von Känel Roland, Dimsdale Joel E, Patterson Thomas L, Grant Igor
Department of Psychiatry, University of California-San Diego, La Jolla 92093-0680, USA.
Ann Behav Med. 2003 Aug;26(1):42-8. doi: 10.1207/S15324796ABM2601_06.
Allostasis designates processes of bodily adaptation to stressful challenges, whereas allostatic load means the costs of wear and tear to the body as a consequence of inefficient allostasis. In distressed dementia caregivers, an acute procoagulant stress response might be one dynamic mediator of allostatic load relevant to cardiovascular endpoints. An interviewer assessed the number of negative life-events independent from caregiving over 4 weeks in 37 spousal Alzheimer caregivers (M age +/- SD = 72 +/- 6 years). Baseline procoagulability scores and procoagulability scores in response to a 15-min speech task included plasma thrombin/antithrombin III complex, D-dimer, von Willebrand factor, tissue-type plasminogen activator, and plasminogen activator inhibitor 1 levels. Allostatic load was defined as the difference in procoagulability scores from baseline to speech, using standardized (z-score) transformations. Speech stress significantly increased heart rate (p =.017), systolic blood pressure (p =.002), and diastolic blood pressure (p <.001). The number of negative life-events (M +/- SD 2.8 +/- 2.0) correlated with allostatic load (r =.367, p =.026). After controlling for age and smoking, which together explained 32% of the variance in the allostatic load (R2 =.324), F(2, 34) = 8.14, p =.001, the number of negative life-events accounted for an additional 13% of that variance (Delta R2=.125), Delta F(1, 33) = 7.49, p =.010. The finding is compatible with the concept of allostasis and allostatic load, suggesting that higher combined caregiving and life distress levels are associated with more dysfunctional hemostatic responses to acute mental stress. The acute procoagulant stress response might constitute a dynamic mediator of allostatic load in Alzheimer caregivers.
适应性负荷指身体适应压力挑战的过程，而应激负荷则意味着由于适应性负荷效率低下给身体带来的损耗成本。在患有痴呆症的照料者中，急性促凝血应激反应可能是与心血管终点相关的应激负荷的一个动态调节因素。一名访谈者评估了37名配偶患有阿尔茨海默病的照料者在4周内与照料无关的负面生活事件数量（平均年龄±标准差=72±6岁）。基线促凝分数以及对15分钟言语任务的促凝分数包括血浆凝血酶/抗凝血酶III复合物、D-二聚体、血管性血友病因子、组织型纤溶酶原激活剂和纤溶酶原激活剂抑制剂1水平。应激负荷被定义为使用标准化（z分数）转换后从基线到言语任务的促凝分数差异。言语应激显著增加心率（p = 0.017）、收缩压（p = 0.002）和舒张压（p < 0.001）。负面生活事件数量（平均±标准差2.8±2.0）与应激负荷相关（r = 0.367，p = 0.026）。在控制了年龄和吸烟因素后，这两个因素共同解释了应激负荷方差的32%（R2 = 0.324），F(2, 34) = 8.14，p = 0.001，负面生活事件数量又额外解释了该方差的13%（ΔR2 = 0.125），ΔF(1, 33) = 7.49，p = 0.010。这一发现与适应性负荷和应激负荷的概念相符，表明更高的照料和生活压力水平与对急性精神应激的止血反应功能障碍有关。急性促凝血应激反应可能是阿尔茨海默病照料者应激负荷的一个动态调节因素。
