Immunogenetic Laboratory, Department of Neurology, Aeginition Hospital, National and Kapodistrian University Medical School, Athens, Greece. artemiad @ med.uoa.gr
Neuroepidemiology. 2011;36(2):109-20. doi: 10.1159/000323953. Epub 2011 Feb 17.
Stress has been considered a triggering factor for multiple sclerosis (MS) since the description of the disease by Jean-Martin Charcot. Until our times, many published studies have supported that both MS onset and relapse could be predisposed by psychological stress. This review aims to synthesize existing knowledge of the relationship between psychological stress and MS onset and relapse, focusing mainly on the quality of observational studies.
We hand-searched MEDLINE with the terms 'stress and multiple sclerosis', using English language restrictions, from January 1980 to November 2010. We included only observational longitudinal studies. The Newcastle-Ottawa scale proposed by the Cochrane Collaboration was used for assessing the quality of the observational studies.
Seventeen publications were analyzed, 5 for MS onset (1 cohort and 4 case-control studies) and 12 for MS relapse (9 cohort and 3 case-control studies). We found a marked heterogeneity in stress measurement that mostly targeted the environmental approach to stress. Only 2 publications used radiological criteria for MS relapse. Quality issues were identified mainly for comparability, meaning that studies failed to control adequately for various triggering and psychosocial factors in the stress-MS relationship. Also, selection and blinding problems were identified in most case-control studies. All studies, with only 2 exceptions, resulted in favor of the stress-MS relationship, but due to marked stress measurement heterogeneity, no secure conclusions could be drawn.
Future studies should incorporate a multidisciplinary approach to stress measurement and radiological criteria for MS. We further encourage researchers to test the effect of early life stress and stress management techniques on the clinical course of the disease.
自让·马丁·夏科（Jean-Martin Charcot）描述多发性硬化症（MS）以来，压力一直被认为是多发性硬化症的触发因素。直到现在，许多已发表的研究都支持心理压力可能导致多发性硬化症的发作和复发。本综述旨在综合现有知识，探讨心理压力与多发性硬化症发作和复发之间的关系，主要关注观察性研究的质量。
我们使用英语语言限制，从 1980 年 1 月到 2010 年 11 月，手工检索了 MEDLINE 中的“stress and multiple sclerosis”一词。我们只纳入了观察性纵向研究。采用 Cochrane 协作组提出的纽卡斯尔-渥太华量表来评估观察性研究的质量。
共分析了 17 篇文献，其中 5 篇用于多发性硬化症的发病（1 项队列研究和 4 项病例对照研究），12 篇用于多发性硬化症的复发（9 项队列研究和 3 项病例对照研究）。我们发现压力测量方法存在明显的异质性，主要针对环境应激方法。只有 2 篇文献使用放射学标准来定义多发性硬化症的复发。主要存在质量问题的是可比性，这意味着研究未能充分控制压力-多发性硬化症关系中的各种触发因素和心理社会因素。此外，在大多数病例对照研究中也存在选择和盲法问题。除了 2 项研究外，所有研究都支持压力与多发性硬化症之间的关系，但由于压力测量方法存在明显的异质性，因此无法得出确切的结论。
未来的研究应采用多学科方法来测量压力，并采用放射学标准来定义多发性硬化症。我们进一步鼓励研究人员测试早期生活压力和压力管理技术对疾病临床病程的影响。
