Wirtz Petra H, Ehlert Ulrike, Emini Luljeta, Rüdisüli Katharina, Groessbauer Sara, von Känel Roland
Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, and Department of General Internal Medicine, University Hospital Berne, Switzerland.
J Psychosom Res. 2007 Jul;63(1):51-8. doi: 10.1016/j.jpsychores.2007.01.014.
The aim of this study was to investigate whether systemic systolic hypertension (SHT) and diastolic hypertension (DHT) are associated with an exaggerated response of factor VII clotting activity (FVII:C), factor VIII clotting activity (FVIII:C), fibrinogen, and d-dimer to acute psychosocial stress.
We performed the 15-min Trier Social Stress Test (i.e., combination of task preparation, job interview and mental arithmetic) in a sample of 42 middle-aged apparently healthy and unmedicated men with normal and elevated blood pressure (BP) (i.e. screening systolic and/or diastolic BP>or=130/85 mmHg). Blood samples for coagulation measures were obtained immediately pre and post stress and 20 min and 60 min thereafter. Repeated measures analyses of covariance controlled for age, body mass index, screening mean arterial BP, and resting level of coagulation factors.
There was a stress-by-DHT interaction for changes across all time points in FVII:C (P=.027), FVIII:C (P=.018), and d-dimer (P=.011) explaining between 14% and 17% of the variance. Compared to subjects without DHT, diastolic hypertensives had higher FVII:C immediately post stress (P=.085, Cohen's d=.60) and at 20-min recovery (P=.19, d=.46), higher FVIII:C at 20- (P=.028, d=.78) and at 60-min (P=.035, d=.75) recovery, and higher D-dimer at 20-min recovery (P=.10, d=.58). A significant stress-by-SHT interaction for fibrinogen (P=.050) became nonsignificant when controlling for covariates.
Diastolic hypertension exaggerated the acute procoagulant response to stress in middle-aged men. This effect was particularly observed during recovery of hypercoagulability from stress. The findings suggest a psychobiological mechanism linking stress with an increased atherothrombotic risk in hypertensive individuals.
本研究旨在调查系统性收缩期高血压（SHT）和舒张期高血压（DHT）是否与因子VII凝血活性（FVII:C）、因子VIII凝血活性（FVIII:C）、纤维蛋白原和D-二聚体对急性心理社会应激的过度反应有关。
我们对42名血压正常和血压升高（即筛查收缩压和/或舒张压≥130/85 mmHg）的中年明显健康且未用药的男性样本进行了15分钟的特里尔社会应激测试（即任务准备、工作面试和心算的组合）。在应激前、应激后以及之后20分钟和60分钟立即采集用于凝血指标检测的血样。重复测量协方差分析对年龄、体重指数、筛查平均动脉血压和凝血因子的静息水平进行了控制。
在FVII:C（P = 0.027）、FVIII:C（P = 0.018）和D-二聚体（P = 0.011）的所有时间点变化上存在应激与DHT的交互作用，解释了14%至17%的方差。与无DHT的受试者相比，舒张期高血压患者在应激后立即（P = 0.085，科恩d = 0.60）和恢复20分钟时（P = 0.19，d = 0.46）的FVII:C更高，在恢复20分钟时（P = 0.028，d = 0.78）和60分钟时（P = 0.035，d = 0.75）的FVIII:C更高，在恢复20分钟时的D-二聚体更高（P = 0.10，d = 0.58）。在控制协变量后，纤维蛋白原的应激与SHT的显著交互作用（P = 0.050）变得不显著。
舒张期高血压会夸大中年男性对压力的急性促凝血反应。这种效应在应激后高凝状态恢复期间尤为明显。研究结果表明了一种心理生物学机制，将应激与高血压个体动脉粥样硬化血栓形成风险增加联系起来。
