Chen Edith, Fisher Edwin B, Bacharier Leonard B, Strunk Robert C
Washington University, St. Louis Children's Hospital, St. Louis, MO, USA.
Psychosom Med. 2003 Nov-Dec;65(6):984-92. doi: 10.1097/01.psy.0000097340.54195.3c.
Previous research has demonstrated links between low socioeconomic status (SES) and clinical asthma outcomes, as well as links between stress and asthma. The objective of this study was to test whether adolescents with asthma from different SES backgrounds differed in biological profiles relevant to asthma, including immune and cortisol measures. The second objective was to test whether psychological stress and control beliefs could explain these differences.
Adolescents with persistent asthma from either low (N= 18) or high (N= 12) SES neighborhoods were interviewed about their stress experiences (chronic stress, acute life events, interpretations of ambiguous life events) and control beliefs. Blood was drawn to assess immune (cytokines, eosinophils, IgE) and neuroendocrine (cortisol) markers associated with asthma.
Adolescents in the low SES group had significantly higher levels of a stimulated cytokine associated with a Th-2 immune response (IL-5), higher levels of a stimulated cytokine associated with a Th-1 immune response (IFN-gamma), and marginally lower morning cortisol values compared with the high SES group. Low SES adolescents also had greater stress experiences and lower beliefs about control over their health. Statistical mediational analyses revealed that stress and control beliefs partially explained the relationship between SES and IL-5/IFN-gamma.
Our finding that low SES was associated with elevations in certain immune responses (IL-5/IFN-gamma) in adolescents with asthma suggests the importance of further exploration into relationships between SES and Th-2/Th-1 responses in asthma. Our findings also suggest that psychological stress and control beliefs may provide one explanation for links between SES and immune responses in childhood asthma.
先前的研究已证明社会经济地位低下（SES）与临床哮喘结局之间存在关联，以及压力与哮喘之间的联系。本研究的目的是测试来自不同SES背景的哮喘青少年在与哮喘相关的生物学特征（包括免疫和皮质醇指标）上是否存在差异。第二个目的是测试心理压力和控制信念是否可以解释这些差异。
对来自低SES社区（N = 18）或高SES社区（N = 12）的持续性哮喘青少年进行访谈，了解他们的压力经历（慢性压力、急性生活事件、对模糊生活事件的解读）和控制信念。采集血液以评估与哮喘相关的免疫（细胞因子、嗜酸性粒细胞、免疫球蛋白E）和神经内分泌（皮质醇）标志物。
与高SES组相比，低SES组青少年中与Th-2免疫反应相关的一种刺激细胞因子（白细胞介素-5）水平显著更高，与Th-1免疫反应相关的一种刺激细胞因子（干扰素-γ）水平更高，且早晨皮质醇值略低。低SES青少年的压力经历也更多，对自身健康控制的信念更低。统计中介分析表明，压力和控制信念部分解释了SES与白细胞介素-5/干扰素-γ之间的关系。
我们的研究发现，低SES与哮喘青少年某些免疫反应（白细胞介素-5/干扰素-γ）升高有关，这表明进一步探索SES与哮喘中Th-2/Th-1反应之间的关系具有重要意义。我们的研究结果还表明，心理压力和控制信念可能为儿童哮喘中SES与免疫反应之间的联系提供一种解释。
