patients (n=150) aged 18–65, admitted consecutively to our Stroke Unit with the diagnosis of incident stroke. Controls: (n=300) neighbours (paired with case ±5 years) recruited from the census registry. Study variables: socio-demographic characteristics, vascular risk factors, psychophysical scales of H&R (Holmes & Rahe questionnaire of life events), ERCTA (Recall Scale of Type A Behaviour), SF12 (QoL scale), GHQ28 (General Health Questionnaire). Statistical analyses included conditional multiple logistic regression models.

Results Mean age was 53.8 years (SD: 9.3). Compared with controls, and following adjustment for confounding variables, significant associations between stroke and stress were: H&R values >150 OR=3.84 (95% CI 1.91 to 7.70, p<0.001); ERCTA (values >24) OR=2.23 (95% CI 1.19 to 4.18, p=0.012); mental SF12 (values >50) OR=0.73 (95% CI 0.39 to 1.37, p=0.330); psychological SF12 (values >50) OR=0.66 (95% CI 0.33 to 1.30, p=0.229), male gender OR=9.33 (95% CI 4.53 to 19.22, p<0.001), high consumption of energy-providing beverages OR=2.63 (95% CI 1.30 to 5.31, p=0.007), current smoker OR=2.08 (95% CI 1.01 to 4.27, p=0.046), ex-smoker OR=2.35 (95% CI 1.07 to 5.12, p=0.032), cardiac arrhythmia OR=3.18 (95% CI 1.19 to 8.51, p=0.022) and Epworth scale (≥9) OR=2.83 (95% CI 1.03 to 7.78, p=0.044).

Conclusions Compared with healthy age-matched individuals, stressful habits and type A behaviour are associated with high risk of stroke. This association is not modified by gender. /P>