Brown R F, Tennant C C, Dunn S M, Pollard J D
Psychology Department, University of New England, Armidale, NSW, Australia.
Mult Scler. 2005 Aug;11(4):477-84. doi: 10.1191/1352458505ms1170oa.
Studies do not provide a consensus opinion of the relationship between stress and relapse in relapsing-remitting multiple sclerosis (RRMS). Few studies have defined the critical features of these stressful situations, or examined the role of stress-mediating and -moderating variables. Available evidence indicates that the relationship between life stress and relapse is complex, and is likely to depend on factors such as stressor chronicity, frequency, severity and type, and individual patient characteristics such as depression, health locus of control and coping strategy use. Little is known about how these factors, individually or in combination, are related to MS disease activity. Viral infections are also likely to precipitate relapse in MS, and significant life-stress may further enhance this relationship. The nature and strength of these interrelationships have strong clinical implications. MS patients are particularly vulnerable to a deteriorating cycle of stressful life events, illness episodes and disability. Timely multidisciplinary care interventions aimed at both minimizing psychological distress and physical symptoms may halt this downward reciprocal cycle. Little is known of the pathogenesis of these putative stress-induced changes in disease activity, and almost all stressor studies suffer from some biases or limitations.
关于复发缓解型多发性硬化症（RRMS）中压力与复发之间的关系，各项研究并未给出一致意见。很少有研究明确这些应激情况的关键特征，或探讨压力介导和调节变量的作用。现有证据表明，生活压力与复发之间的关系很复杂，可能取决于应激源的慢性程度、频率、严重程度和类型等因素，以及个体患者特征，如抑郁、健康控制点和应对策略的使用情况。对于这些因素单独或共同作用如何与MS疾病活动相关，我们知之甚少。病毒感染也可能促使MS复发，重大生活压力可能会进一步增强这种关系。这些相互关系的性质和强度具有重要的临床意义。MS患者特别容易陷入应激性生活事件、疾病发作和残疾不断恶化的循环。旨在尽量减少心理困扰和身体症状的及时多学科护理干预措施可能会阻止这种恶性循环。对于这些假定的压力诱导疾病活动变化的发病机制，我们知之甚少，而且几乎所有应激源研究都存在一些偏差或局限性。
